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VA negligence led to leg amputation, allowed cancer to grow, suit says

Federal filing says patient in Portland received physical therapy while a cancerous tumor near knee remained undiagnosed for years, leading to amputation
The VA center in Portland is located next to Oregon Health & Science University. | U.S. DEPARTMENT OF VETERANS AFFAIRS
May 30, 2023

The Veterans Administration’s prescription of physical therapy for a Portland patient’s knee pain in 2018 rather than more extensive imaging and evaluation allowed a cancerous tumor to grow, leading to the amputation of the veteran’s leg and the spread of potentially metastatic cancer to his lungs, according to a new lawsuit.

A spokesperson for the VA declined to comment on the lawsuit. The U.S. Attorney’s Office, which will be defending the suit, did not immediately respond to a request for comment.

According to the suit filed in U.S. District Court in Portland, veteran Rikyle Holstine complained five years ago to a family nurse practitioner at the VA Hospital in Portland that he had chronic pain in his right knee and decreased muscle mass. According to LinkedIn, Holstine served in the infantry for the Army National Guard.

The nurse practitioner diagnosed Holstine with chronic knee pain and increasing muscle atrophy, ordering an MRI without contrast and as well as a physical therapy consultation.

A March 2018 MRI found a “well-defined lobulated mass within the medial infrapatellar fat pad,” according to the suit, and recommended another MRI, this time with contrast. The follow-up MRI confirmed the mass, according to the suit, and “VA radiologists recommended to (the nurse practitioner) that he order an ultrasound to follow up the MRI.”

The suit claims that the nurse practitioner did not clarify what type of ultrasound to administer, and that Holstine underwent a venous ultrasound, typically used to look for blood clots, rather than a general ultrasound, which can be used to help diagnose tumors. According to the suit, the ultrasound “confirmed only that the arteries and veins appeared patent and without abnormality.”

In June 2018, Holstine spoke with a nurse at the VA who said he would forward the information to the nurse practitioner for possible further evaluation and a potential orthopedic consultation, according to the suit. But according to the suit, Holstine’s nurse practitioner prescribed only physical therapy, which began the following month and lasted a year.

In December 2019, Holstine again complained of pain to his nurse practitioner, and this time was prescribed an orthopedic consult and “imaging as needed.” He was scheduled for vascular imaging, but it was canceled as non-urgent due to the pandemic, according to the suit.

Also around this time, the VA discontinued his benefits, saying his problem was not service-related, according to the suit.

Holstine disputed the finding and returned to VA care in April 2021. His symptoms by then were worse and he required a cane to walk, according to the suit.

In August 2021 an MRI found the mass was much bigger, having more than doubled in size. A follow-up MRI in October found it had infiltrated “nearly the entire patella” and resulted in bone destruction affecting the tibia, according to the suit. Later that month, an orthopedist examined Holstine and performed a biopsy finding “the growth of an aggressive tumor with extensive bony infiltration and destruction of the knee with high risk of malignancy.”

According to the suit, it was “later determined” he suffered from synovial sarcoma, a type of cancer that develops near large joints such as knees, a cancer “which was present in the MRIs of March 2018.”

In late November of 2021, Holstine’s right leg was amputated above the knee and he then underwent chemotherapy, according to the suit. 

“Following extensive imaging studies of the chest, it was determined that Mr. Holstine has nodules in his lungs, potentially representing metastasis, which today remain closely monitored following the termination of chemotherapy.”

The firm Paulson Coletti Trial Attorneys PC, filed the suit, which seeks as much as $46 million to compensate Holstine for impaired earnings and other damages

​​You can reach Nick Budnick at [email protected] or at @NickBudnick on Twitter.