Is this doctor to blame for his brother's death?

Joseph LaBricciosa's sister-in-law thought so, and sued him for malpractice. But what would you have done in his place?

By Neil Chesanow

Joseph LaBricciosa, an FP in the Philadelphia area, has lived through a nightmare. First, he lost his brother, Robert, to colorectal cancer. He then was sued by Rob's widow for medical negligence. A jury not only found for the plaintiff—it awarded her a staggering $8.25 million.

On Dec. 23, 1993, Rob, then a 32-year-old CPA, visited Joe in his office. Six months earlier, Rob had begun experiencing intermittent rectal bleeding and constipation and had noted "maroonish" blood on the toilet paper. He said he hadn't lost any weight.

The LaBricciosa family had a history of hemorrhoids, but no other rectal problems. Even though Rob had been Joe's patient for four years, he squeamishly refused to submit to a digital exam. Joe finally coaxed him into it—and detected an internal hemorrhoid. A stool guaiac test was positive. Joe wanted to perform an anoscopic exam to confirm the hemorrhoid, but when Rob saw the device he exclaimed, "You're not going near me with that!"

Joe didn't press the issue. Instead, he prescribed Proctofoam and hydrocortisone cream and asked Rob to schedule a follow-up visit for re-evaluation in three to four weeks.

Rob never made the appointment. However, the brothers subsequently saw each other two or three times a month at various family functions, and Rob made no mention of further bleeding. Nor did Joe ask. Eight months later, in August 1994, Rob returned to Joe's office for a minor upper respiratory tract infection. Neither brother mentioned rectal bleeding then, either.

In September—nine months after the initial visit—Rob was back. He now told Joe that he had been constipated for months, and his stool was thin and ribbon-like. Alarmed, Joe insisted on performing an anoscopic exam. It showed inflamed mucous membranes in the rectum, but fecal debris obscured anything else. Joe then accompanied Rob to a gastroenterologist for a flexible sigmoidoscopy. The diagnosis: adenocarcinoma of the rectum. A chest X-ray also revealed metastatic pulmonary lesions.

Rob immediately underwent an exploratory laparotomy, which showed a large, bulky tumor occupying the rectosigmoid colon behind the bladder. The tumor was fused to the pelvic wall. Radiation therapy, chemotherapy, and resection of the sigmoid colon and rectum were all tried. But in January 1996, just over two years after first mentioning the rectal bleeding to his brother, Rob died. He left a wife, a 5-year-old daughter with cerebral palsy, and an infant son.