Colonoscopies are widely used for diagnosis and are clearly the gold standard for colon cancer detection and recommended for all adults ages 50 and older. Colonoscopies have saved an untold number of Maryland lives, fighting the insidious disease of colon cancer by allowing for crucial early detection. Colon cancer is reported to be the second most diagnosed cancer, and the second leading cause of cancer death in the U.S. Most colonoscopy injuries are not the result of medical malpractice, but, some are. If you think your injuries during a colonoscopy may have been caused by a medical mistake, call 800-553-8082, or get a free on-line consultation.Colonoscopy Injuries
Colonoscopies are usually well tolerated by the patient; however, injury can occur when the doctor performing the procedure is not skilled and does not perform the test with the appropriate level of care. Potential injuries which may arise include hemorrhaging following polyp removal, aggravation of underlying bowel disorders (e.g. Crohn's disease, irritable bowel syndrome, etc.), and more serious injuries such as bowel perforation, sepsis, and splenic tear/rupture. Certainly, not all of these injuries are from medical malpractice. In fact, as discussed below, the vast majority of bowel perforations are not the result of medical malpractice. Many colonoscopy related problems are, however, the result of a mistake by the doctor performing the procedure.
Reported rates of serious injury due to colonoscopies vary in the literature between 0.34% and 2.5%. Risk of bowel perforation is estimated to be 0.2-1.0%. Perforation of the bowel can lead to sepsis, which can be fatal. Sepsis occurs when bacteria enter the bloodstream and the immune system goes into overdrive. This can result in organ dysfunction. Splenic injury due to a colonoscopy is rare (approximately 1 in 6,387 colonoscopies or 0.015%), and may go undiagnosed due to non-specific symptoms; however, a delay in diagnosis can be serious and even fatal.
There are three potential mechanisms for splenic injury:
- Formation of abdominal adhesions associated with a history of abdominal surgery
- Increased splenocolic ligament traction associated with snare polypectomy and/or forceps biopsies performed during the colonoscopy
- Direct trauma to the spleen (may occur due to external or internal pressure from the colonoscope)
External abdominal pressure may be applied to help ease technical difficulty encountered by preventing looping and reducing the angles in the colon. However, application of too much pressure can result in direct trauma to the spleen.
Risk factors for splenic injury include anti-coagulant (blood thinner) therapy, irritable bowel disorder, gender (females are at higher risk (3:1) compared to males), history of multiple prior colonoscopies, and enlargement of the spleen (splenomegaly).Perforated Bowel During Colonoscopy: Is this Malpractice?
One common complication during colonoscopies is perforating the colon which, in laymen's terms, is making a cut or hole in the colon by mistake. Perforation of the bowel and splenic injury can both present with abdominal pain. Abdominal pain occurs on the left side and is often associated with radiating pain to the left shoulder. The pain is usually progressive and persistent. Dizziness may also occur in some patients. Most patients with splenic injury report problems within 24 to 48 hours of the colonoscopy. Laboratory tests may also reveal a drop in hemoglobin and hematocrit. Perforation should be ruled out prior to diagnosis of splenic injury, as bowel perforation is a more common complication of colonoscopy.
Bowel perforation is a recognized risk of a colonoscopy. Many doctors think this is the end of the malpractice question when in fact, it is only the beginning. Many "recognized risks" are also medical malpractice. But, in this case, it can and does happen frequently in the absence of medical malpractice.
Where the malpractice comes in, in perforated colon cases, is where the doctor refuses to admit that the colon was perforated, and the patient fails to receive the treatment that is needed to best resolve the problem. It is important for problems encountered during a colonoscopy to be documented so that the appropriate follow up can be provided, and these notes may also aid in proper diagnosis should complications arise. Colonoscopies are usually outpatient surgeries, thus determinations of colonoscopy injury prior to release may not be feasible. Proper follow-up in high risk patients, including those in which technical difficulties arose during the colonoscopy, are important factors in ensuring potentially fatal complications are averted.
