Clarksville couple awarded $5.2M after diagnosis errors

CLARKSVILLE, Tenn. – A Clarksville couple was awarded more than $5.2 million in federal court Wednesday after a United States district judge found that Blanchfield Army Community Hospital should have diagnosed the wife's breast cancer almost two years before it was eventually found.

According to court documents filed in the U.S. District Court in Nashville, Roben Carter, 40, has suffered physically and emotionally because a malignant lump in her breast was not properly diagnosed in June 2008, when it would have been considered a Stage 1 cancer. By the time it was diagnosed in April 2010, it was a Stage 3 cancer that is likely to return and could kill her within years.

The order was handed down by U.S. Dist. Judge Kevin Sharp on Wednesday, following a bench trial in December.

"The failures in timely detecting Mrs. Carter's breast cancer were widespread," Sharp wrote in his findings. "They included failures in communication among medial providers and between those providers and Mrs. Carter; poor or improper record keeping and retention; failure to follow-up; and at least one unexplained cancellation of a medical order."

Roben and Timothy Carter sued the United States of America, seeking more than $30 million.

Lumps found in 2008

According to the lawsuit, Roben Carter saw a nurse practitioner at BACH's Blue Clinic on June 27, 2008, after finding two lumps in her breasts.

Mammograms and ultrasound tests were performed on July 22, 2008, and later read by a radiologist. Two days after the screening, Lt. Col. Kathleen Rowe, Chief of Mammography Services at BACH, wrote a letter to Roben Carter "indicating that the mammogram and ultrasound appeared to be benign, but because there was a palpable lump, it was recommended that Mrs. Carter contact her primary care provider for a referral to the General Surgery Clinic."

"Mrs. Carter did not receive this letter and the letter appears to have been placed in her mammography file and not in her treatment files," Sharp wrote.

"After hearing nothing of the mammography, Roben Carter called BACH at the beginning of November 2008 and went to see a nurse practitioner who examined her and ordered bilateral diagnostic mammography and ultrasound," Sharp wrote. "For unclear reasons, those orders were canceled or revised such that no mammography was done and only an ultrasound was done on the left breast on Jan. 20, 2009.

A radiologist interpreted the lump in the left breast as benign.

There was no follow-up to the January 2009 ultrasound by the nurse practitioner, but Carter continued to monitor her right breast.

Biopsy recommended in 2010

In March 2010, Carter returned to the Blue Clinic and after another suspicious mammogram, a biopsy was recommended, which revealed cancer in her right breast.

She then decided to go to Vanderbilt University Medical Center for further care.

Her oncologist, Dr. Vandana Abramson, testified that when she first saw Carter the lump in her right breast "was a very, very large mass, especially for somebody who is small," and was 5-7 centimeters in size. It was clinically sized as being Stage 3 cancer and was "triple negative," which means it was considered the most aggressive type of breast cancer.

Carter underwent chemotherapy, a double mastectomy and removal of 21 lymph nodes, along with breast reconstruction surgery, which required grafts from her inner thighs.

60 percent likelihood cancer will recur within seven years

Abramson testified that she believes there is a 60 percent likelihood Carter's cancer will recur within five to seven years and that, if it does, it will almost certainly be fatal.

"Dr. Abramson also opined that when Mrs. Carter was seen in July 2008 and January 2009 at BACH, it was likely that the cancer was Stage 1 and had not metastasized," Sharp wrote. "Further, the treatment would have been far less aggressive."

In 2008, the cancer was probably only 1 centimeter in size.

Sharp wrote that the failure of BACH providers to timely diagnose Carter's cancer allowed it to grow from a likely curable Stage 1 cancer to a Stage 3 status that metastasized to the lymph nodes and increased the likelihood of a recurrence that would be fatal.

$5.2 million in damages awarded

Sharp ordered that Roben and Timothy Carter be awarded $5,233,590 for various tangible and intangible losses related to the hospital's diagnosis errors.

Roben Carter was 40 years old and the couple had been married for 15 years when the trial was held in December. Their children were 10 and 14 years old.

BACH spokeswoman Laura Boyd declined to comment on the case Wednesday and referred questions to the U.S. Attorney's Office in Nashville.

The Carters were represented by Clarksville attorney Pete Olson.

The action was brought under the Federal Tort Claims Act, claiming the Fort Campbell Army Installation was negligent in failing to timely diagnose the breast cancer. The government "while unable to concede liability, did not contest the point," according to court documents.

Its experts testified mostly about financial matters and future medical expenses relating to a possible judgment.

Read the original story on the (Clarksville) Leaf-Chronicle site.