Michael Hansen shifted on the exam table, crinkling the thin medical paper covering the cream-colored vinyl furniture. It was cold in the exam room four days before Halloween, 2020. The bare white walls amplified the overhead fluorescent light.
The 67-year-old Vietnam vet tried to control his anger. He and wife Lisa Hansen, sitting nearby, had promised each other they wouldn’t scream or cuss when doctors confirmed what the couple had begun to suspect. Not that Michael had late-stage lung cancer — the Hansens already presumed that. Not that he had, at best, a few years to live.
They were waiting to hear that someone at the Omaha Veterans Affairs Medical Center had made a terrible mistake.
A few minutes later, Dr. Gary Gorby, the hospital’s chief of medicine, and Laura Whale, a risk manager, walked into the exam room and admitted just that.
The VA had found a nodule, or growth, in his lungs more than a year earlier, but failed to follow up, they said, according to a report filed by Gorby later that day. A radiologist report had identified the growth as a “possible malignancy” and “significant abnormality.”
The tumor, originally the dimensions of a postage stamp, had nearly quadrupled in size while another had sprouted in his left lung, according to radiology reports. It had grown and multiplied as the couple went about their lives in Omaha, unaware of the aggressive cancer spreading inside Michael Hansen’s lungs.
A different doctor later determined the hospital’s error allowed the cancer to progress from stage IA2 — which has a five-year survival rate of 83% according to the American Joint Committee on Cancer — to stage IV, which kills most people within a year
“It still feels like a gut punch every day,” Lisa said. “It’s hard to live with. … They destroyed our life.”
Later the Hansens learned Omaha’s VA had a safety net system to prevent exactly these kinds of mistakes: a registry meant to organize concerning lung scans that may otherwise disappear in mounds of paperwork. A registry designed to prompt the VA to alert patients like Michael Hansen that they need further medical attention.
But that registry didn’t do its job, not for Hansen or any other patient, because no one was overseeing it at the VA hospital near the corner of 42nd and Center streets. VA administrators confirmed the neglected registry in depositions taken in a lawsuit brought by the Hansens.
The nurse who had maintained the system had retired in 2019. For more than a year, even as VA leaders knew the registry wasn’t working correctly, the hospital failed to fix it or hire her replacement, VA leaders confirmed in depositions.
On Dec. 12, Lisa Hansen’s lawsuit against the government — “Hansen et al v. The United States of America” — will go to trial in Omaha. Because the hospital already admitted liability, a judge will decide how many months or years the mistake cost Michael, who died Dec. 30, 2021, and how much money that’s worth.
But Lisa wants something more than a settlement. Even though it’s not the subject of her suit, she wants to know how many other cases like Michael’s exist. How many other cancers did the Omaha VA miss?
“From the day that (nurse) resigned until they hired somebody, they should be going through every day, reviewing (cases) and sending out letters,” she said. “I think the right thing to do in any situation like that, out of human decency, is to call everybody.”
‘Lost in Plain Sight’
On July 2, 2019, a radiologist at the Omaha VA Medical Center examined black-and-white CT scans of Michael Hansen after the then-65-year-old’s intestinal surgery. That’s when the doctor noticed something in Michael’s right lung.
“Primary Diagnostic Code: POSSIBLE MALIGNANCY,” a radiologist wrote of the 2-square-centimeter spot, according to a report submitted as part of the lawsuit. “Secondary Diagnostic Codes: SIGNIFICANT ABNORMALITY, ATTN NEEDED.”
Lung cancer is the most fatal form of cancer, set to kill an estimated 127,000 Americans this year in part because few people are screened for the disease in its early stages, according to the American Cancer Society.
When early-stage lung cancer is caught, it’s often accidental — a CT scan after a car crash or broken bone. For Michael, a U.S. Army veteran who helped to replace damaged equipment during the Vietnam War, it was the routine, post-surgery scan.
About a third of all CT scans contain something that requires a second look, studies say. Roughly 80 million scans are done every year according to Harvard Medical School — and it’s not uncommon for doctors to miss things.
“Sometimes I think there’s just so much data in the electronic record that stuff just almost gets lost in plain sight,” said Brewster Rawls, a lawyer who has litigated these cases through his Virginia-based firm since 1996.
