On July 15, 2003, plaintiff Courtney Hill, 23, a teacher, called her OB/GYN, Claudia Moise, of OB/GYN Specialists P.C., in Memphis., and reported to the receptionist that she had found a lump in her breast that had “possible dimpling” and asked whether she should come in immediately. The nurse relayed the message in writing to Moise with a question to the doctor of whether the patient should have a mammogram. Moise informed her nurse to tell Hill that she did not need to come in immediately and to tell Hill to wait until her scheduled appointment on Aug. 1. Moise also advised the nurse that an ultrasound may be needed.
Hill alleged that Moise, while performing a gynecological procedure at the Aug. 1 appointment, had to be reminded to examine the lump before the patient left. Moise examined the breast and classified the lump as a cyst or fatty deposit, and said it was “nothing to worry about.” According to Hill, Moise didn’t document her findings in the medical record, and didn’t document any reminders to herself to further evaluate the lump at a later date.
Hill subsequently became pregnant, which eventually masked the lump, and saw Moise on 16 occasions during her pregnancy and did not further evaluate or test the lump. (The November 2004 pregnancy had no complications.)
In January 2005, Hill, noticing that the lump was larger and more painful postnatal, contacted Moise’s office but could not be seen by the physician; her partner saw Hill on Feb. 14 and examined her breasts and found a suspicious mass and immediately ordered a mamogram and ultrasound, which detected the cancerous mass.
On Feb. 14, 2005, Hill was diagnosed with Stage IV cancer in her left breast after an ultrasound and mammogram detected a 4-centimeter mass, which was confirmed cancerous by a subsequent biopsy. That same week PET and CT scans and another biopsy showed that the breast cancer had mestatasized to Hill’s liver and lungs.
Hill sued Moise and her practice for medical malpractice, alleging delayed diagnosis. The plaintiff’s OB/GYN expert testified that the standard of care required Moise to send Hill for diagnostic imaging testing (mammogram or ultrasound, most likely ultrasound in Hill’s case given her age of 23). Plaintiff’s counsel argued that even if the doctor didn’t palpate a lump in Hill’s breast on Aug. 1, Hill was certain that she did. Therefore the standard required that she be sent for diagnostic imaging studies. Both of these standards — the doctor feels a lump or the patient is certain she feels a lump in the absence of doctor feeling a lump — are set forth in publications by ACOG (American College of Obstetricians and Gynecologists
Moise denied the allegations, claiming that she complied with acceptable standards of medical care through her evaluation of the breast by palpation on two separate occasions (Aug. 1, 2003, and February 2004), finding normal fibrocystic tissue. Defense counsel argued that whatever lump Hill complained of in July 2003 was not the same lump found by Moise’s partner in 2005, and that an ultrasound was not required since Hill’s breast did not contain a dominant persistent mass.
The defense experts testified that Moise met the standard of practice; that there was no 18-month delay in diagnosis; and that even if the lump Hill had complained of in 2003 was in fact cancer, it had already metastasized to her liver in July 2003, which made Moise not responsible for Hills’ tragic situation. Further, given how Hill described the lump — that it had been there in July 2003 but had disappeared while pregnant — is in consistent with cancer growth, which shrinks and swells.
The defense pathologist expert, through examination of Hill’s pathology slides, concluded that her cancer was an aggressive, rare grade three “infiltrating ductal carcinoma” that developed around the time Hill noticed the postnatal change in her breast, which was after her last visit with Moise. The pathologist further opined that the lump Hill discovered in July 2003 was not cancer.
Plaintiffs’ counsel contended that during the February 2004 visit, which was Hill’s first prenatal exam with Moise, the defendant had a checklist of 13 items (including breasts) that were all drawn with a line through them, which indicated, according to Moise, that she examined each item on the list. However, Hill claimed that the OB/GYN did not examine or address Hill’s breasts at this exam.
Hill immediately started chemotherapy (approximately 60 rounds that ended just prior to trial) coupled with radiation treatment which was followed by a lumpectomy and then a hysterectomy (since the plaintiff suffered estrogen-positive type cancer). She was later diagnosed with Stage IV liver, lung and bone cancer.
The plaintiff’s oncology expert opined that the lump reported in July 2003 was most likely Stage I cancer with a 95 percent cure rate which progressed to Stage IV cancer by the time of diagnosis in February of 2005 and which was then incurable.
The plaintiffs sought only economic damages — past and future pain and suffering, emotional distress and loss of consortium.
Hill, who was not able to attend the trial due to her deteriorating health and has an estimated six months to live, talked about life before cancer, including how she and her husband began dating in high school and were married one week after she graduated from college; her faith in God, which was a source of strength throughout her battle with cancer; and the legacy she wanted to leave behind for her daughter. She was in the process of creating a scrapbook to preserve her memories.
The plaintiff’s husband testified about how he was present for every examination with his wife, and talked about how he contemplates life without his wife and forced to raise their 4-year-old daughter by himself.
The couple also cited the support within their church congregation which wore pink hats to church one Sunday as a sign of support of the Hills.
The jury found that Moise, as an employee of OB/GYN Specialists, acted with less than or failed to act with ordinary and reasonable care in accordance with the recognized standard of acceptable professional practice for her profession in her treatment of Hill, and that these acts were a legal cause of the injuries to the plaintiff. The plaintiffs were awarded $23.6 million.
Defense counsel filed motions for a new trial and to set aside the verdict or, in the alternative, reduce the verdict.