It is worthwhile to keep in mind that a diagnostic colonoscopy has a different risk than a therapeutic colonoscopy where you take out a polyp, cauterize an angiodysplasia, or perform some other therapy. The risk is much higher for a therapeutic colonoscopy. The diagnostic colonoscopy rate of perforation is less than one-tenth of one percent, on the order of a tenth of a percent. Diagnostic perforations are more likely to be malpractice.What Types of Colonoscopy Related Malpractice Claims Are Successful?
Most of what we have written about colonoscopies is what is not considered medical malpractice. There are, however, many colonoscopy injuries that are malpractice. These are but a few examples of successful fact patterns in colonoscopy medical malpractice cases:
- Negligent in completing the colonoscopy, in light of the fact that the bowel preparation had been given only hours earlier
- Lack of informed consent
- Failure to timely diagnose or treat irritable bowel syndrome while performing colonoscopy
- Failure to recommend a sigmoidoscopy or colonoscopy to identify a source for the rectal bleeding or other symptoms consistent with colon cancer
- Colonoscopy complications in patients where the doctor did not explain to the patient that they had a higher than normal risk of complications
- Negligent attempting to pass the colonoscopy instrument through a colon structure which was overly dilated
These are hard cases to settle without filing suit. Below we have complied a list of verdicts and settlement in colonoscopy error cases. Can you use this to help figure out the potential value of your claim? Yes, you can up to a point. But there are so many factors involved in valuing these claims that it is possible to read the exact same fact pattern and how a very different case value. These cases just have too many variables of differing weight to make hard conclusions.
- May 2013, New York: $180,000 Verdict: A 61 year-old woman undergoes a colonoscopy performed by the defendant, a gastroenterologist. The defendant mistakenly perforates the plaintiff’s colon. Following the procedure, the plaintiff develops sepsis and undergoes a laparotomy to repair the damages. A colostomy is created and later reversed nine months following the procedure. Plaintiff sues the gastroenterologist and his employer, Mid-Hudson Gastroenterology Associates, LLP for malpractice and vicarious liability respectively. Plaintiff’s counsel state that the cleansing solution given to the plaintiff was counteracted by prescription medication the plaintiff was already taking and that the plaintiff had undergone prior surgeries and should have been taken in with extra precautions. They also claim that had the defendant ensured her colon were clean, the injury would have been avoided. Defense counsel contends the plaintiff’s accusations, stating the amount of cleansing solution was appropriate and the administering of a colonoscopy was necessary as the plaintiff was suffering from a gastrointestinal disorder. The jury agrees with Plaintiff’s counsel and finds the defendants did not follow the standard of medical care. They award the plaintiff $180,000.
- January 2013, New York: $1,500,000 Verdict: Plaintiff arrives at the gastroenterologist for a routine screening to detect cancer or pre-cancerous polyps. During the procedure, the Defendant sees bleeding blood vessels and chooses to cauterize them with a “heater probe”. Following the procedure, the plaintiff begins to complain of a burning pain in his abdomen but is advised the pain will subside and he discharged home. Plaintiff returns to the gastroenterologist’s office the following morning with the same complaints. The defendant diagnoses him with a possible perforated cecum and refers him to the second defendant, a surgeon who specializes in laparoscopic surgery. The second defendant identifies and repairs three holes in the colon during a laparoscopic procedure performed on the plaintiff. After the plaintiff spends several days in the hospital following the procedure and is discharged, he returns to the hospital the following day complaining of severe abdominal pain. He undergoes an additional surgery where it is discovered that there are small perforations in his small intestine. The plaintiff files suit against both the gastroenterologist and laparoscopic surgeon for medical malpractice and breaching the standard of care. Plaintiff’s expert in gastroenterology claims that using the heater probe on the plaintiff was risky and should not have been performed. The defendants deny the accusations and claim they followed the standard of care in their respective departments. The jury finds in favor of the plaintiff with the gastroenterologist being 60% liable and surgeon 40% liable.
