A Pennsylvania woman saw her gynecologist in 2008 for vulvar erythema with excoriation of the labia and clitoral hood. She was prescribed an ointment and advised that she would need a biopsy if the condition did not improve. She was also referred to a vulvar clinic, where she began treatment 1 month later with a nurse, who diagnosed recurrent vulvovaginal candidiasis. The patient’s treatment at the clinic continued for 2 more years and included several wet prep tests, gram stains, and fungal cultures, and use of various medications, including antibiotics, topical treatments, and washes. She was seen once by a physician during this time.
In mid 2010, the woman complained of increasing pain and underwent a biopsy, which diagnosed invasive vulvar Paget’s disease. A modified radical vulvectomy with removal of the pelvic lymph nodes was performed. The patient then underwent an operative laparoscopy, pelvic lymph node dissection, and removal of the right fallopian tube and ovary. Chemotherapy was begun, but the cancer had metastasized to the liver. In early 2011 the patient was diagnosed with a cervical compression fracture that was attributed to metastasis to the bones. She died a year later.
A lawsuit was filed against the medical center running the vulvar clinic, claiming the nurse failed to properly treat the condition in failing to perform a biopsy and timely diagnose the cancer.
A $2.4 million settlement was reached.
Delay in diagnosis of breast cancer
A Louisiana woman found a lump in her left breast in 1996 and saw her gynecologist for her annual exam that same month. She reported the lump to the doctor and he told her it was consistent with fibrocystic changes and to not worry about it. No further testing was ordered. Three months later the patient returned, still complaining of the palpable lump. She demanded a mammogram, which the gynecologist ordered but was not performed for a month due to delays with the patient’s health insurance coverage. The results of the mammogram were inconclusive and further evaluation was recommended if the palpable lump persisted.
At the time, the patient’s insurance company no longer covered care with the gynecologist, so the woman went to her primary care physician (PCP) early the following month. He examined her, noted a hard lump in the left breast and immediately ordered an ultrasound (U/S), which was performed a few days later. The U/S reported a probable infiltrating ductal carcinoma. In the next few weeks the patient saw 4 surgeons and underwent several needle biopsies, all of which were inconclusive. One of the surgeons performed a lumpectomy, which confirmed the diagnosis of ductal carcinoma. A radical mastectomy was performed the next day, followed by 6 months of chemotherapy. The patient is free of cancer.
The patient sued the original gynecologist, claiming that he was negligent in failing to order further evaluation of the lump at her first visit. She claimed that the 6-month delay in diagnosis necessitated the radical mastectomy and chemotherapy course.
The physician alleged that the patient told him originally that the lump seemed to get bigger and smaller each month and hurt at times, and he claimed that his examination and this information were consistent with fibrocystic changes and she was to follow up in 6 months. He also argued that he continued to order further tests and referrals to surgeons, even when the patient’s insurance carrier required she be followed by her PCP. The defense further argued that the patient’s treatment would have been the same even if the diagnosis had been made 6 months earlier.
A defense verdict was returned.
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