Colonoscopy resulting in splenic capsule laceration and death (Case #243)

• Medical Probability: 8 / 10
• Medical Error Summary: While splenic injury is a known (albeit fairly rare) complication of a colonoscopy, if a poor prep is found, it is not prudent to proceed with the procedure. Poor visualization due to a poor prep can...
• Causation Probability: 8 / 10
• Causation Summary: As above; the extra pressure needed to maneuver the scope, due to the poor prep, made splenic injury more likely.
• Expert Summary: Have performed > 25,000 colonoscopies, approximately 1 in 7000 complications, never sued.
• Similar Summary: Have seen 3 splenic injuries, one caused by my procedure (15 years ago) and two by colleagues. My patient was quickly treated and was fine.

GI bleed/death case (Case #256)

• Medical Probability: 7 / 10
• Medical Error Summary: There was a lack of continuity of care from the initial hospital to the next, and the patient didn't receive timely workup or temporizing of his obvious GI bleed.
• Causation Probability: 7 / 10
• Causation Summary: Earlier transfusion and more aggressive rehydration would have likely prevented the deterioration of this patient. He needed a bleeding scan or CT angiogram, presuming there was continued hematochezi...
• Expert Summary: 26 years of FT GI practice; we routinely see cases such as this daily at our hospital. I've performed over 25,000 endoscopic procedures; see c.v.
• Similar Summary: Literally very single week in the hospital.

EGD/MI (Case #271)

• Medical Probability: 10 / 10
• Medical Error Summary: Upon seeing an ECG showing acute MI the cardiologist should have been immediately called within 5 minutes, and. STAT consult ordered. Then it’s up to them how quickly to act. This was likely a pr...
• Causation Probability: 9 / 10
• Causation Summary: The patient should have been transported to the ER or cath lab within minutes, not hours. This delay very likely caused injury via ongoing MI.
• Expert Summary: GI practice for 26 years, 25,000 endoscopic procedures, work in close conjunction with cardiologists, surgeons etc.
• Similar Summary: We get pre-endoscopic cardiology risk evaluations daily, and sometimes run into unstable situations like this. I have the cardiologist on speed dial for such cases.

Delayed diagnosis of colon cancer with signet ring cell features (Case #275)

• Medical Probability: 9 / 10
• Medical Error Summary: It's nearly impossible for a colon cancer which is "large" (will need details) to develop in 1 year - this was likely missed; and the colonoscopy report photo labeled "cecum" does not show the appendi...
• Causation Probability: 9 / 10
• Causation Summary: See above; if pt had a colon cancer on the second colonoscopy, it was likely missed on the first one. IF that is truly the cause of the nodes and metastases, it was initially missed and led to the cu...
• Expert Summary: See C.V.; full time GI practice for 26 years, 25,000 endoscopic procedures performed.
• Similar Summary: We do colonoscopies daily, and find polyps/cancers regularly. We abide by current quality guidelines including withdrawal time, monitoring ADR's etc to ensure quality colonoscopies. Those guidelines...

57yo M Colonoscopy Complicated by Perforated Viscus (Case #546)

• Medical Probability: 9 / 10
• Medical Error Summary: First of all, the endoscopist notes "hot snare" used for at least one polyp, but doesn't mention the specific one being removed with that method. Second, the "hot biopsy" technique was proved to be o...
• Causation Probability: 10 / 10
• Causation Summary: Clearly, the colonoscopy led to the perforation - there's no other explanation.
• Expert Summary: I've performed 30,000 endoscopic procedures, and have reviewed about 150 legal cases, about 50/50 plaintiff defense, including multiple cases of complications.
• Similar Summary: I encounter patients with polyps multiple times a day during procedures, and remove them with standard techniques. In terms of perforations, as I'm in a group of 11 doctors, we may have 1-2 perforati...