Chapter 30: COVID-19 Pandemic

INTRODUCTION

To date, as of April 2021, the coronavirus disease 2019 (COVID-19) pandemic has resulted in 560,000 deaths in the United States and 2.9 million deaths worldwide.¹ Among patients with COVID-19, cancer is an independent risk for higher mortality rates compared with those without cancer.² The pandemic has also caused a sharp reduction in cancer screening and postponement of ongoing or planned therapy, which are contributing factors to non–COVID-19–related cancer deaths. Specifically, chemotherapy, radiation therapy, screening colonoscopies and bronchoscopies, surgeries (diagnostic, therapeutic, or palliative), interventional radiology procedures, needle biopsies, and even basic follow-up blood work and x-rays were delayed, postponed, or canceled. The complete disruption of outpatient and hospital services for prolonged periods in many geographic areas (rural, suburban, and urban) has placed a great deal of stress on health care systems managing cancer patients during the pandemic.³

Cancer patients’ increased risk for death during COVID-19 was also due to a host of other factors. Cancer patients were reluctant to go to hospitals, outpatient surgical centers, or offices due to fears of contracting COVID-19.⁴ Some hospitalized cancer patients were discharged prematurely because of the high demand for beds, resulting in risk for readmissions or even patients’ reluctance to be readmitted.⁵ Some cancer patients had limited transportation access during “lockdown,” and family and friends were reluctant to chaperone.⁶ Finally, overly stressed emergency medical services systems resulted in delayed ambulance responses, and ambulances were limited to life-threatening radio-dispatched calls only.⁷

COVID-19 liability, defined as health care workers’ risk for liability during the COVID-19 pandemic, is expected to increase significantly in the coming years after COVID-19 because of the following predispositions:

1. General distrust of the medical community.⁸

2. Misinformation about COVID-19 that has caused confusion and a lack of global census.⁹

3. Distrust of the Black and Brown communities toward the medical community. It is well known that communities of color were disproportionately impacted by COVID-19, with more deaths and hospitalizations.¹⁰ Sadly, Dr. Susan Moore, a Black physician diagnosed with severe COVID-19 infection, chronicled her racist treatment by her colleagues. She subsequently died.¹¹

4. Lack of timely in-person access to providers, which contributed to breakdowns in communications about results or treatment plans.

5. Use of telemedicine, which has skyrocketed to over 1000% for outpatient visits.¹² Telemedicine certainly has added value during the crisis but has obvious limitations, such as the physician’s inability to perform a physical assessment. In addition, it is difficult to build trust and engagement between the physician and patient remotely and to discuss deeply complicated conversations about cancer care, prognosis, and care plans.

LEGAL THEORIES

Medical Negligence

Medical Negligence is committed when a patient received inadequate care from a medical professional. The area of tort law known as negligence involves harm caused by failing to act as a form of carelessness, ...