Cancer Malpractice Lawyers

Bronx, Brooklyn, Long Island, Queens, Manhattan, New York City, NY

Cervical Cancer Case

 

This case involves personal injuries sustained by the plaintiff as a result of medical malpractice in the medical care by the defendant doctor and hospital. The plaintiff, who had no children, showed inflammation on a pap smear on March 22, 2001. On March 26, she was noted to still have inflammation and some subsequent bleeding. By the 28th of April, a vaginal biopsy was performed, revealing squamous cell carcinoma of the upper cervix. On May 2, a CT scan was performed which revealed a 5-6 cm central mass in the proximal vagina, which is in the area of the cervix and lower part of the uterus. The plaintiff was diagnosed as Stage 3B. Between May 30, 2001 and July 10, 2001, the plaintiff was given 4500 rads of radiation and 25 fractions. On August 2, 2001, doctors noticed that the posterior vaginal wall was very firm, about 3-4 cm in diameter, and suspicious for residual cancer. They inserted the tandem and ovoids for additional radiation and they did a second insertion on August 9, 2001 for additional radiation.

 

On August 2, 2002, a total pelvic exenteration was performed for a recurrence of the cervical cancer. There was a soft tissue mass that was 4.5 by 7.5 cm seen on the CT scan in the area which would be the superior aspect of the cervix, where the cervical cancer had occurred the first time. On September 6, 2002, a Barium Enema is performed which showed a 20 cm stricture (7.87 inches) of the distal colon adjacent to the stoma, which is where the colostomy comes out of the skin. This finding demonstrated a band of tissue that is binding the colon. On September 11, 2002, the plaintiff was seen by doctor #1, who wrote a note to the defendant doctor suggesting immediate follow up with defendant doctor. The plaintiff was admitted on September 13, 2002 to the defendant hospital for abdominal pain and leakage around the colostomy. The diagnosis at that time, according to the defendant doctor, was colonic obstruction and the colostomy site showed errythema, which is redness and inflammation and induration or thickening indicative of an infection.

 

Between September 13, 2002 and September 17, 2002 they gave the plaintiff pain medicine everyday, which indicated that the bowel was under siege, being twisted and the bowel was ischemic, causing the plaintiff pain. The plaintiff had a stricture and a bowel obstruction and needed to be operated upon immediately to avoid diminishing blood supply to the infected bowel, causing it to die and become ischemic and even gangrenous. The defendant doctor deviated from the standards of care then and there existing by not operating immediately on this patient and for waiting until September 20, 2002 to perform surgery to relieve the stricture and bowel obstruction noted on the barium enema study of September 6, 2002.

 

Surgery was originally scheduled for September 17, 2002, but was cancelled due to the operating room running late and the colorectal surgeon not being available. The surgery was cancelled for September 18, 2002 as well . The defendant doctor speculated that the operating room may not have been available. The surgery was not performed the 19th of September. It was not performed until the 20th of September. This constituted a deviation from the standards of care on the part of the defendant hospital in that this was a surgical emergency and it was the duty of the hospital to make available an operating room for such a patient. In addition, as the defendant doctor was employed by the defendant hospital, the hospital is responsible for his actions and inactions.

 

