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    Patient disputes surgeon's story

    Adesta L. Hytha says it took 10 days for Dr. Charles E. Cox to tell her he had mistakenly removed her breast.

    By WES ALLISON

    © St. Petersburg Times,
    published June 7, 2001


    TAMPA -- The woman whose breast was mistakenly removed by a top surgeon at Moffitt Cancer Center says the doctor failed to tell her about the error for 10 days, leading her first to believe that the mastectomy was medically necessary.

    Adesta L. Hytha was scheduled for a lumpectomy to remove a small tumor and surrounding tissue in her left breast in November 1998. Instead, operating room staff confused her with another patient and her left breast was removed.

    "My first words to (the doctor) was I had the most God-awful nightmare, I dreamed he removed my entire breast," said Mrs. Hytha, 68. She said he told her that "the farther he got, the worse it got. He had no choice."

    But Dr. Charles E. Cox, head of the breast cancer program at Moffitt, says he explained the error to Mrs. Hytha and her son the day of the surgery and never misled them. He was fined $5,000 last week by the Florida Board of Medicine for performing the wrong operation.

    Cox says they may have been confused by news he had discovered a second type of cancer during surgery, which eventually could have required a mastectomy. But tests later showed the lumpectomy would have sufficed.

    "I informed them all that I had found this additional kind of cancer, and I didn't know what that meant, but that we had done, in error, the wrong procedure on her," Cox said Wednesday.

    The surgery was performed Nov. 20, 1998, under local anesthesia, but Mrs. Hytha was sedated and dozed some. She does not recall hearing another breast surgeon, Dr. Elisabeth Dupont, enter the room and tell Cox he was operating on the wrong patient. She does recall Cox saying he found more cancer and had performed the mastectomy.

    "One of the things Dr. Cox said to me was this was not the surgery we had discussed, and if he had known (she needed a mastectomy) we could have done the reconstructive surgery at the same time," Mrs. Hytha said. "My response was, "Thank God you got it.' "

    Mrs. Hytha's son recalls a similar conversation.

    "The doctor came out and ... he told me that there was some changes in the procedure that was performed," said Stephen Hytha, a financial administrator in Tampa. "He said he started the surgery, started on the lumpectomy, and he told me that he found additional cancer, and the more he cut away the more he found."

    Mrs. Hytha said Cox didn't explain the mastectomy was a mistake until she returned to Moffitt Dec. 1, 1998, with her daughter for her first post-operative exam.

    Mrs. Hytha, a widow, lives in a tidy townhouse with lush grounds in West Tampa and works full-time as an insurance agent. She had planned to simply let the Board of Medicine handle the case, but she called the St. Petersburg Times after reading about Cox's fine.

    She said she was upset the board apparently failed to address what she believed were his misleading statements.

    The Board of Medicine complaint relied heavily on Moffitt's post-operative report, dated Dec. 24, 1998. It states that Cox told the Hythas about the mix-up "at the time of the procedure."

    But Cox's patient progress notes indicate he explained the error on Dec. 1, when Mrs. Hytha returned to Moffitt with her daughter for her exam.

    "Discussed with the patient the outcome of the surgical path and confided with her and her daughter that at the time of surgery the planned procedure was not done due to some problem that had occurred in the operating room," Cox's handwritten notes read.

    "I apologized and accepted full responsibility for the outcome and procedure that was performed."

    Cox said Wednesday he felt he had to explain the error again because the Hythas may not have grasped that the mastectomy was unnecessary.

    "They kind of had the concept that I must have had to do this because the cancer was extensive," he said. "I just said no, no, you got it wrong here."

    Dr. Dupont said Cox was clear about the error when he spoke to Mrs. Hytha after surgery.

    "He never said that (the mastectomy) was performed as a result of finding this additional cancer," she said. "He never linked them."

    Cox is nationally known for his research and patient care. This was his first case before the disciplinary board.

    In April 2000, after reading that Cox was named Moffitt's 1999 Physician of the Year, Mrs. Hytha sent the state a letter detailing what happened. Officials wrote back that they were investigating the matter and her letter would be added to the file.

    The Agency for Health Care Administration didn't contact Mrs. Hytha again. A spokesman said investigators often interview patients, but it appeared they had ample evidence to prove Cox erred.

    Mrs. Hytha's letter was included in the file given to board members for last Friday's meeting. One member, Dr. Gustavo Leon, asked Cox if he had misled the patient.

    Cox said he explained the circumstances, and the board seemed satisfied.

    Dupont said misunderstandings between patients and doctors are not uncommon.

    "You try to get a message across. But they don't always hear what you are telling them," she said. "Especially after you say the word cancer."

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