PUBLIC DECLARATION REGARDING

SCRIPPS CLINIC, GREEN HOSPITAL, LA JOLLA, CALIFORNIA

Laura Walther Nathanson M.D., F. A. A. P.

LINK PACKAGE 1:  MAFI SYSTEM

001:  This is Chuck’s chest x-ray that was taken on January 31, 2000.  The diagnosis of the enlarged heart with fluid in the sac had already been made, in the Emergency room, by an ultrasound (“echo) of the heart.  This x-ray was obtained, according to the admitting note (008) to look for “any obvious masses.”

To understand this x-ray, imagine it as the chest of a person facing you. The dark areas are air, and they outline the lung on each side. The white areas silhouetted on the dark are solid tissues—the big heart, ribs, and tumor. The tumor, about the size of a peach, is on the right side of the person (your left.) It is attached to the outer lining of the right lung, and silhouetted against the right lung tissue.

The highlighting marks were made 22 months after the x-ray was taken, on November 4, 2001. They were made by Dr. Richard Briles, the excellent young emergency room doctor. Dr. Briles had just seen the chest x-ray taken on November 4, 2001 (002), and was very alarmed.  He wanted us to see that the extensive tumor he saw on November 4, 2001, had been very obvious on January 31, 2000,  He said that he hoped the slow growth (over 22 months) of the tumor was a hopeful sign. 

003:  This is the “reading” of the chest x-ray by Walter B. Goff, D. O. You will note that it bears a “Code 1” in the lower left hand corner. You will see no reference to the presence or absence of any mass that might suggest malignance—that is, the reason for obtaining the chest x-ray is not addressed. The report does not fulfill the guidelines of the ACR (006): that is, it does not address patient history, the presence or absence of previous films for comparison, the reliability of the film itself (the heart is so large it could easily mask other masses), the measurement of any abnormal finding, an interpretation, either a list of differential diagnoses or a specific diagnosis, or recommend further studies.

Dr. Goff says that he spoke to Dr. Rambaud. Dr. Rambaud was the emergency room doctor who had seen Chuck only after the ultrasound showed the enlarged heart, upon which Dr. Rambaud admitted Chuck to the Cardiologist Drs. McMahon and Triffon. Moreover, there is no way of telling what Dr. Goff said to Dr. Rambaud. Since the “reading” focuses on the heart findings, already identified by ultrasound, it may have been that Dr. Goff was satisfied with Dr. Rambaud’s stating that Chuck had already been admitted to Cardiology.

004:  This is the first letter from the Osteopathy Medical Board, concerning my complaint against Dr. Goff. It finds him charged with “simple negligence.”

005:  This is the second letter from the Osteopathy Medical Board, exonerating Dr. Goff and rescinding the charge of “simple negligence.” It quotes Dr. Goff’s account of the MAFI system.

006:  These are the Guidelines for Diagnostic Radiology produced by the American College of Radiology, of which Dr. Goff was and is a Fellow in good standing. A phone call to the ACR informed me that, as they state, guidelines are only guidelines, and carry no weight of enforcement.

007:  This is the letter from Chuck’s Internist, Vivian Terkel, M.D., explaining her interpretation of how the MAFI system allowed the mass to go unremarked.

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