Two years in the dark: From 2017 to 2019, doctor ignored tests that pointed to stage 4 cancer

A Manitoba doctor who failed to assess a patient's stage 4 cancer and send her for oncology care–despite tests that indicated her cancer had returned–has been censured and ordered to pay $4,680 in college costs. Dr. Berhanu Balcha, a family doctor in Winnipeg, failed to respond to progressing abnormalities at multiple points over a two-year period, according to the College of Physicians and Surgeons of Manitoba. He also did not refer the patient—who has a history of invasive ductal breast cancer—for yearly mammograms as recommended by her oncologist as far back as 2015. At the same time, noted the college, the patient’s records were not documented in a “legible and cohesive manner that would ensure appropriate follow-up.” “Dr. Balcha’s conduct is unacceptable and represents a significant breach of professional standards and reflects very poor judgment,” wrote the college in its notice of censure. The 72-year-old patient was first diagnosed with invasive ductal breast cancer in 2008 and underwent a treatment regiment of radiation, chemotherapy and surgery. Her adjuvant therapy concluded in 2013. Read: Misdiagnosed emergency: Doctor's appeal is denied in the case of teen patient who lost his only testicle In late 2016, according to the college, the patient complained to Dr. Balcha about numbness to the right side of her face and right shoulder. Her patient record does not document any assessment of this complaint. The patient returned in April of 2017 complaining of the same numbness. Dr. Balcha referred her to a neurologist, who sent her for an MRI and a CT/angiogram. The latter revealed incidental pulmonary nodules and enlarged right supraclavicular lymph nodes. A dedicated CT of the thorax was recommended for further assessment. In July 2017 the neurologist conveyed these concerns by fax to Dr. Balcha and requested that he be involved in further investigating and managing these concerns. The neurologist noted that the nodules were probably related to the patient’s history of breast cancer. Dr. Balcha saw the patient that same month and noted “lung nodule—may need CT” in her medical record but made no referral for a CT scan. He made that referral two months later when the patient came back for a follow-up visit. A CT scan was done on Oct. 2, 2017 and the results were sent to Dr. Balcha the following day. Read: 'Unfit to practise': Doctor's many offences included turning away an elderly patient who collapsed outside But when the patient returned for an appointment in December 2017, Dr. Balcha noted that the CT scan report was not available. There was no indication of any attempt to follow up on the records. In February 2018—almost four-and-a-half months after the CT scan was completed and more than 16 months after the patient first complained of numbness to parts of her face and body—Dr. Balcha reviewed the CT scan report and noted that there were “mets to bones.” He ordered an abdomen/pelvic CT but did not make an oncology referral. After the scan was completed in March 2018—indicating worsening osseous metastatic disease, thickening of the stomach and pulmonary nodules—Dr. Balcha referred the patient to a gastroenterologist. In August 2018, the patient saw Dr. Balcha, who noted at the time that she was experiencing musculoskeletal pain potentially secondary to breast cancer metastases. He gave her Tylenol 3 and a note to be off work but still did not refer her to CancerCare Manitoba. The patient visited Dr. Balcha three more times from March 2019 and August 2019 complaining of shortness of breath and, in the latter visit, also of a lump behind her left ear. Read: Flat denial: When a doctor flouts a patient's wish to forego post-mastectomy breast reconstruction An x-ray done in October 2019 showed progressive metastatic disease with progressive pleural effusion and nodules. Dr. Balcha signed off on the x-ray report but did nothing to follow up, according to the college. In November 2019, a respirologist who did a pleural tap confirmed the presence of cancer and referred the patient to CancerCare Manitoba, which confirmed in January 2020 that the patient had stage 4 metastatic breast cancer. During the college investigation, the patient’s oncologist—who had retired in June 2015 and recommended at the time that Dr. Balcha send the patient for annual mammograms going forward—reviewed the tests and scans done in 2017 and confirmed they were indicative of the return of stage 4 cancer. Yet the patient told the college she was unaware there were concerns about a recurrence or spread of her cancer until she met with the respirologist in November 2019. Read: How breast reconstruction can negatively impact limb functionality: study

Two years in the dark: From 2017 to 2019, doctor ignored tests that pointed to stage 4 cancer

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