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Former patient sues clinic, doctor, says rushed exam missed colon cancer

Mar 12, 2008 | Marshall Allen | Las Vegas Sun News

Kevin Rexford's main concern isn't whether he left the Endoscopy Center of Southern Nevada with hepatitis. Rexford says he left the center with cancer.

The 46-year-old Las Vegas pharmacist filed a lawsuit in January 2007 against the center and Dr. Clifford Carrol, one of its owners. Rexford claims Carrol failed to recognize clear signs of colon cancer three years ago because he rushed through a colonoscopy in half the minimum recommended time.

The alleged failure allowed the cancer to metastasize to his liver and abdominal wall, medical experts claim on his behalf in court filings.

If the cancer had been caught at the time, Rexford would have had better than an 80 percent chance of survival, his experts argue. Now, doctors give him less than a one in 10 chance of living five years.

The lawsuit raises the possibility that problems at the clinic reached deeper than dangerous injection practices by clinic employees that might have exposed 40,000 patients to hepatitis B or C, or to HIV. The lawsuit questions the quality of medical care by the doctors themselves.

Medical experts say failure to find the cancer resulted from one of many flawed practices at the clinic, which is majority-owned by Dr. Dipak Desai, one of the state's most powerful and politically connected physicians.

The clinic committed three fundamental errors in the case, said Dr. Russell D. Yang, a gastroenterologist and associate professor at the Keck School of Medicine at the University of Southern California who is working on Rexford's behalf: failure to identify the signs of colon cancer, technical failure in performing the endoscopy, and institutional failures in quality assurance.

Documents in the case include a report by an anesthesiologist who said the clinic was grossly overbilling insurance companies and Medicare and Medicaid, the government's insurance programs. This information might be interesting to the federal and state authorities who are now investigating possible fraud at the clinic.

Neither Carrol nor his attorney, Sherman Mayor, returned the Sun's calls for comment. But Mayor wrote in court documents that there is no evidence of negligence on Carrol's part. The cancer was caused by factors outside Carrol's control, and the doctor used reasonable care and diligence in treating Rexford, the defense attorney said.

Rexford has a wife and two children, ages 11 and 12. Las Vegas cancer specialist Dr. Arnold Wax, who is now Rexford's doctor and was hired by the plaintiff to examine his medical records, says Rexford showed signs of colon cancer when, on Dec. 6, 2004, he went to the Gastroenterology Center of Nevada, which was founded by Desai.

Wax said Rexford had constipation, abdominal pain, fatigue and hidden blood in his stool, all signs of possible colon cancer.

Wax wrote that the physician assistant who saw Rexford that day did not determine how long he had suffered the abdominal pain. His records said he had no family history of colon cancer, although his grandfather had actually died of the disease, Wax wrote. The physician assistant did not do a rectal exam or test to determine whether Rexford had been bleeding, Wax said.

Two months later, on Jan. 28, 2005, Carrol performed the colonoscopy at the Endoscopy Center of Southern Nevada.

Yang, the university gastroenterologist, noted that Carrol said in his deposition that he could perform 30 to 33 procedures a day, and once set a record at 50.

"With the undue pressure to perform these many procedures by an individual physician in a single day, patients are unnecessarily exposed to procedural risks including missed diagnosis," Yang wrote.

Medical records show that the Rexford colonoscopy lasted eight minutes. Given that the anesthetic took two to three minutes to take effect and that Carrol testified he needed three minutes to advance the scope into the body, he had only three minutes at most to examine 6 to 8 feet of colon, which is done as the scope is withdrawn, Yang said.

Published research shows it takes six to eight minutes to perform an adequate exam, Yang said. Thus, a three-minute exam is half the minimum standard and means the "risk of missing a lesion is unacceptably high and falls below the standard of care," Yang wrote.

Yang said the "pattern of carelessness" continued in Rexford's four follow-up visits, when he was seen by three different individuals. Rexford "fell through the cracks in a practice geared toward seeing a large volume of patients without continuity of care." Rexford was given no plan of action, so he did not have a repeated blood count or stool test for blood, which could have provided other indications of cancer, Yang said. And there appears to be "no coordination or discussion concerning a young male with classic symptoms of colon cancer," Yang wrote.

"Kevin represents a series of failures by Dr. Carrol which resulted in a colon cancer which has progressed to an incurable stage," Yang said.

Finally, Yang said clinics he is familiar with have quality assurance programs that include peer review to ensure doctors follow guidelines for performing procedures. But both Carrol and Desai, who was medical director of the clinic, said in their depositions that no peer review program existed at the clinic, Yang said.

The court record also includes a report by Las Vegas anesthesiologist Dr. Joseph Schifini, who reviewed the Endoscopy Center's anesthesia records. They showed that certified nurse anesthetist Ronald Lakeman documented 31 minutes of anesthesia time. Schifini said that was highly unlikely for an eight-minute exam, noting that the record shows Lakeman was monitoring Rexford 25 minutes after the intravenous catheter was removed by a recovery nurse.

The 31 minutes is significant because anesthesia is billed to insurance companies in 15-minute increments, Schifini said, allowing the Endoscopy Center to bill for three 15-minute time frames because of the extra minute. This also meshes with what a nurse who worked at the clinic told the Sun. She said every procedure was billed for at least 30 minutes of anesthetic.