Between September 17, 2002 and September 20, 2002, the plaintiff’s pain continued. This was documented by the continued administration of pain medication to her. A laparotomy was finally done on September 20, 2002, revealing a peri-stomal abscess and cellulitis, which should have been known when she first came to the hospital. This should have prompted them to operate in addition to the presence of a stricture and documented colonic obstruction. At the time of surgery, the whole left colon was ischemic and because of this a colectomy was performed as well as an end ileostomy. The large bowel or colon was approximately 3 feet, therefore, by September 20, 2002, much more than 7.87 inches of large bowel as noted on the CT and Barium Enema studies of September 6, 2002 was involved. With a complete bowel obstruction, it is necessary to operate on a patient immediately to prevent the colon from continuing to get ischemic and causing a larger portion of the colon to have a compromised blood supply resulting in the death of the bowel wall. In this case, in addition to the colonic obstruction, they knew that there was a stricture. The defendant doctor said that the stricture was related to the ischemic event. It was necessary, in this case, to do surgery immediately not only for the colonic obstruction but because the stricture was there, was not likely to go away and would continue to cause a problem if not then, later on. Indeed, in the hospital progress notes, there is no indication that the patient was passing gas or stool which would indicate a complete bowel obstruction. The dividing line and rule for management with respect to a complete bowel obstruction and a partial bowel obstruction (with a partial bowel obstruction some doctors in some instances might wait to see if it resolves on its own with nasal gastric suction) was not workable here, because it was known that the plaintiff had a stricture. The stricture was not going to go away and it was necessary to operate to remove that stricture. Indeed the defendant doctor said the stricture was causing the ischemic event. When you have a patient with a colonic obstruction and stricture, the longer you wait to operate the greater the risk that the ischemia, as a result of the compromised blood supply, is going to result in death of the bowel wall which will require removal of much more bowel. The plaintiff was in the hospital for a long time prior to surgery being performed. She was in the hospital for a week before she ever even went to surgery. Surgery was planned and unable to be performed once due to the unavailability of the colorectal surgeon and for a second time perhaps because of the unavailability of an operating room once the surgery was even scheduled.

The surgery should have been performed on admission to the hospital and not scheduled for five (5) days later. The surgery should have been performed immediately when the stricture and bowel obstruction was first diagnosed as of September 6, 2002 and that it was a deviation by the defendant doctor and hospital from the standards of care and there existing not to do so. The failure to immediately perform surgery to relieve the stricture and obstruction was a substantial factor in causing compromise and ischemia of the bowel necessitating removal of the entire large colon resulting in an ileostomy rather than an end colostomy with a wet liquid discharge that does not colonize. This type of ostomy is much more difficult to manage because the liquid is not reabsorbed by the colon therefore there is no formed hardened stool, just liquid and particles. If a colorectal surgeon is not available for surgery in an instance such as this, a second colorectal surgeon should be consulted and it was a further deviation from the standard of care not to obtain the proper consultation in this case, by the doctor.

 

With respect to the stricture causing the ischemia, this happens when the bowel binds itself and twists on the stricture, which is an adhesion that catches the bowel and the bowel twists around it. It closes off part of the blood supply because the vessels get crimped closed when they twist. If ischemia is had because of the bowel twisting there is a reason, and in this case, there is a physical anatomical reason that can be pointed out from the Barium Enema study. The study says the stricture was causally related to the ischemic event. In other words, the bowel grabbing itself and getting caught in the stricture and twisting reduced its own blood supply because the vessels get crimped. This is like twisting a garden hose. Because it has a significantly decreased blood supply the bowel starts to die. The bowel is filled with bacteria and if it does not maintain its health then the bacteria will start to attack the bowel from inside.

 

The defendant doctor mentioned that radiation caused the ischemia. There is no evidence here that the radiation caused the ischemia. The plaintiff had radiation, but afterwards her bowel was working. Then she had the exenteration and the bowel was also working afterwards and she recovered. The bowel stopped working only in this instance because there was a mechanical obstruction, not because there was a prior radiation induced vascular change in the bowel wall. As indicated, the defendant doctor admitted that the stricture caused the ischemic event. But not for this stricture, wrapping of the bowel and decreasing the blood supply to the bowel for a prolonged period of time, you would not of had the death of the wall of the colon requiring its removal. Even if it was felt that the patient had partial bowel obstruction, the patient had a stricture, and when you know you have a stricture and you have a partial bowel obstruction, you run the risk of a complete bowel obstruction as the bowel continues to twist and cause ischemia to the bowel. This can cause severe problems and damage to the bowel and the necessity of removal of an extensive amount of bowel at the time of surgery as in this case. Both the defendant doctor and the defendant hospital deviated from the standards of care as listed above.

 

If you or a loved one has had a delay in diagnosing cancer and have questions about the quality of the medical care you received please contact Silberstein, Awad & Miklos' cancer malpractice attorneysfor answers. Our cancer malpractice lawyers serve New York and NYC including Manhattan, Bronx, Brooklyn, Long Island, and Queens. Together we will continue our fight against FRIVOLOUS DEFENSES and DECEPTIVE DEFENSES.

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