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Woman Dies After Delayed Diagnosis of Colorectal Cancer

As patients, we depend on our doctors to alert us to any abnormal signs or test results that could be signs of life-threatening illness or disease.

Such signs, if detected early enough, can be the difference between life and death. That’s why this woman in her 50s filed a lawsuit against her doctor after developing metastatic colon cancer. The diagnosis came months and months after her initial complaint to her doctor of diarrhea which tested positive for blood. Unfortunately, she eventually died from the disease.

The 52-year-old woman visited her primary doctor with complaints of losing weight and diarrhea with mild, occasional cramps. She also complained of joint pain and was diagnosed with osteoarthritis.

Her doctor labeled the diarrhea as “functional;” a hemocult test in the office, however, was guaiac-positive, which meant there was blood in her stool. The doctor’s note stated that the guaiac-positive stools “raise concerns for some form of colitis, polyps, or possible malignancy.”

Otherwise, the doctor labeled the woman’s abdominal and rectal examination to be normal. The addendum to her office note indicated that one additional stool sample tested as guaiac-positive and that “it is likely that she will need a colonoscopy.”

The woman was also diagnosed with high cholesterol and high blood pressure. During a follow-up visit with the nurse for a blood pressure check a month later, the woman said she was anxious about the blood in her stool. Despite that, no more was ever said about the blood.

The woman visited her doctor several times over the next several months, mostly for follow-up related to the hypertension. At no time during any of these visits was the diarrhea, the blood in the stool, or the colonoscopy discussed with the woman.

Four months later, when the woman was seen for a physical examination, her doctor even omitted the rectal examination altogether. Eight months after that, the woman presented with a complaint of right lower quadrant discomfort which had lasted for more than 10 days. The doctor ordered an abdominal CT scan, colonoscopy, and blood work.

The CT scan documented cecal thickening and the colonoscopy showed a large ulcerated lesion in the cecum. The biopsies tested positive for cancer. The woman had to undergo a colectomy and at the time of surgery the findings included peritoneal metastasis. The woman had to undergo a year-long course of palliative chemotherapy and died approximately two years later.

Before her death, this woman’s lawsuit against her doctor for failure to diagnose colon cancer was settled for $700,000.

This lawsuit was successful based on the following factors:

Medical Negligence. The doctor should have ordered a colonoscopy for the woman at the initial visit, based on the standard of care. Although the doctor testified that she contemplated ordering the colonoscopy, she had no reminder system in place to ensure that she assessed the need for the colonoscopy after the additional test results were returned.

No follow-up. During her deposition testimony, the doctor said her plan was to order a colonoscopy if the additional stool tests were guaiac-positive. Despite the notations on file, there is no documentation regarding the additional stool tests or the colonoscopy. The doctor failed to have any system or mechanism in place to ensure proper follow-up for her patient.

Patient problem list was not maintained. An active, up-to-date problem list for all patients is a must in a primary care office practice. Such a list provides a quick and accessible review of major problems and serves as a reminder to the physician of other issues that warrant follow-up during other office visits, whether or not related to the purpose of the visit.

No communication with patient. The doctor’s office notes do not list any conversations or advice the physician provided to the woman regarding the guaiac-positive stool tests. The woman testified that the physician never discussed the tests with her and never explained the importance of follow-up or the need for colonoscopy. To encourage the woman to participate in the care process and take responsibility for her health care, her doctors should have fully informed her of the issues and the risks, benefits and alternatives to treatment.

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