Reprinted with permission from Medical Malpractice Verdicts, Settlements and Experts, Lewis Laska, Editor, (800) 298-6288.
Hemorrhoid or Cancerous Mass?
In May 2000, a 35-year-old woman gave birth to her second child at a Massachusetts hospital. She sustained a second-degree vaginal tear. During repair of the tear, a large hemorrhoid was visualized by the physician, who instructed a nurse-midwife to have the hemorrhoid evaluated, with a possible gastroenterology consult to rule out a mass.
The next day, the patient was examined by another doctor and another nurse-midwife. It was agreed by the clinicians and the patient that she would defer a gastroenterology consult and follow up with her primary care provider in a few weeks. When she saw her primary care physician three weeks after the delivery, her examination was negative for hemorrhoids, and the patient was instructed to call back if she had a recurrence. Since she experienced no recurrence, she did not follow up with the primary care provider. Over the next four years, the woman received medical care from her gynecologist but at no time underwent a rectal examination.
In February 2005, the plaintiff went to her primary care physician with complaints of rectal bleeding during bowel movements. No external hemorrhoids were found, but a rectal mass was present.
The woman was referred for a gastroenterology consult and biopsy, through which an intramucosal adenocarcinoma was identified. Chest CT revealed a nodule in the patient’s right lower lung lobe, which was suspicious for metastasis. Abdominal CT and positron emission tomography showed likely liver metastases. A liver biopsy performed in mid-March 2005 confirmed adenocarcinoma of the liver.
The patient received chemotherapy and chemoradiation. In September 2005, she underwent an abdominal perineal resection, left lateral segmentectomy of the liver, cholecystectomy, and appendectomy. By the time of settlement, she was doing well and was no longer receiving treatment for cancer.
The plaintiff claimed that her primary care provider should have followed up on the initial rectal finding, which would have led to an earlier diagnosis and treatment of her cancer.
The defendant argued that the lesion noted at the time of the delivery was a simple hemorrhoid, which resolved after delivery. The defendant also contended that the absence of any symptoms for nearly five years indicated that the cancer could not have been present in 2000. The defendant further claimed that the cancer found at diagnosis and the hemorrhoid that was originally noted were in different locations.
A $1 million settlement was reached.
Diagnosis, Treatment Delayed by Suspicion of Abuse
A seven-week-old boy was taken to the pediatrician by his parents. They said he had been crying inconsolably all day, with decreased food intake, limited urinary output, and bruising. The pediatrician suspected meningitis and sent them to the emergency department (ED) at a children’s hospital in Georgia. The intake staff and emergency physician, Dr. C., were informed that the pediatrician suspected meningitis.
A blood culture, chest x-ray, and ultrasound were performed. The infant’s white blood cell count was normal, and his condition improved during the ED stay. He was afebrile, and the defendants maintained that he had no symptoms that would indicate meningitis.
Bruising was found on the child’s rib cage and one knee, and an ultrasound indicated that the bruising was due to trauma; thus, a mandatory report was filed with the authorities, and the physician made a diagnosis of abuse. The parents were forced to leave the child at the hospital and were told not to return because the child was in the hospital’s custody. The child was transferred out of the ED and the care of Dr. C.
Subsequently, the blood culture was reported as positive and showed gram-positive cocci. This report was returned about 26 hours after the child’s symptoms had begun at home. The report on the blood culture was relayed to one of the doctors, but no orders were given to evaluate the child. The child was not given antibiotics to treat the meningitis until the following day. The police dropped the report of abuse shortly after the investigation into the allegations began.
The child experienced a severe seizure with catastrophic brain damage, which the plaintiffs attributed to a delay in diagnosis and treatment for meningitis. The child was unable to roll over by age 2 years and would require extensive care and treatment for the remainder of his life.
The defendants claimed that the actions taken were proper and that there was no reason to suspect infection because the child did not have a fever and his condition improved while he was in the ED.