New York Chemotherapy Malpractice Lawyer

Injured by Chemotherapy Extravasation or Oncologist Negligence?

If you or a loved one suffered a serious injury due to improper administration of chemotherapy drugs—such as the extravasation of Doxorubicin (Adriamycin)—you may have a valid medical malpractice claim. The top-rated New York medical malpractice attorneys at Gair, Gair, Conason, Rubinowitz, Bloom, Hershenhorn, Steigman & Mackauf have decades of experience representing cancer patients who suffered severe and preventable harm as a result of oncologist negligence.

Call our Manhattan law office at (212) 943-1090 or contact us online for a free consultation.

What Is Chemotherapy Extravasation?

Chemotherapy extravasation occurs when an intravenously administered chemotherapeutic agent inadvertently leaks into the surrounding subcutaneous tissue. This is a known and documented risk in oncology, especially during the administration of vesicant agents—drugs that are inherently caustic and capable of causing extensive tissue damage. The extent of injury depends on the drug involved, the amount that has leaked, and how quickly the problem is recognized and treated.

If not identified and managed promptly, extravasation can cause disfigurement, extensive tissue necrosis, loss of limb function, or even amputation. In severe cases, patients may experience permanent impairment requiring multiple surgeries, including debridement, skin grafting, and reconstructive procedures.

High-Risk Chemotherapy Drugs That Cause Severe Extravasation Injuries

Among the many chemotherapeutic agents used in cancer treatment, DNA-binding vesicants pose the greatest threat when extravasation occurs. These drugs bind directly to nucleic acids in healthy tissue, leading to progressive and irreversible damage. Notable examples include:

• Doxorubicin (Adriamycin) – A cornerstone chemotherapy drug since the 1960s, known for its ability to induce deep-tissue necrosis upon extravasation.
• Mitomycin C – Highly cytotoxic with severe consequences if it leaks into surrounding tissues.
• Vincristine and Vinblastine – Vinca alkaloids that can lead to neurotoxicity and tissue breakdown.
• Actinomycin D – An antitumor antibiotic with severe vesicant properties.

Medical literature has consistently emphasized that extravasation of these agents requires immediate recognition and specialized intervention.

Medical Negligence and Chemotherapy Extravasation

Extravasation injuries can be devastating—but they are often preventable with proper technique, vigilance, and timely intervention. Oncology professionals must follow strict protocols to minimize the risk and to act swiftly when complications arise. Malpractice may be alleged when healthcare providers:

• Fail to properly secure or monitor the intravenous (IV) line during chemotherapy
• Ignore or misinterpret signs of extravasation, such as swelling or erythema
• Administer inappropriate or contraindicated treatments, such as corticosteroid injections
• Delay plastic surgery or vascular surgery consult despite signs of tissue necrosis
• Lack adequate training or awareness regarding the treatment of vesicant extravasation

In many cases, early surgical intervention—such as excision of affected tissue—can significantly reduce permanent injury. Delay in treatment, conversely, allows the agent to bind further to tissue DNA, prolonging the extent and progression of injury.

Signs and Symptoms of Chemotherapy Extravasation

Early recognition is critical. If you or a loved one experience any of the following symptoms during or after chemotherapy, report them immediately:

• Redness, swelling, or firmness at the IV site
• Burning, tingling, or stinging sensation
• Skin blanching or discoloration
• Formation of blisters or ulcers
• Reduced mobility or function in the affected limb

Unfortunately, some patients are unaware of the seriousness of these symptoms and are discharged from care with insufficient follow-up, leading to irreversible complications.Treatment Guidelines and Controversies in Extravasation Management

Medical literature and clinical protocols vary regarding the management of extravasation injuries. Historically, treatments such as corticosteroid injections, hyaluronidase, saline dilution, or cold/warm compresses have been used with varying results depending on the agent involved. However, agents like Doxorubicin, which bind to DNA, present unique challenges. The consensus among experts is that local injection of antidotes is often ineffective and may even exacerbate tissue damage by dispersing the agent.

In such cases, early surgical consultation and aggressive excision are the recommended standard of care. Elevation of the affected limb, close observation, and documentation are also critical steps. When providers fail to follow these evidence-based practices, the resulting harm can justify a malpractice lawsuit.

