A Dermatologist’s Trash Can Cost a Veteran His Face -By Fransiscus Nanga Roka

Not all malpractice verdicts penalize the unlucky. The $56.8 million judgment against Dr. Joseph Payne punishes something worse than a mere mistake: it penalizes an established, unnecessary policy of tossing cancerous tissue in the garbage rather than sending it to the lab. It is NOT the story of medicine failing。 This is the story of a doctor who would not practice it.

Dr. Joseph Payne and his practice, Dermatology Associates of Atlanta, has been found guilty by a Fulton County jury of providing Tony Waldrop, a Vietnam War veteran, with care so careless that no license should survive. In 2013, Payne took a biopsy of Waldrop’s ear revealed perineural invasion, a classic marker for invasive disease that requires referral to an oncologist. He never made one. Months later, as the cancer returned in the form of an excruciating lump, Payne mistook it for a harmless cyst, excised it and disposed of the tissue unbiopsied. The disastrous error happened in late 2013. In less than two months, aggressive cancer spread to Waldrop’s parotid gland, ear canal and facial nerve. Fulton County, Georgia – Yes, yet another state of too many juries sending a message about public outrage at institutional medical negligence rather than sympathy to the doctors. Because Payne considered confirmation of pathology optional. This is not a judgment call; this is going against the most fundamental protection in oncologic dermatology—discarding suspicious tissue instead of performing a biopsy. The impact was devastating and permanent. Waldrop had radical facial reconstruction in February, 2014 loss of a large portion of his right ear, salivary gland and teeth and permanent paralysis to the right side of his face, he could not blink or close his right eye, chronic pain, hearing loss and speech and eating difficulties for eight years before succumbing to death in 2022. $32 million for suffering and $16 million to his widow, Patricia Worley, for loss of consortium; Judge Eric Richardson added $8.8 million in interest which brought the total to $56.8million.

Practitioners of every ilk ought to be terrified by this ruling, not because of its size but because the failure was so ordinary. No exotic technology failed. No rare complication struck. Yeh, which a doctor casually deemed unnecessary and a war veteran is paying for with his own face.

The verdict is just the latest tragedy visited upon a doctor; Dr. Joseph Payne was ordered to pay nearly $56.8 million after a child died of severe hypothermia following surgery on his shoulder and upper arm at UCLA Medical Center in May. It is a call to arms for every dermatologist you can think of today, the doctor does not need sympathy but secular change.

The first and most important step is zero tolerance for unbiopsied tissue. Every single lesion removed from a patient with history of malignancy and sent to pathology. The answer: No lump looks “benign enough” to avoid the lab. Laboratory confirmation should supplement clinical judgment. Payne made the last big mistake of his life: He trusted his eyeballs over a pathologist’s microscope, and a war veteran paid for that trust — in facial injuries. Second, referral to an oncologist can no longer be a matter of individual judgment. Perineural invasion, positive margins, or other markers of aggressive disease must trigger a referral automatically as part of clinic protocol and be recorded in the patient’s chart. A referral is made, and if not taken up it should be reflected immediately in an audit trail and not years later in a court case. Third, clinics should expect third-party review of excision records. Tony Waldrop was a subject of self-policing for months. It is not a life-altering injury and thus, it likely will not be future grounds for a lawsuit until regular chart audits performed by reviewers external to the treating physician’s own practice catch an avoided biopsy or omission of a referral. Patient transparency that you can wrap your hands around is the forth.

All patients who have tissue taken should be given written documentation that the sample is sent for histopathological examination, together with the result. That shot is now an invisible step, lost in the labyrinth of internal lab systems patients never touch. Visibility transforms an otherwise ambiguous process into a clear and responsible pact between doctor and patient.

Lastly, we need medical boards and malpractice insurers to stop viewing discarded, unbiopsied tissue as a private failure that should be settled out of the public view. This should not only be classified and reported as a sentinel event, the same category mandated for wrong-site surgeries and preventable medication errors, but treated as such. Right now actual consequences, at the licensing level, not just in the courtroom will change behavior throughout an entire profession. Tony Waldrop’s disfigurement, and the eight years of pain that followed it, were entirely preventable. The $56.8 million judgment against Dr. Payne won’t restore what he lost. Waldrop’s widow won the case. But no verdict can restore a face, a career, or eight years lost to chronic pain. The only real justice is prevention and that begins with dermatologists finally treating the pathology lab as mandatory, not optional.

Fransiscus Nanga Roka

Faculty of Law University 17 August 1945 Surabaya and  Managing Partner Law Firm Victorious Indonesia