Patient Claims Unread Pap Smears Delayed Diagnosis Of Cancer
In June 2000, plaintiff Sheryle Trainer, a 51-year-old schoolteacher, underwent an annual gynecological examination that was performed by gynecologist Dr. Claudia Ravins. A Pap smear was performed, and the sample was sent to a processing facility, Bio-Reference Laboratories Inc. Although the lab reported the Pap smear as “within normal limits,” it also reported the presence of an incomplete specimen that had “no endocervical component in a menopausal patient.” Ravins did not read the Pap smear and had a “nurse” file it. Trainer was not informed that an incomplete Pap smear had been reported, and she was not offered a repeat Pap smear.On March 17, 2001, Trainer returned to Ravins for an exam and Pap smear. Ravins performed a pelvic exam and reported normal findings. A Pap smear was performed, and the sample was sent to Bio-Reference Laboratories. The report stated, “within normal limits,” but it also stated that there was inflammation and/or infection present. Ravins did not read this report either, and it was put in Trainer’s file.
About four weeks later, Trainer hemorrhaged vaginally. She made an appointment with Ravins, and a biopsy was taken from the hemorrhaging mass. Pathology returned with a 5- by 6-centimeter mass that obliterated the cervix. Further tests revealed that Trainer was suffering stage-IIIB cervical cancer. She underwent numerous rounds of chemotherapy, internal radiation and external radiation. The cancer went into remission, but it returned in June 2002, thus resulting in a total pelvic exenteration.
Trainer sued Ravins and Bio-Reference Laboratories. Trainer alleged that Ravins failed to read the Pap smears’ results, that Ravins failed to perform proper pelvic examinations, that Bio-Reference Laboratories’ staff misread the Pap smears, and that the defendants’ failures constituted medical malpractice.
Plaintiff’s counsel noted that Ravins admitted that she did not read the Pap smear reports because they had been filed by a “nurse” who would presumably have read them.
The gynecological surgeon who performed the exenteration testified that a Pap smear dramatically decreases the need for total a pelvic exenteration because it provides an early detection of cervical cancer.
Trainer’s expert gynecologist opined that Ravins departed from the standards of good and acceptable medical practice in her pelvic exams of Trainer and that the mass should have been palpated on pelvic examination. He contended that the lack of endocervical tissue in June 2000 was significant and that further testing, such as a repeat Pap smear, was warranted. He also contended that stage-I cervical cancer was present at the time of the June 2000 exams with a mass the size of a marble.
Trainer’s expert gynecologists also opined that Ravins failed to perform proper and adequate pelvic exams in 2000 and 2001. They contended that the lab report from March 2001 required immediate investigation because inflammation is a warning sign of cervical cancer.
Trainer’s expert pathologist opined that Bio-Reference Laboratories misread the slides from 2000 and 2001. In 2000, the pathologist claimed, a high-grade intra-epithelial lesion was present but not reported to Ravins. Ravins claimed that if she was aware of this lesion, she would have ordered follow-up work.
The expert pathologist also claimed that, in 2001, invasive squamous cell carcinoma was present in the slide but not reported. Ravins claimed that had she been aware of this, she would have done further testing.
The defense’s expert gynecologist opined that Ravins’ care and treatment of Trainer was appropriate. He contended that the lab reports were within normal limits. Based on these, he claimed that no further testing was required.
Plaintiff’s counsel noted that at the close of their examination of Ravins, she admitted responsibility as to the delayed diagnosis of Trainer’s cervical cancer. However, the next day she testified differently. Ravins admitted that the endocervical cancer is where cancer originates and that inflammation is a warning sign of cervical cancer.
During the trial, Trainer and Bio-Reference Laboratories agreed to a $2.5 million settlement. The matter proceeded against Ravins.
Trainer was diagnosed with stage-IIIB cervical cancer in April 2001. The cancer was treated via chemotherapy as well as internal and external radiation. The cancer went into remission but returned a year later, in June 2002. At that time, Trainer’s only option for treatment was a total pelvic exenteration, which removed her bladder, rectum, colon, anus and vagina. She required three surgeries and now requires an ileostomy and colostomy for her urinary and bowel needs. Both bags are permanent and require hourly draining.
Trainer’s expert oncologist opined that, based on the size of the mass when it was detected in April 2001, it had to be present in June 2000 and certainly in March 2001. He contended that if the mass had been detected in June 2000, only a radical hysterectomy would have been required to treat the cancer, given that it was in an earlier stage.
Trainer sought recovery of damages for her past and future pain and suffering.
The jury found that Ravins was negligent, but Bio-Reference Laboratories was assigned 10-percent liability. The jury determined that Trainer’s damages totaled $30 million. The offset of Bio-Reference Laboratories’ liability and the addition of the $2.5 million settlement produced a net recovery of $29.5 million.
Sheryle Trainer
$15,000,000 Personal Injury: Past Pain And Suffering
$15,000,000 Personal Injury: Future Pain And Suffering
Defense counsel has moved to set aside the verdict as against the weight of the evidence and excessive as a matter of law.