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32 year old woman adenocarcinoma of bladder, diagnosed as Stave IV, Grade 3, TNM at least T3b N2 Mx with the following time line:
1. June 26, 2003 presents to ER with pain. ER does CT scan and sonogram, finds "4 cm anterior pelvic mass with calcifications." Impression, Urinary Tract Infection. Advises to go to gynecologist next morning
2. July 23, 2003 (month later) client presents to Primary Care Physician (Kaiser) with complaints of abdominal tenderness, vaginal discharge. Provides PCP with discharge docs from ER which clearly describe the mass. Rx antibiotics, no further testing
3. August 6, 2003 client returns to Kaiser complaining of constant pelvic pain. Tell her she probably has UTI. Advise her to continue antibiotics and do not advise her to return.
4. March 18, 2004 returns to Kaiser. Notes merely state "urinary tract infection symptoms." They do urinalysis and urine dipstick. Diagnose UTI and vaginitis. Dipstick shows blood, client NOT on menses. Rx more antibiotics.
5. April 20, 2004 client returns to Kaiser complaining of blood in urine for 3 months, dizziness. Rx more antibiotics
6. May 26, 2004 client returns for Urinary Tract Infection follow up. Rx Doxycycline for Pelvic Inflammatory Disease and ask her to return for follow up in 2-3 weeks
7. June 7, 2004 client returns, they find blood in catheter urinalysis. Rule out PID. Nurse take client aside and tells her for first time that she should insist on seeing a specialist. All of this time she has been seen by the same PCP.
8. August 13, 2004 client returns because having pain in both legs for 1 month. They give her support hose and tell her she's got varicose veins. This woman, by the way, is 5'2 and 110 pounds.
9. August 20, 2004 seen by Kaiser urologist. Cystoscope reveals "large bladder tumor on right lateral posterior wall."
10. August 31, 2004 perform random bladder biopsy and diagnose her with "adenocarcinoma of bladder."
11. September 22, 2004 pathology report shows the following:
1. Mucin producing adenocarcinoma
2. Tumor invades completely through the muscle wall with serosal extension
3. Vascular invasion identified
4. Perineural invasion identified
5. Margins cannot be assessed due to extensive nature of the tumor
6. Three lymph nodes with metastatic tumor, bilateral
7. TNM: At least T3b N2 Mx (stage IV)
This is an employed, unsophisticated married mother of 2 with no prior health problems.
Was Kaiser potentially negligent in their care and treatment of this woman and, if so, given this time line what are your opinions on causation? Could she possibly have avoided going into Stage IV bladder cancer had Kaiser been more vigilant in their treatment when she first presented or at any time along the time line?
Thank you for your input.
Lowell Steiger, Attorney at Law
8383 Wilshire Blvd. #830
Beverly Hills, California 90211
(323) 852-1100 office
(323) 852-1033 fax
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