Allegation
Plaintiff alleges failure to properly track and follow up on test results in a timely manner, leading to patient’s death.
Case Details
The patient, a 67 YOM (5’7”, 117 lb), had a history of anxiety, depression, dyslipidemia, COPD, peripheral vascular disease (PVD), hernia surgery, glaucoma, asthma, HTN, BPH, and dementia. He had a social history of smoking a half pack of cigarettes per day for the past 50 or more years, and had previously used alcohol. The patient saw the defendant internist for primary care.
Approximately five years later, the patient presented for an evaluation. He was accompanied by his son. The patient’s son stated his father was forgetful. The defendant internist performed a mini mental test, and indicated mild dementia. The defendant internist discussed the patient’s condition with his son and provided smoking cessation education.
The patient returned in eight weeks for a physical exam and a review of symptoms, which were the same as the previous visit. At a follow-up three weeks later, the defendant internist noted the patient was agitated and abusive per the son, and was not taking his medications. The patient was positive for suicidal ideation with a plan to overdose on medication. He was sent to the local ED to be evaluated and treated.
Two weeks later, the patient returned to the defendant internist for follow-up after discharge from the hospital. The defendant internist noted the patient’s gastrointestinal review was negative for heartburn, nausea, abdominal pain, diarrhea, and blood in stool. Approximately one month later, the defendant internist received a phone call from the patient stating he had been experiencing rectal bleeding for the past three weeks. The defendant internist instructed the patient to go directly to the ED; the patient replied that his son would take him immediately.
Upon presenting to the local hospital, the patient reported he noticed bleeding after bowel movements for the past several months. The defendant physician saw the patient and assessed for acute anemia secondary to acute blood loss, as well as HTN, COPD, PVD, dyslipidemia, and depression. The internist’s plan was a serial hemoglobin. The chart indicated the patient had refused a colonoscopy for over 10 years, and that the son witnessed the refusal several times.
The patient underwent a colonoscopy when he was admitted to the hospital. The defendant gastroenterologist’s diagnoses were benign appearing polyp in the traverse colon, and a large soft friable polyp seen with a broad-based polyp in the rectum at 10 cm from the anal verge. The patient was discharged the next day. The defendant internist noted the patient underwent a colonoscopy; he was stabilized and feeling better. His notes indicated the colonoscopy did not show any cancer. The patient was discharged home in stable condition and was to follow-up with the defendant in one week
Three days after the patient’s discharge from the hospital, the pathology report noted the rectal polyp biopsy contained fragments of tissue showing both tubular adenoma and adenocarcinoma. The presence or depth of invasion of the adenocarcinoma could not be determined on the biopsy specimen. Clinical correlation was recommended. The pathologist spoke with the defendant gastroenterologist concerning the results of the biopsy.
The patient did not return to the defendant internist’s office for approximately two months after discharge from the hospital; it would be another two months before the next visit. The documentation from these two visits was the same as the office notes prior to the patient reporting rectal bleeding and being told to go directly to the ED.
Over the next year, the defendant internist saw the patient 12 times for multiple reasons including nasal congestion, sore throat, depression, upper respiratory infection, anxiety, insomnia, medication changes, and medication refills.
Nearly 17 months after the patient received his colonoscopy, the defendant internist’s office received a facsimile from the hospital regarding the patient. It noted a diagnosis of rectal, tubular adenoma with adenocarcinoma. In the comment section it read: “Did this patient ever have any treatment for the rectal cancer?”
Three days later, the patient presented at the defendant internist’s office for his results after being contacted by the defendant internist. The encounter diagnosis was malignant neoplasm of the colon. The patient was referred to an oncologist along with a colon and rectal surgeon for an evaluation.
Upon presenting to the colon and rectal surgeon’s office, the patient was mostly concerned with his fatigue. The surgeon suspected anemia was causing the fatigue and ordered a STAT CT of the chest/abdomen/pelvis along with STAT CBC, CMP, and CEA levels. The patient’s Hgb resulted at 6.8 (13.5-18), and he was subsequently admitted to the hospital for transfusion of packed red blood cells. The CT scan showed a rectal mass of at least 5 cm, extensive liver metastases, and multiple metastatic pulmonary nodules. Palliative care was consulted; it was noted the patient expressed his wish to have hospice care at home, and his goal was to stay in his home.
Four months after receiving the results from his colonoscopy, the patient was pronounced dead at his home. An autopsy performed by the deputy chief medical examiner noted the patient died of metastatic carcinoma of the rectum.
The hospital produced an audit report that showed the pathology report was mailed to the defendant physician five days after the patient’s colonoscopy. Further, a “communication” note had been entered in the hospital records and requested clarification of conflicting documentation between the discharge summary that noted no signs of cancer, and the pathology report that identified tubular adenoma plus adenocarcinoma. The defendant internist electronically signed this “communication” three times within 16 days of receiving the notification.
Expert Testimony
The plaintiff filed suit against the defendant internist and the gastroenterologist. The plaintiff’s experts stated the defendant internist and the gastroenterologist failed to properly care for the patient and refer for treatment, which allowed the colorectal cancer to progress and metastasize, resulting in the plaintiff’s death.
Defense experts stated that when the plaintiff presented with complaints of rectal bleeding and gastrointestinal complaints, it was appropriate and within the standard of care to refer the plaintiff to a gastroenterologist through the ED at the hospital. Once the referral was made, it was the gastroenterologist’s responsibility to do the follow-up with respect to any testing that was to be done. The defense experts were supportive until they learned the defendant internist had reviewed the communication information on three occasions.
Resolution
The case was settled on behalf of the defendant internist and the defendant gastroenterologist.
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