Improper colorectal testing leads to $2 million wrongful death settlement

2009 Medical Malpractice Trial Report

Failure to diagnose colon cancer results in death of 46 year old woman

Failure to perform proper colorectal testing results in the delayed diagnosis and treatment of colon cancer causing the premature and preventable death of a 46 year old woman.

In August 2001, the Plaintiff’s decedent, had been experiencing constipation for approximately 5 weeks despite over-the-counter treatment. In addition, the decedent reported episodes of bleeding with bowel movements. After notifying the Defendant, her primary care physician, a thyroid test and sigmoidoscopy were recommended. In September 2001, the decedent again spoke with the Defendant and told him she continued to have rectal bleeding. At that point, the Defendant scheduled her for a sigmoidoscopy. Plaintiff’s experts were prepared to testify that rectal bleeding and constipation are classic symptoms associated with colorectal cancer and required inspection of the entire colon via colonoscopy or sigmoidoscopy plus barium enema.

On 10/23/2001, the second Defendant, a gastroenterologist, performed a flexible sigmoidoscopy for the decedent. The Defendant noted the reason for the scope was gastrointestinal bleeding and constipation. The sigmoidoscopy was reported as essentially normal and that the endoscope was passed, without difficulty, under direct visualization to only 40-cm from the anus. Plaintiff’s experts were prepared to testify that unless met with significant resistance, a sigmoidoscopy performed to less than 60–cm past the anus is an incomplete, and therefore, insufficient sigmoidoscopy that failed to visualize the entire sigmoid colon and did not show any cause for the rectal bleeding. No further testing was ordered at that time.

During the decedent’s yearly exam on 3/19/2002, the primary care Defendant noted that she had been constipated. During another yearly exam on 1/23/2003, the primary care Defendant again noted that the decedent was complaining of constipation and after an urgent visit in July 2003 the Defendant’s plan was to check her TSH levels. On 8/4/2003 the Defendant noted that he spoke with the decedent’s daughter regarding IBS (irritable bowel syndrome) and commented that he would increase her fiber a bit and “consider colonoscopy at some point. ”

The decedent again complained of recurrent constipation on 12/16/2003 to which the Defendant suggested she try lactulose and offered to follow up with an appointment. During a subsequent physical examination on 1/6/2004 the defendant noted a tender left lower quadrant with a firm, tubular structure consistent with stool in her colon. The defendant’s plan included rechecking the decedent’s TSH level given her symptoms of constipation and further noted, that he “thinks she warrants a colonoscopy. ”

On 1/19/2004, the decedent presented to the emergency department with a 1-month history of constipation. The decedent stated that she was prepping for a colonoscopy scheduled for the next day when she suddenly developed worsening abdominal pain and vomiting. On physical exam, the decedent had a distended abdomen with some hyperactive bowel sounds, and a diffuse mild tenderness in her abdomen with more tenderness in the left lower quadrant.A CAT scan showed a right large cystic mass in the decedent’s pelvis with carcinomatosis metastases throughout her peritoneum.

On 1/22/2004, the decedent underwent surgery to remove a large tumor from her sigmoid colon. Pathology from the surgery revealed a primary mucinous adenocarcinoma of the sigmoid colon measuring 4.2-cm that was moderately differentiated with invasion through the muscularis propria and involving the inked serosa surface. Further, the decedent had metastatic spread to her lymph nodes, bladder, diaphragm, greater omentum, bilateral ovaries, cul de sac, right pelvis, uterus, right utero-sacral region, terminal ileum, and recto-sigmoid. Despite treatment and chemotherapy, the decedent died on 5/5/2004 from her metastatic sigmoid colon cancer.

The Plaintiff’s experts were prepared to testify that the standard of care required the defendants to order and perform a visualization of the entire colon in light of the decedent’s complaints of rectal bleeding and constipation. In addition, the plaintiff’s experts were expected to testify that sigmoidoscopy alone was not sufficient to fully investigate the potential source or cause of the decedent’s rectal bleeding. Further, experts were prepared to testify that a sigmoidoscopy to only 40–cms was not adequate to fully inspect and visualize the sigmoid colon and was, therefore, incomplete and needed to be repeated. The Defendants argued that the decedent’s complaints were intermittent and reasonably explained by her thyroid dysfunction.

The case settled in the weeks prior to trial for $2,000,000.

Lubin & Meyer attorneys represented the plaintiff in this lawsuit.

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