MEDICAL NEGLIGENCE CASE: DELAYED BREAST CANCER DIAGNOSIS
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DELAYED BREAST CANCER DIAGNOSIS CASE REPORT
IN THE MATTER OF :-
GLENICE HEWITT Claimant
(represented by JMW Solicitors)
-v-
CALDERDALE & HUDDERSFIELD
NHS TRUST Defendant
CASE REPORT
FAILURE TO CORRECTLY REPORT HISTOPATHOLOGY DELAY IN DIAGNOSIS OF BREAST CANCER
Background to the Claim
In September 2001 Mrs. Hewitt attended her GP, Dr. Ford, of the Far Town Health Centre in Huddersfield. She had noticed a lump in her right breast the week before. She had previously had a benign breast lump removed in 1983. Other than, she was generally fit and well. At the time, she was employed as a Lollypop lady and at the local working men's club as a cleaner.
She was seen on the 5th October 2001 by Mr. Modgill at Huddersfield Royal Infirmary. Mrs. Hewitt recalls having a mammogram, and this being seen by Mr. Modgill, who then suggested an ultrasound scan of the breast, and a core biopsy.
The histopathology report on the breast specimen following biopsy was written up by Dr. M.M. Aslam.
The histopathology was reported as showing "…no definite evidence of micro-calcification". In turn, Dr. Aslam graded the biopsy findings as DCIS (Ductal Carcinoma In Situ).
Mrs. Hewitt was seen by Mr. Modgill again on the 2nd November 2001. She recalls him explaining that breast lumps can either be benign, pre-cancerous or cancerous. He told her that he had obtained the test results from the biopsy, and informed her that the lump in her breast was pre-cancerous. He advised removal of the lump. She does not recall any mention of having a mastectomy at that time.
Mr. Modgill wrote to Mrs. Hewitt's GP following the consultation, and in his letter of the 2nd November 2001 he stated:-
"The histology report reports this as a B5A ductal carcinoma in situ. In view of this, I have arranged for her to come in and have a wide local excision of this DCIS".
On the 21st November 2001 Mrs. Hewitt underwent wide local excision under general anaesthetic. She was discharged home the same day.
On the 26th November 2001 the tissue from the wide local excision was reported upon by Dr. M.A. Khan. His histopathology report states "No evidence of invasion is seen".
Subsequently, the surgical registrar wrote to the GP on the 30th November 2001 stating:-
"I have reviewed this lady recently who had a suspicious lesion in the right breast, and core biopsy revealed DCIS. As you are aware, she had a wide local excision of this lesion, which confirmed DCIS. Histology of the lesion confirmed that it was an oestrogen and progesterone receptor negative and consequently, following discussion at the multi-disciplinary team meeting, we have arranged for her to discuss the option of radiotherapy".
Mrs. Hewitt was subsequently referred to Dr. Crellin at the Yorkshire Regional Centre for Cancer Treatment, and underwent a course of radiotherapy at the Cookridge Hospital.
Thereafter, Mrs. Hewitt continued to be reviewed as an out-patient at the Huddersfield Royal Infirmary.
In late 2002 she felt a lump, like a pea, on the right side of her neck. She attended her GP who said that because of the problems she had had with her right breast he would send her to hospital for review.
She attended the hospital for an out-patient appointment on the 13th December 2002. A scan was recommended.
By the time Mrs. Hewitt attended for ultrasound scan the lump had gone down completely.
Mrs. Hewitt had a further out-patient review on the 13th December 2002 when no abnormalities were detected. She was given a follow-up appointment in 6 months time.
Mrs. Hewitt continued to be reviewed at intervals at Huddersfield Royal Infirmary on the 17th July 2003 and the 12th December 2003.
On the 3rd September 2004 Mrs. Hewitt attended hospital for a further review appointment with Mr. Modgill. She recalls that Mr. Modgill told her that the histology that had been done on the breast lump that had been removed in 2001 had been reviewed and was found to have been cancerous. He explained that the hospital needed to take some of the lymph nodes to check whether or not the cancer had spread. Mrs. Hewitt was shocked.
