Delay in breast cancer diagnosis during pregnancy alleged

May 1, 2011

At approximately 7 months gestation, a 29-year-old Illinois woman complained to the physician that she was experiencing burning pain in her right breast and clear discharge from the nipple.

After her 2003 delivery, a lump in her right breast was found by another physician during her 6-week postpartum visit. The patient subsequently was diagnosed with triple-negative breast cancer and underwent mastectomy and radiation. She died from metastatic breast cancer at 32 years of age in 2005.

A lawsuit was filed on behalf of her estate alleging that the obstetrician was negligent in failing to conduct a clinical breast examination at her visit at 7 months' gestation, which delayed the diagnosis of her breast cancer and thereby reduced her chance of survival.

A $1.5 million verdict was returned against the obstetrician.

LEGAL PERSPECTIVE

In malpractice cases in which a delayed diagnosis of cancer is alleged, the issues usually are whether the physician could and should have diagnosed the cancer earlier and, if so, whether it would have made a difference in the patient's chance of survival or treatment options. The second question usually is argued by the expert medical witnesses for each side.

In this case, the patient's estate alleged a 3-month delay in diagnosis. The physician denied that the patient had complained of any breast symptoms at the visit in question because the records did not indicate this complaint. There was, however, a documented phone message prior to this visit in which the patient complained of burning pain in her right breast and clear fluid leaking from the nipple. The obstetrician admitted that he would have followed up on the phone call at the visit and said that the patient must have told him that those symptoms had subsided or he would have noted continuing complaints in the record and performed a breast exam. He claimed that the patient had not expressed any complaints about her breast during the office visit to warrant an exam; thus, there was no negligent care.

While it might not be the standard of care to document all negative findings for all possible conditions, it would probably be prudent for clinicians to document whether patients have complaints of breast changes, palpable masses on self examination, or abnormal discharge during any examination by the caregiver. This effort is even more important in a case in which records of a patient's phone call document these complaints and indicate that follow-up documentation are noted.

Lap sponge found in intestine after cesarean delivery

A 34-YEAR-OLD LOUISIANA WOMAN underwent a cesarean delivery in 2005 performed by her obstetrician. She was released 2 days later. After her release she reported abdominal swelling, pain, and nausea to her physician, who suspected it was related to a nervous somatic condition. The patient presented at the emergency room with increasing abdominal symptoms about 2 months after the delivery, but no definitive diagnosis was made. One month later, at another hospital, she was diagnosed with a bowel obstruction and underwent surgery. During the operation a lap sponge was found inside her small intestine.

The woman sued her obstetrician and the hospital at which the delivery took place, claiming that the lap sponge had been left in her abdomen during the cesarean delivery.

The defense claimed that the sponge count was correct at the time of surgery, and suggested that the patient must have swallowed the sponge, as it was found within the lumen of the intestine and not in the free space in the abdominal cavity. The surgeon who removed the sponge also believed the patient had swallowed it and recommended a psychiatric consult.

A defense verdict was returned.