Patient wins 500,000 rubles for late cancer diagnosis

The city hospital must pay half a million rubles (approximately $5,000 at current rates) to a Zlatoust resident for late-detected cervical cancer. This decision was made by the Chelyabinsk Regional Court. The patient managed to prove that she received substandard care.

«I had thrush all the time»

At the women«s clinic on Mashzavod, Tatyana had been under observation since 2009, in 2010 she was registered for pregnancy, after which she visited the gynecologist quite often.

«After childbirth, they detected cervical erosion in me, said it needed to be cauterized. So they did — after that, I started having thrush. And it recurred every six months,» she recalls. «And so throughout these years, I had thrush constantly. Every time I came to the doctor, got tests done, she said: “Everything is fine.”»

According to the patient, her gynecological health problems worsened in 2019.

«I was running to doctors because the thrush didn«t stop. They didn»t really do any tests or anything for me, they only took a cytology test in 2021. Before that, they probably took a smear once. I brought them tests from a private clinic, I was just getting everything checked. And they all said: “Everything is fine with you. Well, maybe you were stressed, maybe you took some medication.” I take “Fluconazole” as they prescribe, for a month — and it all repeats again, then every two weeks, then every week,» says Tatyana. «Then neither pills nor suppositories helped at all. In 2021, I already had sand inside, in consistency like sea sand — you can«t tell the difference. I tell the doctor about this, she twirls her finger at her temple, meaning it can»t be. Again, she prescribes the same pills, suppositories. I say that my stomach hurts a lot, she sends me to a neurologist.»

At an appointment in February 2021, Tatyana had a cytology test done; such a smear is usually taken from women to detect cervical diseases and precancerous conditions. According to the patient, she was not scheduled for a follow-up appointment to learn the result, they told her to just come and ask, and the answer was, as before: «Everything is fine». After that, the patient came with complaints two more times in July, but no one told her that the cytology from February had come back poor.

«Why did you delay so much?»

In the spring of the following year, Tatyana scheduled a paid ultrasound, and there the doctor suspected something was wrong and advised her to urgently go to a private clinic in Chelyabinsk.

«I went there, they ordered tests for me, did a colposcopy, and diagnosed “cervical cancer”, wrote a referral to the regional oncology clinic. Moreover, the doctors immediately said that I needed to resolve the issue with surgery quickly because time was not on my side. I borrowed money, rushed to undergo all the examinations, I did everything in literally two weeks,» she recalls. «At the cancer center, when they removed all my female organs, all the adjacent lymph nodes, the surgeon said: “A little more, and you wouldn«t have lived until the surgery.”»

The surgery took place in July 2022, oncologists diagnosed Tatyana with stage three cancer because there were already metastases in the lymph nodes. After the surgery, they prescribed chemo- and radiotherapy.

«When I went through all these circles of hell, my radiation therapy ended, I needed to see a gynecologist to check the burns and how to treat them. My dad brought me to our women«s clinic to our “magical” gynecologists. I could barely move at that time. I came to my gynecologist, she didn»t want to see me, then she grabbed my chart and said: “Why do you have such a stage? You had a poor cytology back in 2021, why did you delay so much?” I almost fell off my chair,» Tatyana is indignant. «I say: “What do you mean in 2021? I was here several times.” She says: “I don«t know why [she named another doctor»s surname] didn«t tell you.” I say: “But I had it done with you! You sent me for cytology.”»

Insurance Company«s Conclusion

After that, the patient photographed her medical record and wrote a complaint to the insurance company. They conducted an inspection and identified violations.

«During the provision of medical care from July 12 to 30, 2021, defects in examination were identified that created a risk of disease progression: with the presence of cytology results LSIL (low-grade squamous intraepithelial lesion), there was no referral for HPV (human papillomavirus) testing, colposcopy,» states the conclusion of the insurance company “Sogaz-Med”.

Lawyer from the advocacy college “Kairos” Yevgenia Rudova believes that the doctors violated clinical guidelines and therefore did not detect the cancer in time:

«The last cytology was done for her in 2021, and the test was poor, there were atypical cells, and the doctors should have shown oncological vigilance, but they did not do that. The result was filed in the chart, the patient was not informed that her test was poor. At the appointment, they prescribed some suppositories, it helped for a while, then everything started again, the inflammatory process continued. She applies again in July, they again don«t properly prescribe treatment for her. And most importantly, they don»t prescribe colposcopy and HPV typing — these are mandatory examinations according to clinical guidelines, because some strains of the human papillomavirus are oncogenic and cause cancer.»

500,000 rubles — for health

Tatyana decided to appeal to the Zlatoust City Court and seek compensation for moral damages from the hospital — 5.6 million rubles (approximately $56,000 at current rates), exactly how much she valued her suffering and the suffering of her teenage son, who during his mother«s treatment was forced to live with his grandmother and grandfather.

«The child asked: “Mom, are you going to die?”, he cried constantly,» recalls Tatyana — «My life collapsed: I underwent a very difficult surgery, went through all circles of hell that could have been avoided. I am only 38 years old, and at such a young age I completely lost my intimate life, I can no longer give birth, and I wanted more children. Now I feel like an incomplete woman, and this is for the rest of my life.»

The doctors in court said that Tatyana herself did not come for the follow-up appointment after the cytology test, although the patient insists that she came, even without an appointment. The judge did not accept this argument because there is no documentary confirmation.

To understand the case, an examination was appointed at the “Privolzhsko-Uralskoye Bureau of Forensic Medical Examination”, according to its results, an indirect cause-and-effect relationship between the defects in care provision and the disease was established. The experts noted that the patient needed additional examination. But the hospital did not agree with such conclusions and demanded a repeat examination, which was carried out at the “Bureau of Forensic Medical Examination of the Ministry of Health of the Republic of Tatarstan”. There, the experts also noted that the patient was not given mandatory examinations, but did not see a cause-and-effect relationship between the identified shortcomings and the development of cancer, they believed that the woman had chronic diseases, did not follow the schedule of repeat visits to the gynecologist, which led to the progression of the inflammatory process and its transition to a malignant formation.

The patient, by the way, insisted in court that her chart at the women«s clinic was rewritten and the examinations were conducted based on forged documents (the initial version, let»s recall, she photographed), but the court considered that there is no evidence of changes made to the medical record.

The Zlatoust court and the prosecutor sided with the hospital.

«The court considered that the second examination is more complete and reliable, and denied the patient in everything. We appealed this decision,» says Yevgenia Rudova. «We asked the regional court for an additional questioning of the expert, posed additional clarifying questions. Naturally, no expert will speak against their own, but we found an order from the Ministry of Health, clinical guidelines that clearly state that there should be prevention, that is, the main goal of a doctor«s work is prevention and early detection of oncological diseases, and the doctor did not pay attention to the poor test.»

At the end of October, the regional court agreed with the lawyer«s arguments and partially overturned the first decision, ordered to recover from the Zlatoust hospital in favor of the patient 500,000 rubles (approximately $5,000 at current rates). At that, Tatyana believes: «Money is not the main thing», it is important that doctors pay more attention to their patients, because not only health but also lives depend on them.

All about cancer and prevention of oncological diseases — in the special project of 74.RU “Oncolikbez”.