Penningtons Manches has settled a claim against a former GP for a delayed diagnosis of kidney cancer which led to a client’s death.
The client was diagnosed with metastatic renal cell cancer in May 2011. By that stage, his cancer had spread to the organs surrounding his kidneys, jaw and lungs. The diagnosis was terminal and the only treatment available was palliative to try to extend his life for as long as possible. He underwent surgery to his abdomen and jaw and began a daily chemotherapy regime. As time went on, the cancer spread to his brain and leg. Although the client survived for almost five years, he died several months before his claim was concluded. The claim was conducted by his wife on behalf of his estate and on her own behalf for her loss of dependency upon him.
When Penningtons Manches was first instructed, the client was concerned that his GP had not taken appropriate steps to investigate a growing lump on his jaw in the year before he was diagnosed with cancer. When he was eventually diagnosed with cancer in 2011, he discovered that this jaw mass was a metastasis from his kidney cancer.
During the investigation of the case, it transpired that several years before the jaw mass formed, the client’s routine blood tests done for the purposes of routine hypertension monitoring showed evidence that something was wrong. Penningtons Manches obtained evidence from a GP expert which found that the client’s GP was negligent for failing to refer him to a hospital physician for further investigations into raised alkaline phosphatase levels in his blood from as early as 2008. There were repeated failures in 2009 and 2010 to recognise and act upon the abnormality. Alkaline phosphatase is most commonly raised where there is a bony malignancy or a problem with the liver.
Evidence was obtained from an expert physician that, if our client had been referred, investigations would have taken place which would have led to a diagnosis of kidney cancer.
Expert evidence from a urological surgeon and an oncologist concluded that the raised alkaline phosphatase levels from 2008 were caused by a liver condition called Stauffer Syndrome, itself caused by the presence of the primary kidney cancer. The levels were not caused by the jaw metastasis at that time. This meant that, on the balance of probabilities, our client’s kidney cancer had not spread in 2008. Had he been diagnosed then, the cancer would have been confined to the kidneys which would have meant that surgery would have removed the cancer before it spread and he would have survived. He would have avoided the need for chemotherapy and radiotherapy treatment, and the various surgeries he required on his metastases would have been avoided.
The defendant GP admitted that there was a breach of duty for failing to act upon the abdominal blood results. However, he disputed that referral to a physician would have resulted in an earlier diagnosis of the kidney cancer. He also disputed that an earlier diagnosis would have made a material difference to our client’s outcome, arguing that the cancer had already started to spread in 2008.
Penningtons Manches issued court proceedings in the High Court. The claim continued to be defended on the grounds of causation but then settled following the exchange of expert evidence on causation, when the defendant accepted a Part 36 offer made by the claimant.