The corresponding note stated as follows:-
"Seen in Breast Clinic following review of histology. The histology was reviewed and it has now been reported that there is an area of invasive carcinoma as well. This lady had primary treatment for her carcinoma of the breast. There has been no recurrence and tests and current mammograms have been normal. She nevertheless does need axillary sampling to complete her primary treatment".
On the 20th September 2004 Mrs. Hewitt underwent axillary clearance to level 2.
The axillary clearance confirmed the presence of metastatic tumour in 7 lymph nodes.
On the 7th October 2004 Mrs. Hewitt was seen by Dr. Joffe, Consultant Oncologist, for treatment.
Mrs. Hewitt recalled that at the appointment that Dr. Joffe seemed very angry about what had happened.
In a letter of the same date, Dr. Joffe notes:-
"Her pathology was reviewed following concerns about a locum Pathologist working in the Trust in 2001. She was one of a small number of cases in which a diagnosis was changed following review. It was felt appropriate to offer her axillary dissection, which was unfortunately positive. She is awaiting a bone and CT scan. Her last mammogram was November 2003.
……Mrs. Hewitt discussed the failure to diagnose her cancer in 2001, and recognises that a mistake has been made. She is appreciative of the apologies that she has received from both myself and Mr. Modgill……".
On the 14th October 2004 Dr. Joffe wrote to Mrs. Hewitt's GP:-
"I was pleased to be able to tell this nice lady that her staging investigations were negative. CT showed a benign looking cyst in the liver but no areas of concern. There is still some stranding in the axilla, which is probably post-operative. Her bone scan is not yet reported but looks satisfactory to me. Her mammogram shows no changes since last year, and no sign of any new primary. Bloods tests are normal. Her tumour type is fairly aggressive, with high grade histology, negative ER/PR and positive ER2. Because of this, I have recommended that she have adjuvant chemotherapy, as well as discussing the standard FEC regime. I also discussed the evidence of switching from Anthrocycline treatment to Taxane based treatment…".
On the 18th October 2004 Mrs. Hewitt attended for her first cycle of chemotherapy.
Unfortunately, Mrs. Hewitt suffered significant side-effects of her chemotherapy regime.
Mrs. Hewitt concluded her chemotherapy, and an additional course of radiotherapy.
Allegations of Negligence
Mrs. Hewitt alleged that there was a negligent failure on the part of the Defendant to properly report the tissue taken from the wide local excision performed on the 21st November 2001 when the histopathologist in question referred to their being "no evidence of invasion". With appropriate care it was alleged that the histology would have reported an area of invasive carcinoma.
Causation
Had the histopathology been properly reported in November 2001 it was alleged that Mrs Hewitt would have undergone axillary surgery soon thereafter to level 1 or level 2. She would have had chemotherapy but not Taxane/Taxol. Mrs Hewitt would have undergone radiotherapy to the axilla and supracavicular fossa. Her chemotherapy would have been less intense and less toxic over a shorter period of time.
As a consequence of the Defendants negligence Mrs Hewitt experienced distressing side effects from her chemotherapy.
She had 4 injections Taxol each 3 weeks apart. For a period of several days following each injection Mrs Hewitt experienced considerable pain and discomfort in her legs such that she could not walk. She could sit. She had to take painkillers but these had little effect.
Mrs Hewitt was unable to perform her usual activities of daily living and furthermore was unable to perform her duties at the working mens club where she was employed. Fortunately, her colleagues were able to cover for her and she lost no earnings.
Additionally, Mrs Hewitt required assistance from friends to do her shopping for her and to take her to hospital appointments. She experienced pain and discomfort in her hands and toes. The discomfort in her toes continued. It was alleged that this was a result of Taxol, a known neurotoxic drug. Mrs. Hewitt described the discomfort as akin to receiving electrical shocks to her feet.
In addition as a result of the Defendant's negligence Mrs Hewitt had to undergo an additional course of radiotherapy.
Expert oncology evidence concluded that the delay in treating Mrs Hewitt's cancer marginally increased the risk of recurrence. However, the expert could not conclude that the risk had gone from less than 50% to in excess of 50%.
Settlement
Following service of a letter of claim, and the Claimant's causation evidence, together with a Part 36 Offer, the matter concluded with the Defendant accepting the Claimant's Part 36 Offer in the sum of £15,100.00, of which damages for pain suffering and loss of amenity were estimated at £15,000.00.