Some large hospitals bring order to the messy system by using a tracking registry — a rare but highly effective practice, said Dr. Jeffrey Thiboutot, assistant professor of medicine at Johns Hopkins University.
The Omaha VA’s system, also used by veterans hospitals in Iowa, Minnesota, North Dakota and South Dakota, is called a lung nodule registry. When a radiologist sees something that doesn’t look right he or she enters a code alerting others that follow-up is required, according to VA leaders’ depositions as well as a 2021 study in Annals of the American Thoracic Society. A nurse manages that information in a registry, making sure those recommendations are followed.
The system becomes more important in complicated cases like Michael Hansen’s.
Dr. Carolina Landeen, Hansen’s pulmonologist, said during a deposition his potential cancer likely got pushed aside because his doctors were more concerned with the Vietnam vet’s other pressing health issues. In addition to the intestinal surgery, he had also been on dialysis three times a week for kidney failure since 2006. Lisa Hansen remembers at least 10 doctors, maybe more, talking to her husband and examining his records. Still, no one followed up on the alarming CT scan.
Dr. Jonathan Shelver, a pulmonologist in Minnesota, said that’s where registries like this can make a difference. He studied the effectiveness of Minnesota’s system in 2017 and found it drastically reduced the rate of tracking failure — from 74% before the registry to 10% after it.
“Complicated patients have small details missed because there’s so much going on,” Shelver said. “That’s where this nodule registry was effective.”
The Nebraska Methodist Health System uses artificial intelligence to identify concerns in CT scans, said Dr. Sumit Mukherjee, a pulmonologist. Hospital staff then flag concerning findings among the scans, of which the health care system did 3,000 last year according to a spokeswoman, and schedule follow-ups. The program, introduced in 2021, has been expensive and time consuming, Mukherjee said.
(Editor’s note: a previous version of this story said the Nebraska Methodist Health System did 30,000 CT scans. It actually did 3,000)
It has also caught 20 early-stage cancers that may have otherwise been missed.
“When we started seeing the data from this, we realized this is a huge, huge part of lung cancer management: trying to find these spots,” Mukherjee said.
Slipped through the cracks
In court records, Omaha VA leaders said they knew the registry wasn’t working correctly — and, as a result, things likely got missed.
“I tried to mitigate that (by) alerting providers to the gap in the registry,” said Dr. David Williams, the Omaha VA Medical Center’s chief of staff, in a deposition. “But I would expect there were veterans” who didn’t receive follow up.
The registry wasn’t monitored between 2019 and 2021, for a period somewhere between 15 to 22 months, VA leaders said in depositions.
What the VA doesn’t know — or won’t say — is if, or how many, other Omaha-area veterans had undetected cancers, grew sicker or died because of the monitoring failure.
In depositions, the VA leaders acknowledged Michael Hansen’s case went undetected as a result.
“There was no safety net or no notification to anybody else that this needed follow-up,” Landeen said in her deposition.
Another complaint filed in July 2020 against the same doctors Michael Hansen had at the VA alleges that “lack of follow up on lung nodules resulted in a lung biopsy and death” of another patient. That complaint was settled, according to court documents.
Kevin Hynes, a spokesman for the Omaha VA, declined to answer questions about the nodule registry and efforts to find cases that had been missed.
Thiboutot, the Johns Hopkins professor, pointed out the vast majority of problematic CT scans, a small fraction of which result in cancer, are typically noted and followed up on by multiple doctors.
“Most of those patients are not going to completely fall through the cracks,” he said. “Even though your registry wasn’t kept, they’re still being seen by other doctors. That registry is not the only person responsible here.”
The VA could possibly identify more missed cancer by alerting other potentially affected patients through a process called a large-scale disclosure. Past large-scale disclosures have been done, as when the VA determined one podiatrist at a Maine veterans hospital harmed residents in 88 different cases.
But the VA has thus far declined to do so.
“I understand your point, that yeah, this seemed like a terrible vulnerability and we should’ve told veterans,” Williams told the Hansens’ lawyer Robb Futhey during a deposition. “But I don’t believe, based on familiarity with this, that that situation met the VA’s intent for mass disclosure.”
