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 severe 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%. The 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 dangerous 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 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 before 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 frequently happen 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 necessary 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 before release may not be feasible. Appropriate 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 of 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 same fact pattern and how a very different case value. These cases just have too many variables of differing weight to make hard conclusions.
- 2016, Illinois: $1,000,000 Settlement. A 47-year-old man has two digital rectal exams done at defendant's office. Once he turns 51, he has a third digital rectal exam and is referred for a screening colonoscopy. He undergoes the procedure under sedation. During the exam, a mass is detected in the man's rectum and the 8 cm mass is confirmed during the colonoscopy. The next week, he is diagnosed with T3 colon cancer. The man files a claim against defendant, claiming that he failed to detect the mass while the cancer was still in a mild stage. After the jury is deadlocked during deliberations, the parties settled the case for $1,000,000.
- 2016, New York: $5,100,000 Verdict. A 47-year-old woman has a colonoscopy done at defendant hospital, by defendant doctor. During the colonoscopy, she alleges that she contracts hepatitis due to the defendant using unsterilized equipment. She also alleges that defendant failed to properly perform the colonoscopy. A jury held the defendants liable for the woman's hepatitis, and awarded her $5,100,000.
- 2015, New Jersey:$6,000,000 Verdict. An adult male has a colonoscopy done, during which he alleges his colorectal surgeon fails to remove a polyp. The man claims that the polyp was clearly visible and the standard of care required the removal of it. As a result, he suffers colon cancer that spreads to his liver, ultimately causing his death. At trial, a jury found that the defendant's negligence caused 80% of the damages and attributed 20% to the man's pre-existing cancer. They awarded him $3,000,000 for pain and suffering, $1,000,000 to his wife for loss of consortium, and $2,000,000 for wrongful death.
- 2015, Massachusetts:$4,500,000 Verdict. A 42-year-old man goes to his primary care provider, defendant, for a routine examination in addition to an exam for rectal bleeding. The defendant diagnoses him with hemorrhoids, but does not refer the man for a colonoscopy or to a specialist. A year later, he returns to defendant, with the same complaints. Defendant relates the bleeding to hemorrhoids again. A year and a half later the plaintiff goes to a gastroenterologist on his own as he continues to have rectal bleeding, constipation, and abdominal pain. The specialist sends him for a colonoscopy immediately, which discloses a large rectal mass. Ultimately the man is diagnosed with Stage IV cancer that has metastasized. He brings this case against his primary care provider, alleging negligence and the failure to timely diagnose colon cancer. The parties resolved the claim after mediation for $4,500,000.
- 2015, Massachusetts:$3,600,000 Verdict. Plaintiff is a 45-year-old woman. Her father has a history of colon cancer and defendant physician knows this. The woman goes to defendant, complaining of abdominal pain after eating and small bowel movements. Defendant diagnoses her with an ulcer and gives her acid-reducing medication. A month later, the woman returns, with similar symptoms. The defendant notes that the medication is working but increases the dosage of the medication. Another month later, the woman is constipated. She is eventually referred to a gynecologist who does a colonoscopy. The results of the colonoscopy confirm Stage IV colon cancer metastasized to the woman's ovaries. The plaintiff sues defendant, arguing that due to her family history and complaints, defendant should have ordered a timely colonoscopy to diagnose her cancer at an earlier date. A jury awarded the woman $3,600,000 after trial.
- 2015, New York:$725,000 Settlement. A woman in her 60's goes to defendant gastroenterologist for a colonoscopy. During the procedure, defendant allegedly uses excessive force and negligently perforates her already weakened bowel wall (due to her medical history). Additionally, defendant does not determine that the perforation occurred during the procedure, despite the woman's complaints of severe abdominal pain. She is discharged home, but two days later, is rushed to the hospital. Due to the week delay in diagnosing the bowel perforation, shew as required a colostomy that was reversed months later and she alleges permanent gastric complaints along with surgical scaring. The parties settle her claims for $725,000.
- 2014, Maryland:$2,512,179 Verdict. A 19-year-old woman goes to defendant surgeon with a history of blood in her stool. She is diagnosed with a healing anal fissure, but no colonoscopy is ordered. Four years later, the woman goes to a gastroenterologist with bloody diarrhea. A sigmoidoscopy identifies a lesion in her rectum. It is biopsied and reveals a low-grade adenocarcinoma. Studies later reveal the cancer has spread to the woman's lungs and liver, and she is diagnosed with Stage IV rectal cancer. She ultimately dies of her cancer two years after diagnosis, despite extensive treatment and surgical procedures. Her Estate alleges that defendant failed to order a colonoscopy when the woman's cancer was early-stage and could have been surgically removed. A jury awarded her estate $2,512,179.
- 2014, New York:$1,100,000 Verdict. A 59-year-old man has a colonoscopy done. He quickly develops a fever and his abdomen becomes swollen and painful. For the next few days symptoms worsen. Four days later, he has a CT scan done to evaluate the polyp that was marked during the colonoscopy. This reveals two bubbles, suggesting a possible perforation of the colon. This is communicated to the surgeon, who opines that this was due to diverticulitis and prescribes an antibiotic. The next day, the man develops severe pain and he goes to the hospital. He is diagnosed with acute peritonitis as a result of perforation of his colon that occurred during the colonoscopy. A jury finds that the defendant was negligent and awards the plaintiff $1,100,000.
- 2014, Massachusetts:$1,000,000 Settlement. A man in his 60's is under defendant physician's care. He has a family history of colon cancer and bowel pattern disturbances. Despite this, defendant fails to recommend that he have a screening colonoscopy. He is ultimately diagnosed with, and dies as a result of, colon cancer. His estate alleges that defendant was negligent in failing to recommend a colonoscopy for a man with a family history of colon cancer. The parties settled for $1,000,000.
- 2014, New York: $766,210 Verdict. Plaintiff has a history of prior abdominal surgeries, including a hysterectomy and ovarian cancer surgery. Due to these conditions, she is encouraged to have colonoscopies every few years. Defendant gastroenterologist performs three successful colonoscopies on plaintiff. The woman begins to have increasing difficulty advancing the colposcopy past the sigmoid colon, and during the latest colonoscopy, defendant used a pediatric scope. When plaintiff goes for the next colonoscopy, defendant attempts to use the adult scope, lacerating her colon, resulting in an emergency. Due to the prior surgeries, the colostomy can't be reversed and the woman requires a permanent colostomy bag. Defendant argues that it was acceptable to use the adult scope and that she was more comfortable with it. A jury awarded the plaintiff $766,210.
- 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. H is 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 for 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 an 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 for 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 surgery to repair the perforation, she is deemed too 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 for 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.