Malpractice Case Witness Says Doctors Missed Signs : Trial: Jury is told the female patient had telltale symptoms of colon cancer. The landmark suit focuses on HMO payment policies.

Two Simi Valley doctors “dropped the baton” when they failed to diagnose colon cancer in a 35-year-old female patient who complained of stomach pain and other telltale signs of the disease, a longtime Camarillo physician told a Ventura County jury Wednesday during a groundbreaking medical malpractice trial.

Dr. Richard Loft of Camarillo, an initial witness in the trial, told the jury that physicians Elvin Gaines and Dan Engeberg neglected to notice several obvious symptoms of colon cancer when Joyce Ching visited their Simi Valley Family Practice medical offices in the summer of 1992.

Her husband David Ching, 38, and his 5-year-old son Justin are suing Gaines and Engeberg, alleging medical malpractice for the death of Joyce Ching. The family contends that had Ching’s cancer been diagnosed sooner, she would have had a greater chance of survival.

The case, being heard in Ventura County Superior Court, is considered a landmark lawsuit because the Ching family is challenging the restrictive payment policies that health maintenance organizations have with their member doctors. It is the first known case that challenges the HMO system of capitation, which generally pays a flat rate for patient care and rewards primary care physicians for cutting down on expensive treatments and referrals.

The lawsuit contends that the two Simi Valley doctors delayed sending Ching to a medical specialist for 11 weeks because they feared a loss of profits. The Chings’ attorney, Mark Hiepler, also alleges that the two doctors are guilty of professional negligence in their poor treatment of Joyce Ching.

Loft, a paid expert witness called by Hiepler, told the jury Wednesday that he believed the two doctors failed on several fronts during three months of treating Ching in 1992. “I felt there were areas where the standard [of care] was not met,” Loft said. He said the doctors either ignored or failed to see several “red flags [of cancer] hanging on the post.”

Loft said rectal bleeding, a palpable lump in the colon and Ching’s family history all pointed to cancer. Joyce Ching’s father died of stomach cancer at the age of 36. Loft said the doctors erred when they failed to put cancer at the top of their diagnosis list. Instead, they considered other, more benign problems first.

“It’s cancer until it’s not,” Loft told the jury of eight men and four women.

But under cross-examination by defense attorney Michael Gonzalez, Loft conceded that Ching’s initial description of her ailments could have been symptomatic of several other diseases and infections, including intestinal parasites and ulcers.

Loft acknowledged that even the medical specialist Ching ultimately consulted was surprised to discover she had cancer. Her age and the other possible diseases made cancer unlikely, Loft agreed with Gonzalez.

“Common things happen commonly and uncommon things happen uncommonly,” Gonzalez said, quoting a popular medical adage.

But Loft continued to repeat his central theme: “You always have to assume the worse case scenario” and first rule out the most serious illness when patients complain of nagging, undefined pains and discomfort. The two doctors in his opinion, Loft said, failed to do that.

“It would have changed the course of the whole illness,” he said.

Loft, who has run a family practice in Camarillo since 1965, was the only witness called Wednesday and his testimony lasted the entire day. Loft did not address the plaintiff’s allegation that HMOs’ restrictive payment system is partly responsible for Ching’s death.

The two doctors Wednesday also broke their long silence on the case and released a statement, which was prepared by a public relations firm they hired after a negative story about HMOs aired on national television Sunday night that featured the Ventura County case.

In the short statement, the doctors proclaimed their innocence and said that they will not comment on the HMO aspect of the case because “we are not employed by an HMO and cannot speak to the larger issue of managed care.”

The two doctors are not HMO employees but were paid to treat Ching, who was insured by Metropolitan Life’s health maintenance organization, which is not named in the lawsuit.