'Clearly rang alarm bells': Doctor disregarded radiologist's CT scan note about lymphoma and thought lump was injury from COVID shot—but patient never got the vaccine

A Nova Scotia doctor with a disciplinary history of poor communication with patients and specialists has been reprimanded again, this time for failing to follow up with an autistic patient whose CT scan report noted a lymphadenopathy that subsequently remained undiagnosed for more than a year, by which time it had developed to stage 4 lymphoma.Dr. Venkata Puppala, a family doctor who also runs an aesthetic and hair transplant clinic in Sydney, N.S., did not communicate the findings from the scan to the patient or to his mother, despite their repeated calls over several months to his office, according to the case document from the College of Physicians and Surgeons of Nova Scotia.Instead he concluded that the malignant lump could have been a COVID vaccine-related injury or that the patient might have had COVID. But the college’s discipline committee noted that had Dr. Puppala followed up on his interim differential diagnosis, he would have learned that the patient had not been vaccinated against COVID.He received a reprimand and was ordered to pay $2,500 toward college investigation and hearing costs.“The most insulting thing is that even after the diagnosis of malignant lymphoma, Dr. Puppala did not reach out, did not offer assistance or concern,” the case document noted in its summary of the complaint filed by the patient’s mother.Read: Legal column: A sudden illnessDr. Puppala testified that he did read the CT scan report, which contained a comment from the radiologist about a “left supraclavicular, mediastinal and right internal mammary lymphadenopathy from lymphoma.” However, he told the college, he was not sure the radiologist could conclude that this was lymphoma because that would have required a histologic diagnosis from a pathologist.The discipline committee noted that the CT scan report “clearly rang alarm bells” and, coupled with the patient’s blood work results, should have spurred Dr. Puppala to investigate the possibility of lymphoma.Dr. Puppala saw the patient again about six months after the CT scan results came in. At this subsequent appointment, he noted that the patient continued to feel unwell and that the lump was unchanged in size. He ordered a biopsy which, according to his notes in the patient’s medical record, was to “rule out malignancy” as the “CT suggested lymphadenopathy in the mediastinum.”At this point, he still had not discussed the CT scan results with the patient or the patient’s mother.When the radiologist later sent a notification that the patient had missed his biopsy appointment, Dr. Puppala should have followed up, the discipline committee ruled. But Dr. Puppala initially told the college investigator that when he saw the missed appointment notification, he thought: “Well, the lymph nodes must have gone back to normal because the patient did not show up.”He later revised his testimony, telling the college that the notification was not time-stamped and he wasn’t sure he had seen it.Read: Not so fast, doc: Physician signed death certificate one year before patient diedIn 2021, in relation to another complaint, Dr. Puppala was cautioned for failing to manage a patient’s care appropriately and told he needed to integrate information from specialists into the care plan and communicate the care plan to the patient’s family. As part of the caution, he was ordered to complete a communication skills training course.He was also cautioned to have an open line of communication with pharmacists and to respond to them in a collegial manner.In prior years, he had received cautions related to medical record-keeping, physical examinations and ordering appropriate investigations based on the presenting complaints.Read: Woman sues dentist after 4 root canals, 8 dental crowns and 20 fillings in a single visit

'Clearly rang alarm bells': Doctor disregarded radiologist's CT scan note about lymphoma and thought lump was injury from COVID shot—but patient never got the vaccine

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