Legal Review and Commentary-Community Failure to communicate need for cancer tests: $850,000

News: The plaintiff patient and her husband received a jury verdict of $850,000 against a physician who failed to communicate the need for a colonoscopy after an endoscopy showed no ulcer despite bleeding, and did not contact the patient when the preoperative blood work indicated anemia. Colon cancer was diagnosed a year later and had progressed significantly.

Background: The patient/plaintiff in this case went to her gynecologist for her annual checkup. The day before she had noticed blood in her stool and had experienced severe stomach pains, both of which she reported to her doctor. She was thirty-three years old and had given birth to her first child six months earlier. The blood in her stool was confirmed by the internist to whom her gynecologist had referred her, and the internist ordered an upper endoscopy that was performed one week later. The endoscopy showed mild gastritis for which over-the-counter medications were prescribed. The medical records from the procedure indicted that she was to be tested for anemia and based on the results she might need a colonoscopy. However, the potential need to seek further testing was not provided to her in her discharge papers from the endoscopy nor was she informed through any other means of the potential need for any follow-up tests.

Further, when the preoperative blood test results were made known to the internist the next day and indicated anemia, once again the patient was not contacted. Even though both the internist and a nurse initialed the medical records notation to "contact patient," neither the physician or nurse had actually contacted the patient. The physician believed that by initialing the results, the nurse would contact the patient; and conversely, the nurse acknowledged the abnormal results, but believed the practice to be that only the physician contacted the patient when abnormal results occurred. Accordingly, the patient was not notified at either point of the need for further testing.

After two months of using the over-the-counter medications for gastritis, her symptoms disappeared. When she returned for her annual physical one year later and complained of fatigue and pain in her right side, a subsequent blood test revealed severe anemia, for which she was hospitalized, during which time a colonoscopy was performed. The colonoscopy revealed colon cancer, which had advanced to a Dukes B2 tumor requiring chemo therapy. The plaintiff claimed that her chances for survival had fallen from 85-95% to 60-75% because of the one year delay in diagnosis of the cancer. Because of the chemotherapy, the patient suffered infertility and arthritis.

What this means to you: Cheryl A. Whiteman, RN, MSN, HCRM, a private health care consultant in Florida, says, "apparently, the preoperative blood work was reported to the internist the day after the endoscopy was preformed. Review of preoperative testing before beginning a procedure would be the expected standard of care. Also, although the internist and a nurse initialed the records notation to 'contact patient,' regarding her anemia, neither took responsibility to do so. Each assumed that this would be done by the other. Assumptions lead to errors and omissions. A written policy regarding patient notification and corresponding documentation could have prevented such an omission," notes Whiteman.

"Communication is critical to the provision of quality health care, regardless of the clinical setting. Accurate and complete information must be relayed among providers and between providers and the patients and/or their families. This unfortunate example demonstrates how repeated failures in communication resulted in advance ment of colon cancer in this young patient. Incomplete documentation and documentation without appro priate follow-up left a readily visible paper trail of errors," concludes Whiteman.

Reference

Lynda Figueroa and Melvin Figueroa v. Internal Medicine Associates, Orange County (FL) Circuit Court, Case No. 98-9503.