Cancer Malpractice Lawyers

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Colon Cancer Case

 

This case involves personal injuries sustained by the plaintiff resulting from the Brooklyn medical malpractice misdiagnosis of colon cancer by the defendant doctor. The plaintiff was diagnosed with metastatic colon cancer, invasive mucinous moderately differentiated adenocarcinoma, stage Duke D. She was diagnosed with metastatic colon cancer in February of 2007 and was receiving “palliative” chemotherapy for the metastatic cancer. The cancer spread from the colon to the liver, lungs, and omentum. The plaintiff suffered from thrombosis and anemia related to the chemotherapy, among other conditions.

Given the extent of the metastasis of the colon cancer (stage Duke D), the plaintiff had the worst prognosis for this type of cancer, with a 5 year expected survival rate of less than 5 percent. The palliative treatment the plaintiff was receiving was not aimed at curing the cancer. Review of records showed a deterioration in her health and imminent danger of death. It was possible that the plaintiff would not survive a delay in conducting her trial.

 

Within a reasonable degree of medical certainty, the defendant doctor’s medical departures were substantial factors in causing the plaintiff’s terminal condition and being in imminent danger of death. On or about June 1, 2004, the patient presented to the defendant for examination. During that office visit, the defendant performed a rectal examination due to the significant drop in hemoglobin levels from 11.5 to 8.5 on the patient’s prior visit. The rectal exam revealed that the stool was yellow (i.e. no blood in the stool) and that the guaiac test was “weakly positive.” The defendant doctor testified that it was his opinion that the patient “might be losing some blood” and that he wanted to “rule out any colon cancer or any loss from the GI tract. At that time, a referral was made to doctor #2, a gastroenterologist for a colonoscopy and endoscopy.

 

On or about June 15, 2004, at the request of the defendant doctor, the
patient underwent a colonoscopy and endoscopy performed by doctor #2, who reported to the defendant doctor that the findings on endoscopy was gastritis. As for the colonoscopy, doctor #2 reported to the defendant doctor that the ileum was not seen as that the impression was internal hemorrhoids and diverticulosis. The medical records of the defendant documents a finding of gastritis and internal hemorrhoids. There is no documentation in his medical records of diverticulosis being found during the colonoscopy. The endoscopy report has a checkmark indicating that the defendant doctor saw the report. The colonoscopy report has no checkmark indicating that the defendant doctor saw the report. The defendant testified that he forgot to write diverticulosis.

 

The plaintiff was next seen by the defendant doctor on December 14, 2004 for cough related complaints. Antibiotics and cough medication was prescribed. The plaintiff was then seen by the defendant on July 5, 2005 with complaints of a gaseous feeling in her stomach with nausea sometimes. The defendant’s diagnosis was “simple gastritis.” No medications were prescribed. No rectal exam was performed. As of this visit, the plaintiff’s hemoglobin level was 11.6, which was considered low by the defendant. The plaintiff was next seen by the defendant doctor on October 15, 2005 complaining of right shoulder pain. No rectal exam was performed. No hemoglobin level were drawn. The plaintiff was next seen by the defendant on February 23, 2006 complaining of cough and phlegm. Her hemoglobin level was 9.5, which was considered low. No rectal exam was performed. During this visit, the defendant noted that he referred the plaintiff for a colonoscopy due to dropping hemoglobin levels but that the patient refused.

The plaintiff was next seen by the defendant on May 15, 2006 complaining of swelling of the ankle, feet and legs. A rectal exam was performed and black stool was noted. The defendant doctor testified that he performed a rectal examination at this visit because he wanted to make sure there was no tumor in the pelvic area which would restrict blood flow and cause swelling in the legs. Despite the defendant testifying that rectal examinations are used to screen for colon cancer and that black stool would be expected if colon cancer is present, he testified that a finding of black stool was not significant since the patient was on iron pills. The defendant doctor testified that a negative guaiac test does not rule out colon cancer. He also testified that the guaiac test performed on the plaintiff on May 15, 2006 was negative.

 

The plaintiff was next seen on May 24, 2006 with complaints of swelling of both feet, ankles and legs for approximately 2 weeks. The defendant testified that it was his opinion that it was venous insufficiency versus drug induced. At that time, the plaintiff’s hemoglobin level was 9.3. She was next seen on October 17, 2006 complaining of right shoulder pain as well as unresolved edema of +1 in the ankle. Her hemoglobin level was 9.5. The defendant’s impression at that time was venous insufficiency.