Chemotherapy Malpractice Case Study

The following case involved a patient being treated for Non-Hodgkins Lymphoma with, among other chemotherapeutic agents, Doxorubicin. During his second round of chemotherapy, the treating oncologist administered 60mg of Doxorubicin by I.V. push via a free flowing intravenous line. The infusion site was the right upper anterior arm just above the elbow. Fifteen minutes following the infusion the “chemo line” was noted to be red and swollen. Ninety minutes later, pursuant to order of the oncologist, Hydrocortisone, 100mgs was instilled subcutaneously. Hydrocortisone ointment was also topically applied. Two days thereafter, swelling and redness of the right arm was noted to be increased. The patient complained of increased swelling and redness in the right arm. The oncologist ordered topical application of Hydrocortisone cream four times a day. The patient was discharged from the hospital five days post extravasation with the right arm still swollen and hard, to be followed on an out-patient basis by his oncologist. The patient was, 3 ½ weeks later, noted to have a still swollen right arm with a necrotic area. Two weeks thereafter, he was admitted to the hospital with a fever of 103E, a swollen and erythematous right arm with a large necrotic area with dry eschars. The patient thereafter required numerous surgical debridements of the right arm as well as a fasciotomy, repair of a pseudoaneurism of the brachial artery and extensive skin grafting. The patient was left with significant atrophy of the right arm, a 90E extension contracture at the right elbow and significant restriction of motion of the wrist, hand and fingers.

The plaintiff alleged that the oncologist failed to recognize the significance of the extravasation injury, failed to understand how to treat it, failed to seek proper consultation and failed to understand the pathology of the extravasation injury. It was alleged that, given the signs and symptoms documented in the hospital record, a consult with a surgeon experienced in treating extravasation injuries was mandated and would have avoided the extensive and permanent injuries suffered by the patient.

The following is excerpted from the deposition of the oncologist:

Q. You have had training, have you, in the administration of chemotherapeutic agents such as doxorubicin?
A. Yes.
Q. Adriamycin is doxorubicin; correct?
A. Yes.
Q. Doxorubicin is a chemo-therapeutic agent which binds to nucleic acid, correct?
A. Yes.
Q. Binds to DNA, true?
A. Correct.
Q. In fact, that’s the mechanism by which it fights cancer cells, true?
A. Correct.
Q. What is the significance of the fact that doxorubicin binds to nucleic acid with regard to the progression of injury which may be caused by extravasation of doxorubicin into subcutaneous tissue?
A. It makes the damage irreversible.
Q. During the patient’s admission to the hospital did he suffer an extravasation of intravenously administered chemotherapeutic agents?
A. The answer is yes.
Q. Doctor, by extravasation we mean the escape of intravenous fluids into subcutaneous tissues, correct?
A. Correct.
Q. Do you recall what you did then?
A. I went straight back to the patient to see what happened.
Q. What did you observe or what did you find out?
A. I noticed that there was redness in the upper arm, a streak, along the long vein.
Q. Do you recall what you did next?
A. I took insulin syringes and first I aspirated around. Then I injected decadron a corticosteroid.
Q. Why did you do that?
A. To minimize the inflammatory process.
Q. Why did you want to do that?
A. This is a chemical irritant and to reduce the impact, the inflammatory impact.
Q. What is a chemical irritant?
A. Adriamycin.
Q. Adriamycin is not an irritant, it is a vesicant, isn’t it?
A. It’s a vesicant.
Q. A vesicant agent by definition is a blistering agent; is that right?
A. Correct.
Q. Doctor, I believe you stated that you administered the steroids to combat the inflammation, if you will; is that right?
A. To limit.
Q. Would you agree that severe local tissue necrosis may occur following doxorubicin extravasation?
A. Correct.
Q. Would you agree that the necrosis is progressive following extravasation?
A. Correct.
Q. And would you agree that the extravasation of a DNA binding vesicant agent leads to a more prolonged course of injury than a non-binding agent?
A. Correct.
Q. That’s because the pathogenesis of injury with a DNA binding agent is that, in this case, when the agent extravasates, it starts being up taken by healthy cells?
A. Correct.
Q. And it progresses and progresses as a result of that?
A. Right.
Q. Doctor, the cause of injury as a result of doxorubicin extravasation is not an inflammatory process; is it?
A. Inflammation follows.
Q. See if you can answer this question: We are talking about an agent, a vesicant agent that binds to nucleic acid. The injury caused by the extravasation of such agent is not caused by an inflammatory process; is it?
A. The initial injury is not an inflammatory – inflammation follows.
Q. I would like an answer to this question: In the face of extravasation of a vesicant chemo-therapeutic agent such as doxorubicin, which is a nucleic acid binding agent, it binds to DNA, how would the injection of steroids prevent the process of injury?
A. As I said before, the secondary process – I cannot remove the Adriamycin which is already bound to the nucleic acid. But the secondary process is the inflammation and I can do everything to limit that.
Q. But the progress of the injury I think we agree, is caused by the doxorubicin being up taken by healthy cells?
A. Yes.
Q. It progresses and progresses, correct?
A. Yes.
Q. Would you agree that doxorubicin, when extravasated into subcutaneous tissue, produces a permanent loss of that tissue’s ability to heal itself?
A. I don’t think it’s permanent to heal itself. It is a lasting damage. But I don’t think it’s permanent to heal itself.
Q. You think eventually it could heal itself?
A. Yes.
Q. Doctor, would you agree that there is no agent, that when injected locally, can alter the final result from extravasation of doxorubicin?
A. I believe so.
Q. You believe there is no agent or your believe there is an agent?
A. There is no agent that has been proven to reverse the damage produced by Adriamycin.
Q. Given the fact that you had no experience in treating a patient who had sustained an extravasation of doxorubicin, do you think it would have been a good idea for you to have talked to a physician who had experience in treating such patients; “yes” of “no”?
A. As I have stated before, I have discussed it with some colleagues and the conclusion was it’s not severe enough. Just monitor it carefully.
Q. Those are the people you don’t remember who they were, right?
A. Correct.
Q. The ones you made no note of, correct?
A. Correct.
Q. Would you agree that the only effective remedy for doxorubicin extravasation is the complete excision of the tissue containing the doxorubicin?
A. Yes.
Q. Well, if that’s so, why didn’t you obtain a surgical consult?
A. I thought it was improving. The arm was improving.
Q. As far as this patient’s arm was concerned and the effect of the possibility of extravasated chemo-therapeutic agents, that was your responsibility, correct, that was your expertise as an oncologist; wasn’t it?
A. I believe we all were involved, had this responsibility.
Q. But you were the attending oncologist, true?
A. Yes.
Q. That was in your particular area of expertise, correct?
A. Yes.
Q. Certainly when you are an oncologist and you are using chemotherapeutic agents such as doxorubicin, you should be aware of the effects of extravasation of such a drug, correct?
A. Correct.
Q. You should be aware of how to treat it, correct?
A. Correct.
Q. That is within your responsibility as the oncologist administering those drugs, true?
A. True.
Q. Is it the responsibility of the oncologist to determine when surgery should be performed in a given patient?
A. It is usually a team approach between the oncologist and vascular surgeon.
Q. Or a plastic reconstructive surgeon?
A. Plastic reconstructive surgeon.
Q. And a plastic reconstructive surgeon should be part of the team?
A. Yes.
Q. Doctor, you never ordered a plastic surgical, vascular surgical or any type of surgical consult for the patient at any time during your treatment of this man, true or not true?
A. I have not ordered the initial consult.

