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| Disposition:
(Settlement/Arbitration/Trial) |
Settlement |
Date: |
12/20/1998 |
Type of Case: |
Medical Malpractice |
Allegation(s): |
Primary caregiver fails to diagnose rectal
cancer; Female, 37 |
Result: |
$850,000 |
Case Name: |
Shilling v. Doe Medical Group (confidential) |
Facts: |
Defendant doctor of defendant medical group was plaintiff's primary caregiver. On 8/31/95, plaintiff, a 37-year-old metallurgical engineer, was seen by Defendant doctor in a 15-minute examination for complaints of nausea and dizziness with exercise for several months. She also expressed concern about a mole on her right pubis. Defendant doctor ordered routine blood work, including a CBC. Results were reported back on 9/5/95, showing clear evidence of iron deficiency anemia, and the need to slightly reduce the patient's thyroid medication. Defendant doctor saw the thyroid results but not the anemia results.
On 1/18/96 Defendant doctor instructed her nurse to advise plaintiff that her thyroid level was good but that her iron level was low and that she needed to take ferrous sulfate as well as eat foods rich in iron. Plaintiff complied, although she had the side effects of nausea and constipation. Between late February and early July 1995, plaintiff continued to have her previous symptoms of nausea and fatigue but also developed constipation and irritable bowel syndrome. Defendant medical group advised her that she could have some constipation because of the iron supplement.
On 7/7/96 plaintiff was seen with a complaint that her last two menstrual cycles had been longer but not heavier than normal. Medical group personnel recommended that her IUD be removed and also ordered routine blood work. This time her thyroid level was good but there was evidence of significant anemia.
After plaintiff had her IUD removed on 7/23/96, she was told that her TSH level remained good but that her iron level was still low. She was told for the first time that she was "somewhat" anemic. No additional follow-up was suggested or required. Her menses returned to normal within two cycles, but she continued to have gastrointestinal problems over the next several months, including stomach pain within 2-3 hours following meals. She also was constipated.
From 9/96 until 2/97 plaintiff was out of Defendant medical group system as a result of a change in her insurance.
On 2/24/97, plaintiff called defendant doctor and left a message indicating that she sometimes felt as though she was going to black out. She thought it might be related to the medication Inderal which she was taking for migraines. Plaintiff was not scheduled for an appointment. Instead the doctor changed her dosage of Inderal.
On 5/5/97 Plaintiff called Defendant doctor indicating she had no appetite at all. A nurse returned the call the next day. On 5/9/97 plaintiff was seen by Defendant doctor with a complaint of lack of appetite, having lost 30 pounds since September, secondary to no appetite. The doctor's assessment was weight loss in a "compulsive female." She sent plaintiff to a dietician for a consult.
Blood work drawn on 5/9 showed plaintiff to be severely anemic and hyperthyroid, but the results were not conveyed to plaintiff until 5/14/97 by a partner of plaintiff's doctor (who had gone on vacation). He advised plaintiff that she was so anemic she should be seen in Urgent Care that day. Blood work was re-run, but the doctor did not see a life-threatening situation. He advised plaintiff to take her iron supplements, decrease her thyroid medication and follow up with Defendant doctor.
Plaintiff called for Defendant doctor repeatedly over the next several days. She was eventually seen on 6/17/97 when she was assessed as having severe anemia with constipation, pale and hyperthyroid. The doctor attempted to obtain both endocrinology and OB/GYN consults. While waiting for those consults, plaintiff called the medical group on 6/27/97 indicating severe constipation for two weeks. She was advised to take a laxative as well as encouraged to eat fruits and vegetables.
On 7/5/97 plaintiff was seen in the ER at Defendant medical group. A rectal examination revealed a firm, irregular mass in her rectum. She underwent surgery on 7/11/97.
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| Injury/Injuries: |
Surgeons found a 6 cm well-to-moderately-differentiated adenocarcinoma of the rectum, invading the entire bowel wall with one of seven regional lymph nodes positive for cancer, requiring a low anterior resection with colostomy. Plaintiff's life expectancy is less than five years.
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| Contentions: |
This tragedy was avoidable had Defendants complied with the applicable standards of practice and care as well as their own policies and protocols; that the standard of care was repeatedly violated as the personnel at Defendant medical group repeatedly failed to follow up with Plaintiff's continued evidence of worsening iron deficiency anemia and increasing gastrointestinal symptoms.
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| Special Notes: |
As a family
practitioner, Defendant doctor was required
to manage a "patient panel" of 3,000 patients,
five days a week, every 15 minutes. Additionally,
she was required to return patient phone
calls as well as handle one Urgent Care
Clinic per week, either at night or on
a weekend. Physicians at Defendant medical
group would frequently not have access
to their patient's primary charts which
were kept at another location.
The same doctor who missed this diagnosis
also missed a diagnosis of appendicitis.
See the Warren case. The doctor
is under investigation by the Medical
Board.
Claimant's parents' potential wrongful
death case is still at issue.
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