 

Ultimately, in or about January of 2007 the patient was diagnosed with metastatic colon cancer, invasive mucinous moderately differentiated adenocarcinoma, Stage Duke D. She received and continues to receive palliative chemotherapy with 5FU, Leucovorin, Eloxitin and Avastin. Her current chemotherapy regime is six weeks on and two weeks off. Within a reasonable degree of medical certainty, the defendant deviated from standards of good and accepted medical practice in failing to send the patient to radiology for a barium enema in or about June 15, 2004 upon learning from doctor #2, either through his report or conversation, that he could not visualize the ileum during the colonoscopy. A barium enema would have allowed visualization of the large bowel as well as the terminal ileum. That within a reasonable degree of medical certainty had a barium enema been done at or about the time of the June 15, 2004 colonoscopy report, it would have disclosed the presence of small tumor in the region of the ileocecal valve. At that time, the cancer would have been diagnosed at an earlier stage.

 

The defendant doctor’s referral of the plaintiff to doctor #2 for a colonoscopy was not an appropriate substitute for timely ordering of a barium enema as mentioned above. The defendant doctor could not rely on the colonoscopy in evaluating the patient’s complaints and unexplained anemia as only the large bowel was examined. The defendant doctor had the responsibility as requesting physician to request a complete work-up of the large and small bowel in order to rule in or rule out a malignancy. Within a reasonable degree of medical certainty, the defendant’s failure to timely and properly order and/or refer the patient for a barium enema, either at the same time of referral for a colonoscopy or promptly after learning that the colonoscopy did not visualize the ileum was a departure from standards of good and accepted medical practice in the community.

Furthermore, after repeated visits by the plaintiff to the defendant doctor, the defendant was reminded of the lack of work-up of the patient’s small bowel. He should have recognized that the colonoscopy of June 2004 was limited and therefore not diagnostic. Given the plaintiff’s repeated gastrointestinal complaints, unexplained anemia and positive guiac testing, the defendant should have referred the plaintiff in or about June of 2004 or promptly thereafter for the above-mentioned barium enema. Within a reasonable degree of medical certainty, the defendant’s failure to timely order the above-mentioned barium enema in June of 2004 or promptly thereafter was a departure from standards of good and accepted medical practice in the community.

 

Within a reasonable degree of medical certainty, unexplained anemia is a warning sign of colon cancer. A tumor bleeding out can cause a drop in blood levels, thereby resulting in anemia. Given that this patient’s anemia was unexplained during her care and treatment with the defendant doctor, it was a departure from standards of good and accepted medical practice to work-up the patient’s unexplained anemia and rule out a malignancy.

Ultimately, the patient underwent exploratory surgery and it was determined that the patient had metastatic colon cancer in the region of the terminal ileum and cecum. The delay in performing the barium enema caused a delay in visualizing and examining the ileum, thereby resulting in a delay in the diagnosing and treating of the patient’s colon cancer. Had there been timely referral for a barium enema and timely work-up of the patient’s complaints as described above, there is a substantial probability that the plaintiff’s metastatic colon cancer would have been diagnosed and treated at an earlier time (i.e. at an early stage and prior to metastasis). The defendant’s departures mentioned above were substantial factors in causing a delay in diagnosis and treatment of the carcinoma. As a result of the delay in diagnosis and treatment of the colon cancer, it was permitted to grow further in size and extent thereby increasing the likelihood that this type of carcinoma (colon cancer) would metastasize.

 

There is a substantial probability that timely diagnosis of the plaintiff’s carcinoma would have reduced the likelihood of its metastasis and the departures mentioned above by the defendant doctor were a substantial factor in depriving the plaintiff of a favorable prognosis and a chance for a cure.

 

If you or a loved one have questions about the timeliness of a cancer diagnosis and have questions about the quality of the medical care you received please call our cancer malpractice lawyers at Silberstein, Awad & Miklos' attorneys for answers. Together we will continue our fight against FRIVOLOUS DEFENSES and DECEPTIVE DEFENSES. Our lawyers serve clients in New York and NYC including Manhattan, Bronx, Brooklyn, Long Island, and Queens.

 

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