Case Study: Would a Timely Diagnosis have Prolonged a Patient's Life?

A 37-year-old patient sought help for what seemed like routine abdominal pain—only to later learn he had an aggressive, nearly untreatable cancer. Would earlier intervention have saved him?

Posted in ND Insights on Tuesday, April 22, 2025

In June 2011, 37-year-old Travis Criswell visited Archer Family Health Clinic for a number of symptoms he believed were associated with Crohn’s disease, including persistent pain in the right quadrant of his abdominals, weight loss, and having to walk in a hunched-over posture due to pain.

Initial Visit

During his initial visit at Archer Family Health Clinic, Joel Stuart, ND, conducted a thorough physical examination and patient history. Mr. Criswell and his mother filled out an extensive new patient questionnaire and did not identify any family history of colon cancer. He also denied bowel changes, diarrhea or darkness or blood in the stool.

Based on the patient’s history and presenting symptoms, Dr. Stuart prescribed naturopathic supplements and initiated a regimen of supportive care. At that time, Dr. Stuart was able to rule out an acute abdomen and no further invasive diagnostic procedures were pursued, as Mr. Criswell’s clinical presentation did not suggest an immediate life-threatening condition.

July-November 2011

Mr. Criswell returned to the clinic on several occasions over the following months. During these visits, further diagnostic testing was performed, including allergy tests—which revealed a high reactivity to wheat—and a comprehensive digestive stool analysis. Despite these evaluations, the diagnostic studies did not raise suspicion for colon or appendiceal cancer; notably, no occult blood was detected, and the patient’s symptoms appeared to be responding, at least temporarily, to the prescribed treatments. In August, Mr. Criswell reported that all symptoms were improving daily—until another flare-up reported on September 26.

Dr. Stuart prescribed an antibiotic and charted that Mr. Criswell would need an abdominal CT scan with contrast if the medication didn’t seem to be working. He recommended that Mr. Criswell return for a follow-up appointment in one month. Mr. Criswell waited more than two months, but when he did return, his condition seemed to be improved. Dr. Stuart wrote in his records, “Travis is gradually getting better! Right lower quadrant abdominal discomfort comes and goes but is no longer severe.” He recommended Mr. Criswell return in three months, which was not heeded.

April 2012

By April 2012, Mr. Criswell’s condition had deteriorated, prompting a trip to the emergency room with complaints of generalized abdominal pain. In the five months since his previous visit to Archer Family Health, he had not made an appointment with Dr. Stuart or any other health care provider.

CT Scans Do Not Reveal Cancer; Colonoscopy Does

The patient was hospitalized in May and underwent multiple CT scans, which revealed findings consistent with a perforated appendicitis, but no presence of cancer. At that time, the focus was on managing an acute inflammatory process, and interventional radiology was employed to drain an abscess. After the abscess was drained, Mr. Criswell was treated by a general surgeon, an infectious disease specialist, and an interventional radiologist. It took this team five weeks to refer him to a gastroenterologist and recommend a colonoscopy, which was conducted on June 7.

The colonoscopy revealed a mass, and the next day, the patient underwent a right hemicolectomy to remove the portion of the colon containing the tumor. During the surgery, doctors confirmed that the mass was a right cecal lesion with perforation and invasion into adjacent structures. Expert analysis later suggested that the tumor most likely originated in the appendix and had already spread to the surrounding tissues, including the right psoas muscle—a muscle that is essential for posture and lower back stability. Mr. Criswell was diagnosed with Stage IV mucinous adenocarcinoma.

The tumor returned in late July with metastasis to the lymph nodes and lung, and although additional surgery and chemotherapy were done, the tumor markers had skyrocketed by October 2013. Mr. Criswell was given less than two years to live.

The Lawsuit

Mr. Criswell’s lawyers argued that a diagnosis within three months of his initial June 2011 visit to Dr. Stuart would helped doctors catch and treat the cancer during Stage I or II, providing a better chance at survival.

Defense experts maintained that Dr. Stuart met the standard of care and that the patient’s symptoms at the time of the initial presentation did not warrant an emergent referral for invasive diagnostic procedures such as a colonoscopy.

They also emphasized that the patient’s advanced disease was already established by the time he first sought treatment, as evidenced by his hunched-over posture, which would indicate that the psoas muscle had already been damaged. An earlier diagnosis would not have significantly altered the inevitable outcome.

Outcome

Despite the evidence that Mr. Criswell was already in an advanced stage of cancer at his first appointment with Dr. Stuart, this case was settled for $1.3 million at mediation. Why? Lack of informed consent. At Mr. Criswell’s first visit, Dr. Stuart and Archer Family Health Clinic should have informed Mr. Criswell that getting a colonoscopy was an option he could explore to rule out colon cancer. The judge ruled that any reasonable person would have undergone this option had they been informed of it, and failing to inform the patient of this option was an automatic breach in the standard of care.

Mr. Criswell’s attorneys filed for $500,000 in medical expenses and $1.2 million in lost wages, ultimately less than Dr. Stuart’s $2 million policy limit.