The deposition of the treating oncologist demonstrated a complete failure to understand the significance of the extravasation. Further, it was apparent that the physician did not understand how to treat the extravasation injury either acutely or long term. The deposition left no doubt that the physician had no understanding regarding the pathology of an extravasation injury caused by doxorubicin, had no training in treating same and had no knowledge as to the indications for injecting steroids into an extravasation.

Based on the total lack of knowledge of this physician, undeniably confirmed by the deposition testimony, the case settled for a substantial sum prior to trial. Further, it demonstrates that the plaintiff’s attorney must, prior to the deposition of the defendant physician in a malpractice case, be fully versed in the area of medicine involved as would be the case at trial.

Why Choose Our NYC Chemotherapy Malpractice Attorneys?

The New York personal injury law firm of Gair, Gair, Conason, Rubinowitz, Bloom, Hershenhorn, Steigman & Mackauf has earned national recognition for securing justice in complex medical malpractice cases. Our track record includes:

• Over $5 billion recovered in verdicts and settlements for our clients
• More than 60 jury verdicts exceeding $1 million
• Successful outcomes in complex cases involving oncology negligence and drug administration errors
• A reputation for taking on difficult cases—and winning

We understand the scientific, medical, and legal nuances of chemotherapy malpractice and have the resources to hold negligent providers accountable.
Speak With a Chemotherapy Malpractice Lawyer Today

The Chemotherapy Malpractice Attorneys at Gair, Gair, Conason, Rubinowitz, Bloom, Hershenhorn, Steigman and Mackauf  are expert at helping cancer patients who suffered extravation of chematherapeutic agents. If you or a love one suffered such injury please contact us through our secure contact form to discuss your case or give us a call at (212)-943-1090 for a free consultation.

Disclaimer: Please be advised that the results achieved in any given case depend upon the exact facts and circumstances of that case. Gair, Gair, Conason, Rubinowitz, Bloom, Hershenhorn, Steigman & Mackauf cannot guarantee a specific result in any legal matter. Any testimonial or case result listed on this site is based on an actual legal case and represents the results achieved in that particular case, and does not constitute a guarantee, warranty or prediction of the outcome of any other legal matter.