A $49 Million Verdict Exposes Medicine’s Deadly Complacency -By Fransiscus Nanga Roka

Over on the obstetric-gynecological side of American medicine, it appears a Stamford, Conn., jury just slapped a $49 million rebuke to that hang-wringing and the rest of the world’s obstetric-gynecological community should take note. The judgment was rendered to Jennifer Anderson of Darien after a five-week jury trial with Judge Yamini Menon and it is much more than an award for damages. It is an indictment of routine, systemic negligence masquerading as “standard care.”

The sequences seem less a voyeuristic thrill than an industrial disaster in slow motion. Anderson was a conscientious and compliant patient of Westmed Medical Group Dr. Dzwinka Carroll between 2013 through 2019. Each year, her Pap smears and HPV screenings were positive for high-risk strains including HPV 16, the single most-carcinogenic type of virus linked with cervical cancer. This was not a gray area or near-but-not-quite result needing an adjudication of sorts. A textbook trigger: high-risk HPV is positive / persistent = colposcopy referral. That referral never happened.

When abnormal bleeding finally prompted action in 2019, doctors discovered that Anderson had already developed invasive squamous cell carcinoma that had metastasized to his chest, abdomen and pelvis and which was classified as terminal. During the three hours of jury deliberations, they decided that Westmed was negligent and delivered an award of $38 million for pain and suffering, an additional $1 million in economic damages, and $10 million to her husband Daniel for loss of consortium. Westmed has denounced the amount as “unjust” while expressing pity for the family, a position that in itself uncovers an ill-disposed environment of law-battling over reckoning between organizations and sympathetic families.

This case is such a damning one because it is so unremarkable. Cervical cancer is in the top tier of preventable cancers known to medicine exactly because there are guidelines for HPV screening and colposcopy. This wasn’t a diagnostic conundrum; it was a misadventure in form filling, and the checklist had been disregarded six times. The fact that such a blunder could go on for six years in an operational lab without detection by any internal audit points to a structural oversight: labs create risk detail, however none of the momentum within an institution requires that clinicians receive and act on it.

This cannot be spun by the world’s OB-GYN elite into a stand-alone American tort tale. Several strategic reforms are overdue. To begin, mandatory automatic flagging systems should have the capacity to hard stop in electronic health records (EHR) each time a patient logs two or more consecutive high-risk HPV results without documentation of a colposcopy referral removing oversight from a decision that was never meant to be discretionary. Second, professional bodies, FIGO, ACOG and their international partners should create audit trails mandating that every clinic undergo periodic third-party audits of screening to referral conversion rates rather than relying on voluntary self-reporting. Third, informed-consent models have to change so that patients receive direct notification regarding positive high-risk HPV results in language they can understand (not what a physician writes down and hopes will be followed) putting patients on the front lines of the battle against clinical drift. Fourth, malpractice insurers and regulators should link premium structures and the renewal of licenses to veri-fication of adherence to screening protocols, thereby transforming negligence from the passive liability it is today into a risk that can be priced proactively.

But Jennifer Anderson’s tragedy is a warning flare, not an exception. Each unattended lab, of each type, everyplace is a ticking time bomb. It is now up to the medical profession either to regard this verdict as an expensive oddity or pay attention, because it is evidently a wake up call.

Fransiscus Nanga Roka

Faculty of Law University 17 August 1945 Surabaya and  Managing Partner Law Firm Victorious Indonesia