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The cases in this column are selected by the editors of The Journal of Family Practice from Medical Malpractice: Verdicts, Settlements & Experts, with permission of the editor, Lewis Laska (https://www.triplelpublications.com/product/medical-malpractice-newsletter/). The available information about the cases presented here is sometimes incomplete; pertinent details of a given situation therefore may be unavailable. Moreover, the cases may or may not have merit. Nevertheless, these cases represent the types of clinical situations that typically result in litigation.
Cancer missed in patient with rectal bleeding
A 44-YEAR-OLD MAN went to his family physician, an internist, with complaints that included rectal bleeding. The physician performed a flexible sigmoidoscopy, which found hemorrhoids that weren’t inflamed or bleeding. A hemoccult test at a physical exam before the sigmoidoscopy was positive for bleeding.
A year later, the patient returned to the doctor complaining of blood in his underwear almost every other day. The doctor noted a “slightly inflamed hemorrhoid” on anoscopy, but no bleeding from the hemorrhoid; he didn’t test for occult bleeding.
Early the next year, the patient saw the physician for a complaint of blood in the stool and changes in bowel habits. A hemoccult test was positive, and the doctor diagnosed irritable bowel syndrome. The patient returned 6 months later with the same complaints and, he said, requested referral to a gastroenterologist. The doctor again attributed the complaints to irritable bowel syndrome.
Early the following year, the patient went to another internist because his insurance changed. This internist immediately diagnosed stage-3 rectal cancer. The patient underwent radiation, chemotherapy, and 2 surgeries, one to remove part of his rectum and a second to reverse an ileostomy done during the first operation. The patient was left impotent, with permanent, variable bowel dysfunction.
PLAINTIFF’S CLAIM: The diagnosis of hemorrhoids wasn’t reasonable; the patient should have been referred to a gastroenterologist or for colorectal cancer surgery. Early detection and diagnosis would have resulted in removal of a polyp or early cancer, which could have been done during a colonoscopy or by transanal excision.
DOCTOR’S DEFENSE: The patient’s doctor denied that the patient had requested a referral to a gastroenterologist and maintained that he believed the flexible sigmoidoscopy had ruled out a serious cause of bleeding.
VERDICT: $1 million Virginia verdict.
COMMENT: When a patient has persistent rectal bleeding without a clear cause, no matter what the patient’s age, further evaluation or referral is prudent.