Why, Futhey asked, would that not meet the criteria?
“Because there’s no harm until the nodule comes back as cancer,” Williams answered.
In depositions, VA leaders did elaborate on what caused the registry to stop working for more than a year.
It was, they said, a hiring issue.
The hiatus resulted from the hospital’s inability to recruit a nurse, said Gorby, the hospital’s chief of medicine, during a deposition. Landeen, Michael’s pulmonologist, said she spent months awaiting approval to hire a physician’s assistant or nurse practitioner who could oversee the registry.
Ultimately the hospital did upgrade the position and hired an advanced practice registered nurse in March 2021.
At one point Williams, the VA’s chief of staff, pulled “a couple hundred” patient names from the registry that were being unmonitored and told their providers “we have a gap, you need to follow this,” he said in a deposition. Williams said that happened only once and was likely before Michael came to the VA in July 2019. In 2021, Williams said the hospital also started screening scans for the word, “nodule” to find cases that may need follow up.
Shelver, the Minnesota doctor familiar with the registry, said searching for the word “nodule” might not be enough.
Radiologists can describe the same finding in different ways. Meanwhile, their patients could be in the dark about their lung cancers, potentially for years, he said. Some forms of the disease can grow for up to a decade before showing symptoms, Shelver said.
It underscores the importance of these systems that allow doctors to track cancers and be proactive, Shelver said. And most importantly to not miss anything.
When asked during deposition in December 2022 whether the VA had processes in place to make sure no case or patient fell through the cracks, Landeen was blunt.
“Now there are,” she said.
For years, Michael Hansen felt he got good care at the VA, long headquartered in a beige building in midtown Omaha, and also the site of a gleaming new 157,000-square foot, $86 million outpatient care center.
He liked his doctors, Lisa Hansen said. When he didn’t, the couple felt comfortable advocating for better ones.
In part because of that care Michael had a good life after coming home from Vietnam, she said. He had a son and a career selling insurance. In 1998 he moved to Las Vegas. Six years later he and Lisa got married after she’d followed him to the desert.
They moved back to their hometown of Omaha in 2016 and enjoyed spending time with family: his son, two grandkids, three older sisters, and nieces and nephews. The couple liked to sit under the Friday night lights at Millard North and Millard West football games and hear sneakers squeak during basketball games at Omaha Burke.
At home, they watched TV shows like Tim Allen’s sitcom “Last Man Standing” and played card games like 99.
It was quiet, Lisa Hansen said. Lovely.
Then her husband got diagnosed with cancer, which was bad enough. Knowing it could have been prevented made it devastating.
“My stomach feels like it’s a volcano,” Lisa said, “I can’t sleep at night. I am beyond tired. My mind doesn’t shut up. It plays it over and over and over.”
The chemo and the lawsuit they filed against the VA in September 2021 distracted them — but the treatments failed and it became clear Michael wouldn’t survive to see the end of the suit.
A few months after his diagnosis, Michael Hansen could barely climb stairs. He’d tell his wife something and forget it five minutes later. He almost passed out on the second step of a ladder trying to change a lightbulb.
“They’ve taken all that away from me,” Michael Hansen said of his future during a March 2021 deposition.
Lisa Hansen said he never really found peace, but looking back at pictures from Christmas 2021 she can see he was ready to go. A few days later, Dec. 30 at 6:10 a.m., he died at their Millard home.
The lawsuit lives on. Attempted settlements have failed, though Futhey would not say how much the plaintiffs wanted or how much the U.S. government offered.
An economist’s report Futhey commissioned for the suit estimated that had Michael lived to be 83 years old, his death would be worth nearly $1 million, which doesn’t include additional damages for pain and suffering.
The larger implications — how many, if any, other veterans may have had the same thing happen to them — are not part of this lawsuit. But they’ve motivated Lisa Hansen to keep fighting, she and her lawyer say.
“Even if it’s two, three or four more people that’s two, three or four more people that should be alive that aren’t,” Futhey said.
Lisa Hansen wants others to know her husband’s life mattered. She hopes his story will motivate the VA to find other cases like Michael’s — to prevent this story from happening again.
“Do better,” she said of the VA. “Do better in every situation.”