Physicians' Legal Obligations
in treatment of Acoustic Neuromas

by attorney April Kutay

The diagnosis of an acoustic tumor, and ensuing treatment, can be a life-altering event for the patient.  In the hands of competent, compassionate medical professionals, coping effectively with the enormity of a brain tumor is a realistic goal.  However, when an act of medical negligence intervenes, or when a patient is mislead by his physician through the failure to inform thoroughly and completely of risks to treatment, as well as the various alternatives to treatment, disappointments inevitably result. In some instances, the end result is tragically catastrophic.

What should the acoustic tumor patient be entitled to expect in diagnosis and treatment of his tumor?
What standards are imposed by law to govern physicians’ conduct in these circumstances?

Each patient who seeks the attention of a medical professional for symptoms which should trigger the suspicion of a potential tumor should be able to count on:

  1. competent diagnostic attention and a timely diagnosis;

  2. accurate and complete information about the treatment options, and the individual risks attendant to each category of each treatment;

  3. professional treatment.

We discuss all of these below.

1. A timely diagnosis

Each and every patient that comes to his physician with symptoms which indicate a potential tumor is entitled to a thorough neuro-otologic work-up, certain mandatory testing, and prompt diagnosis. Sadly, all too often, the seemingly minor hearing loss, and associated symptoms such as tinnitus (ringing in the ear) or mild imbalance are trivialized or ignored. The world’s literature on acoustic tumor treatment is replete with pleas to physicians to diagnose these lesions at the earliest possible time when the opportunity for effective treatment, and minimization of complications, is greatest. It is not uncommon for a patient to complain to his physician of these early signs of the tumor, only to be dismissed, with diagnosis then taking place months or even years later.

Frequently, a physician who has been negligent in failing to make a timely diagnosis of an acoustic tumor will contend that since such tumors are slow-growing (often only enlarging 1 to 2 millimeters per year), there is no urgency in establishing a diagnosis.  They claim that the resulting delay did not change the patient's treatment options and the risks of complications. As an attorney who has specialized in representing patients afflicted with brain tumors, it has been my experience that this claim can almost always be proven false. With careful scrutiny of the patient’s medical history leading up to diagnosis, as well as a competent review of medical records, it is frequently possible to definitively prove growth of the tumor during the time period encompassing the delay, as well as to demonstrate that as a consequence of the delay, the patients no longer has those treatment options that would have had the best opportunity to preserve their health.

2. Accurate and complete information

The risks associated with the treatment of Acoustic Neuromas are serious, and need to be accurately portrayed to the patient before they consent to a treatment. These risks include, but are certainly not limited to, complete hearing loss in the affected ear, varying degrees of facial paralysis, prolonged and untreatable post-operative headache, new onset or exacerbation of vertigo, cerebral spinal fluid leak, meningitis, cognitive difficulties, and depression.

Very often, the Acoustic Neuroma patient, by virtue of tumor size and tumor position, is a suitable candidate for more than one type of treatment. In many instances, traditional surgery can be avoided by employing the non-invasive treatment option known as "radiosurgery." Where surgery is the preferred option, and/or the patient desires surgery as his primary treatment choice, he may be entitled to choose from a menu of surgical approaches, with each approach offering certain advantages and disadvantages. Still yet, under certain circumstances, the patient may decline active treatment at the time the tumor is diagnosed, preferring to monitor the tumor over a period of time with serial imaging studies.

Because there is no standard treatment which is "right" for each patient, it is well recognized in the law that patients are entitled to be informed of all feasible treatment choices, and the pros and cons of each choice, so that he can make an intelligent decision which best fits his personal criteria and his particular lifestyle. When the information given to a patient is incomplete or misleading, and, sometimes, baldly inaccurate, the patient is deprived of this fundamental right to determine the course of his treatment, and, ultimately, to control the destiny of his health. Wisely, the law, applicable to all states in this nation, appreciates that it is the patient, himself, and not the physician, who must, in the end, live with the consequences of the treatment method employed. It is for this obvious reason that the patient’s preference of treatment among all potential feasible treatment options must be respected and honored.

Unfortunately, it is not unusual that a patient is given incomplete information about treatment options, and is therefore forced to make a critical decision in the dark. Occasionally, patients are told nothing about treatment options other than the treatment method which is being recommended by the physician! Quite often, when dealing with inexperienced surgeons, patients are told of only one operative approach - that approach which with the surgeon is most familiar, without regard for the operative approach best designed to maximize a good result in light of the size and position of the individual tumor in question.

3. Professional treatment

Even when diagnosis is timely, and treatment options, and the risks inherent in treatment, are thoroughly discussed between patient and physician, there are sometimes instances of medical negligence in the performance of surgery itself, or in the response to surgical complications, which constitute negligence. It is important to stress that the mere happening of a bad result does not prove, nor necessarily even imply, negligence on the part of the operating team or hospital staff. Complications are sometimes unavoidable even under the best of care. Only an attorney schooled in the subject matter of brain surgery, in the company of highly experienced medical professionals, are in a position to evaluate whether a patient has sustained an unavoidable complication, or whether a bad result was occasioned by negligent conduct.

The best weapon against falling victim to medical negligence in the treatment of acoustic tumors is the patient who makes an effort to educate himself, and who comes to the physician appointment armed with questions to help him understand his medical status. No physician should be "put off" or offended by his patient’s desire to understand his own medical condition, and concomitant desire to take an active role in making intelligent decisions about treatment. When medical professionals and patients work together for the mutual goal of restoring the patient to health, the spirit of teamwork can accomplish very acceptable results, and, sometimes, results little short of miraculous.

The diagnosis of an acoustic tumor, while at first a shock to any patient, does not have to end with disastrous consequences. On the contrary, when the patient/physician team concept crystalizes, and efforts are combined, the overall experience can be positive, and represent a true opportunity for personal growth.


April Kutay is a medical negligence attorney who has represented victims of malpractice for the past 16 years. Since the mid-90's, Attorney Kutay has limited her practice to representing patients afflicted with brain tumors, including acoustic neuromas, menigiomas, cavernous haemangiomas, haemangiopericytomas, glomus tumors, pituitary adenomas, and others. She has successfully represented patients in the areas of delay in diagnosis, lack of proper informed consent, surgical error, and negligent medical follow-up for surgical complications. Ms. Kutay’s brain tumor litigation practice is nationally based, and she presently represents patients in multiple states. She is also a frequent lecturer to physician groups and patient organizations on the subject of the role of the law in treatment of brain tumors. Ms. Kutay may be reached for consultation at her e-mail address, ask@goldbergkatzman.com, or by phone  at 1-800-334-4119.

Last Edited: Monday, November 18, 2002