- January 2013, Maryland: $8,344,514 Verdict: A 42 year-old woman arrives at Endocentre for an outpatient colonoscopy as a work up to determine the cause of her anemia. She also has a history of diabetes and is overweight. The plaintiff is put under anesthesia for the procedure. Suddenly, she suffers from complete deprivation of oxygen during the procedure – known as anoxic insult. Concerned the plaintiff could be suffering from a bowel perforation, an emergency exploratory surgery is performed. Unfortunately, no perforation was found and the plaintiff died from a lack of oxygen to the brain. She left behind her husband and children. Plaintiff’s estate sues the surgeons and anesthesiologist for medical malpractice. They claim not only did the defendants fail to monitor the mother during her procedure but also pumped too much air into her colon, causing excess pressure on the lungs and heart and resulting in perforation. While the defendants did not argue that the plaintiff died from anoxic insult, they did challenge that the perforation was the source of the anoxia. The jury finds in favor of the plaintiff and awards $8,344,514.
- May 2012, Pennsylvania: $250,000 Settlement: A woman arrives at UPMC Shadyside Hospital in Pittsburgh, PA for a colonoscopy per the request of her personal care physician. During the procedure, the gastroenterologist attempts to irrigate an area where there was stool stuck on the walls of the cecum. Following the procedure, the plaintiff begins to feel stomach pains, nausea and dizziness. She repeatedly leaves concerned messages with the physician’s office the days following the procedure, only to be contacted by a nurse who tells her the symptoms are expected. Five days later, the woman is taken by ambulance to UPMC Shadyside due to severe abdominal pain. An emergency surgery is conducted where they discover the woman’s abdomen has been contaminated with fecal matter and her cecum had been perforated. The woman is placed in long-term treatment for countless issues as a result of the perforation including, but not limited to, renal insufficiency, anemia, jaundice and hypotension. Three months after the colonoscopy, the woman unfortunately passes away. Plaintiff’s estate files suit against the gastroenterologist and UPMC Shadyside Hospital for negligence. The defendants argue that the perforation did not occur during the colonoscopy and that they were unaware of the perforation until the plaintiff arrived at the hospital after the procedure as they had no record of the plaintiff’s phone calls. The parties agree to resolve the case for $250,000.
- April 2012, Michigan: $100,000 Settlement: A woman is in line for a liver transplant and requires a colonoscopy. She arrives at Henry Ford Hospital in Detroit for the procedure, which is aborted just after an hour as the physician can not get past the first turn. Following the procedure, the woman becomes ill and a quarter-sized perforation is discovered in her colon. Though she was able to undergo a surgery to repair the perforation, she is deemed to sick to receive the initial liver transplant and unfortunately dies. The woman’s estate files a medical malpractice suit against the physician and the hospital for a breach of care. They claim the defendants failed to properly perform the colonoscopy and failed to provide appropriate care and treatment, which consequently led to the plaintiff’s death. The parties agree to settle out-of-court for $100,000.
- November 2011, Connecticut: $249,747 Verdict: A 62-year old female arrives at a gastroenterologist’s office for a routine colonoscopy. After the procedure she begins to complain of abdominal pain that only seems to be worsening. She is rushed to a hospital via ambulance where a CT scan is ordered. The scan shows the woman is suffering from internal bleeding as a result of a torn spleen. An emergency surgery is conducted to remove the spleen and perform a blood transfusion. The woman brings suit to the gastroenterologist for negligence, claiming that the tears in her spleen were the result of the defendant using excessive pressure during the colonoscopy. The defendant denied the allegations, claiming that while this type of injury was rare, it was still a risk of the procedure that the plaintiff had given informed consent. The jury returns the verdict in favor of the plaintiff and awards her $247,747.
If you live in the Baltimore Washington area and believe you have been a victim of medical negligence in Maryland, call 800-553-8082 or get a free online medical malpractice consultation.