Katrina Dennis was a 36-year-old corporate lawyer in Baltimore in 2015 with lots of demands on her time from business and civic groups and a tight-knit group of family and friends.
Today she lies in a hospital bed at Johns Hopkins Hospital with cancer in her organs, blood and bones that is certain to end her life.
A jury will decide whether this outcome could have been prevented by her doctor, head of the Breast Center at the University of Maryland St. Joseph Medical Center who diagnosed her with a curable form of the disease more than four years ago.
The civil case in Baltimore County Circuit Court will be decided in coming days and will be an unusual public airing for a charge of medical malpractice, cases that are more often settled or dropped.
It won’t change the outcome for Dennis, but it could mean a payout of up to $24 million from the doctor and hospital for medical bills and economic and non-economic damages, as well as a blot on a nearly four-decade career for Dr. Michael Schultz.
“She was a rising star, is a rising star,” said Robert Weltchek, her lawyer, in his opening remarks Tuesday. “This is a case of medical malpractice. It’s negligence, and not what a reasonable doctor would do.”
Dennis went to see Schultz in 2015 on the recommendation of a friend after finding a lump in her breast. She quickly developed a rapport with the doctor.
She was diagnosed with ductal carcinoma in situ, the earliest version of breast cancer where abnormal cells are found in milk ducts. About 20 percent of new breast cancers are DCIS, according the American Cancer Society.
It’s treated with surgery. The doctor recommended removal of her right breast, but she opted to remove both.
This is where the stories diverge.
Weltchek told the jury of nine, which includes three alternate jurors, that Schultz discovered from testing before surgery that the cancer cells might have spread beyond the milk ducts. And the lawyer said Schultz also did not make it clear that testing after the surgery found conclusively there was a small tumor outside the duct wall in the breast.
The doctor did not properly explain that she was no longer “Stage 0” but “Stage 1A,” which meant the cancer had spread and there was indeed a chance, however small, of continued spread rather than her being cured, Weltchek said.
Further, the lawyer said, the doctor also did not fully explain that there was a drug that might have stopped the spreading in such an early case of breast cancer. And during a panel discussion with other doctors to discuss the Breast Center’s cases, an oncologist had recommended Dennis see a cancer doctor to discuss use of that drug, Tamoxifen, Weltchek said.
Schultz, Weltchek emphasized, was a surgeon and not an oncologist. He recommended a plastic surgeon to reconstruct her breasts, but not a cancer doctor.
“He told her she’s cured,” Weltchek said. “You’ll have a normal life.”
About 20 months after her initial diagnosis, Dennis had back pain and went to an urgent care center where a blood test had such an abnormal reading that practitioners there told her to go to the emergency room. She was soon diagnosed with late-stage disease.
Dennis, a partner at Saul Ewing and a regent for the University System of Maryland, continued her work in between treatments as long as she could.
Mary Downs, a lawyer representing the doctor and the hospital, said the situation is tragic but that is sometimes the case with cancer even when doctors do everything right.
“This is a tragic case. There is no doubt about it," she said. “We have to put that aside and look at this as scientists.”
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Downs portrayed Schultz as a caring and available doctor, often returning calls and emails after-hours and launching a program at St. Joseph’s where patients can get imaging and biopsies done immediately so they don’t have “sleepless nights” waiting for information on their condition.
The Breast Center also has outside accreditation that requires a team of specialists to decide on the proper course of care. All the standards were followed, Downs said.
Specifically, the amount of cancer outside the duct wall was so small and contained in the breast, it didn’t change the course of care, which was surgery to remove the breast. Testing showed no spread of cancer to Dennis’ blood or sentinel lymph nodes, a first stop for cancer that spreads outside the breast.
Dennis, Downs said, was advised there was a small tumor the duct, though the doctor might not have labeled it Stage 1A. She was told she could take Tamoxifen, but that the panel of St. Joseph doctors believed the potential benefits were outweighed by the potential harm and side effects, which can include blood clots and stroke over the five or 10 years it’s used.
Dennis was also reluctant to take the drug, which she had used briefly before surgery, because of the terrible way it made her feel. And there was statistically little chance for more related cancer, Downs said.
Dennis deserves “sympathy,” but said she was unlikely to show that Schultz didn’t provide the standard of care or was the cause of her terminal condition.
The case, Dennis vs. University of Maryland St. Joseph Medical Center, LLC, et al., is expected to last two weeks.