Advanced Nasal Septal Squamous Cell Carcinoma: Legal Implications of Treatment Delay Due to COVID-19

During the COVID-19 pandemic, there were state-mandated suspensions of elective surgeries, which raised legal concerns about delays in treatment. Skin squamous cell carcinoma (SCC) is one condition where postponement of care can lead to aggressive progression and significant morbidity. This case explores the legal and clinical implications of surgical delays during the pandemic. A 93-year-old male presented with advanced nasal septal SCC two weeks after New Jersey lifted its suspension on elective procedures. The lesion, which began as a small growth nearly a year earlier, had rapidly progressed during the suspension, rendering it unsuitable for Mohs micrographic surgery. Otolaryngology proceeded with the case due to extensive invasion evident on imaging. The patient required a partial rhinectomy and complex reconstruction, which resulted in an uneventful recovery with minimal complications. Medical malpractice claims require a breach of duty, injury, and causation. However, during a public health emergency, crisis standards of care may redefine the physician's duty. Guidelines from the Institute of Medicine and the American College of Surgeons (ACS) supported triaging surgeries based on urgency and survivability, providing a legal and ethical framework for such decisions. In this case, the surgical delay was aligned with ACS recommendations for elective cancer surgery, likely protecting the providers from legal liability. This case demonstrates the importance of clearly defined crisis standards of care in protecting healthcare providers during emergencies. The multidisciplinary response following the delay ensured optimal patient outcomes and prevented legal consequences, highlighting the value of adaptive guidelines and expert consensus during public health crises.