In September of 2022, Dr. Ralph Pagano’s medical license was surrendered. Dr. Pagano attempted to treat a 40-year-old female’s migraines with medications and Botox injections when a brain tumor was the actual cause of the problem. According to the plaintiffs and the Arizona Medical Board, he should have ordered an MRI when he first saw the patient in 2019. Ultimately, the patient died a slow death and Dr. Pagano lost his license to practice medicine in Arizona.
Timeline
- 18 July 2019–40 year-old femail patient (“KS”) sees Dr. Pagano with “intractable migraines that had not responded to previous treatment modalities.” Dr. Pagano prescribes low dose topiramate with follow up to consider different mediation or Botox injections.
- August 2019–KS sees Dr. Pagano for Botox after meds didn’t work. Follow up planned for 3 months
- 24 December 2019–KS hospitalized following a collapse; found to have an intracranial mass with intraparenchymal hemorrhage. The mass was removed but the patient was paraplegic and non-communicative following the collapse and accompanying surgery.
- 15 June 2021–KS died from complications from her condition.
Outcome
The Arizona State Medical Board looked into the case after they received notice of a malpractice settlement related to it. The malpractice suit alleged that Dr. Pagano failed to order proper imaging which resulted in the missed brain tumor diagnosis and death of the patient. A medical consultant (possibly hired by the family or insurers of KS) argued that Dr. Pagano had deviated from “standard of care” by not ordering an MRI at the time of establishing care with the patient.
An unanswered question
Didn’t KS’s previous care providers order an MRI? Apparently she’d seen other doctors about the same issue and nobody was able to help?
Conclusions
First of all, mistakes happen. It’s impossible to know everything that is going on inside of a patient’s body and most doctors are doing their best to help. But consider that the neurology practice where Dr. Pagano worked in Sun City does not have an in-house MRI capability. Could this lack of convenience by a part of the problem? Nearby Neurology Associates Neuroscience Center has an MRI capability in both of its locations. Would Dr. Pagano have ordered the MRI if he had worked at Neurology Associates? Also consider the flip-side: Perhaps he felt that the ordering of too many diagnostics was unnecessarily inflating patients’ expenses. There is of course a trade-off, given the expense of the imaging to the patient and their insurance.
Aaron Charlton, PhD, MBA is the marketing lead for Away Clinic, a yellow fever vaccine clinic located in Mesa and Chandler, Arizona.