In the hospital, an abdominal pelvic ultrasound and a pelvic CT scan showed free intraperitoneal air, indicating a perforated bowel. Mr. C was taken to emergency surgery to repair his bowel. During the surgery it was discovered that Mr. C had colon cancer. A pathology report indicated that the patient had invasive adenocarcinoma which had spread to the lymph nodes. Mr. C was told that he had stage 3 colon cancer and did not have long to live. Within the next few months the cancer spread to his lungs, and within six months of his diagnosis, Mr. C died.

Mr. C’s devastated widow sought the counsel of a plaintiff’s attorney.

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“I don’t understand,” said Mrs. C. “My husband was going to the doctor every six months, like clockwork, for the past five years before he was diagnosed with cancer. Why didn’t the doctor suggest he get a colonoscopy? Why didn’t she realize he had cancer?”

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The attorney acquired the patient’s medical records and looked at them carefully. Then he hired a medical expert to do the same. The expert told the attorney that he had never seen such strange medical records before. “It appears the doctor did nothing other than check Mr. C’s blood pressure for five years,” he said.

“What should the doctor have been doing?” asked the attorney.

“This is a general practitioner,” said the medical expert. “She should have been doing a general physical, blood work, and certainly some sort of colorectal cancer screening – a fecal occult blood test, or referring the patient for a sigmoidoscopy or colonoscopy. For a patient in his 60’s, this would be standard.”

The attorney took the case and filed a lawsuit against Dr. N.

As soon as she heard about the lawsuit, Dr. N knew she had a problem. She realized the records would look strange with just blood pressure readings and nothing else. Plus she had neglected to note anything about the special arrangement she had made with the patient.

She met with her defense attorney and explained the situation. The defense attorney looked somber and suggested that they proceed with the discovery process, but that they should consider settling if it looked like it was going to trial.