Dorothy Duffy obtained a defense verdict in the Philadelphia Court of Common Pleas on behalf of a surgeon in a medical malpractice action. The plaintiff’s decedent came to the surgeon complaining of hemorrhoids. The surgeon recommended that she proceed with a colonoscopy before undergoing hemorrhoid removal. A colonoscopy was performed and two small polyps were removed. Otherwise, no abnormalities were seen.
Nine months later, the patient presented to the emergency room with abdominal pain. A CT scan revealed a large right-sided colon tumor, abnormal ovaries, numerous liver masses, and masses throughout her abdomen. A repeat colonoscopy showed an ascending colon mass which appeared to be an “extrinsic process.” A biopsy confirmed that this was the primary site of her cancer. Palliative treatment was initiated and the patient eventually passed away.
The plaintiff contended that the surgeon failed to perform the colonoscopy to the cecum (the beginning of the colon), thereby missing the ascending colon mass which would have been visible nine months earlier. The defendant testified that he observed the landmarks of the cecum, indicating that he performed a complete colonoscopy. The defense presented extensive expert testimony to the jury that the patient’s cancer actually began in her appendix. Primary appendeceal cancer cannot be diagnosed on colonoscopy. The appendeceal cancer spread to the outside of the patient’s ascending colon and pushed in, leading to the finding seen during the second colonoscopy. The diagnosis of primary appendeceal cancer was supported by subsequent radiology studies.
The jury found that the surgeon was not negligent, that is, that he complied with the standard of care. Therefore, the jury did not reach the question of causation. However, the defense also argued that the patient had metastatic cancer at the time of the colonoscopy. The plaintiff’s oncology expert agreed with this conclusion during his cross-examination. Therefore, the defense also argued that any delay in diagnosis did not change the patient’s prognosis or ultimate outcome.