Marlaina Leigh Kim delayed getting an ultrasound to help pinpoint her medical problem and skipped numerous birth-control injections to control persistent bleeding, which contributed to a delayed diagnosis of a rare type of uterine cancer, her local obstetrician/gynecologist testified Monday.

Shortly after being referred to Dr. Wendy Humphrey in December 1999 from a primary care physician because of heavy bleeding, Kim twice missed an ultrasound that Humphrey, as her new OB/GYN, requested. After having the ultrasound in March 2000, Humphrey scheduled a dilation and curettage, a D & C, which is a scraping of the uterus, and the resulting pathology report said the fibroid tissue removed was benign. Humphrey gave Kim two choices: monitoring her condition or putting her on Depo-Provera injections, birth control that also limits bleeding with consistent injections.

"It is used by millions of women successfully. The longer you are on it, you get better and better," Humphrey said on her third day of testimony in a medical malpractice wrongful-death trial for the lawsuit the Kim family filed against her in 2004 in Collier County Circuit Court.

Marlaina Kim died June 12, 2004, at the age of 35 from a rare from of uterine cancer that was not diagnosed for three years after she began going to Humphrey. The diagnosis ultimately came in March 2003 by the Armed Forces Institute of Pathology in Washington, D.C., but by then the cancer was no longer treatable and had spread to her lungs, pelvis and ribs, according to the lawsuit.

Depo-Provera shots are recommended every month to two months to control bleeding and Kim started on the treatment course in April 2000. The shots appeared to help for a while but then she skipped injections for seven months, Humphrey testified.

"She was not keeping her bleeding under control," she said. "We decided to get back on track with Depo-Provera."

In January 2002 another D & C was done because Kim had a prolapsed fibroid. That pathology sample was interpreted by the same local pathologist, Dr. Thomas Rynalski at DSI Laboratories who examined the tissue sample from the first D & C. His report said the second tissue was a mitotically active smooth muscle tumor, and a specimen was sent to the Armed Forces Institute, which is renowned in the gynecological field. The institute came to the same conclusion as the local pathologist.

"The report said it wasn't just one pathologist but an entire committee opinion came back from the (institute) and agreed with Rynalski," she said.

"But upon getting that report, I was concerned it is not cancerous now but could it potentially be cancer. I would have told (Kim) it was borderline. I would have told her it was uncertain how this precancer would act and so it's best to do a hysterectomy."

The plaintiff's attorney, Jeremy Alters of Miami, pressed Humphrey about why she chose to put Kim on the Depo-Provera after an earlier treatment of birth control pills was not successful. He also questioned Humphrey about an April 2001 pelvic exam that showed Kim's uterus had gotten larger but Humphrey advised Kim to make her appointment for her annual exam, which was scheduled for Jan. 16, 2002.

In the meantime, Kim reported to Humphrey's office that she continued to have problems and tried to get in earlier to see the doctor but was told no appointments were available before Jan. 16, 2002. Two days before the annual appointment, Kim experienced the prolapsed fibroid that lead to the second D & C on an emergency basis. On Feb. 19, 2002, Humphrey did the completed hysterectomy.

Alters continued questioning from last week about fatty tissue on the removed fibroid and how often that occurs. Humphrey responded there is one type of fibroid where that can occur but she couldn't provide incidence data. The pathologist did not report fatty tissue and if she noticed a yellow hue on a photo of the fibroid, she thought it was a sheen on the fibroid.

"The pathologist who looked at all of the tissue did not see any fat," Humphrey said.

The plaintiff's expert witness, Dr. Gary Donovitz, an OB/GYN from Arlington, Texas, took the stand late in the day and said there were multiple occasions when Humphrey breached standards of care. A fibroid with fat inside is abnormal and yellowish "should have immediately rang a bell," he said. "To me, that is an atypical fibroid."

Donovitz continues his testimony today and Rynalski, the local pathologist, is expected to testify.

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