EGD/MI (Case #271)

• Medical Probability: 6 / 10
• Medical Error Summary: The GI MD contacted cardiology within 11 minutes of the ECG being obtained. Of critical importance here is what exactly is meant by "routine consult"? Different hospitals/institutions have different...
• Causation Probability: 7 / 10
• Causation Summary: The delays in cardiology evaluation led to ongoing, undermanaged acute MI, and the time to intervention was unacceptably long, with ample evidence ([initial] ECG, symptoms, etc.) suggesting it needed ...
• Expert Summary: I'm the director of endoscopy at my institution, Professor of Clinical Medicine, work closely with anesthesia, ED, and other services to manage and guide the care of outpatients and inpatients with co...
• Similar Summary: Acute MI prior to starting EGD? Perhaps once per year. But dyspnea or chest discomfort or bradycardia prior to EGD, considerably more often.

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

• Medical Probability: 8 / 10
• Medical Error Summary: This matter has several facets and technical components which should be understood if not by a judge or jury than by plaintiff's (and maybe defense) counsel in order to best strategize/approach. Wil...
• Causation Probability: 8 / 10
• Causation Summary: Granted there was indeed a medical error, it seems at least " very likely" that it resulted in injury (the formation of metastatic disease that is no longer curable, as opposed to a localized pre-mali...
• Expert Summary: I'm the a Health Sciences Clinical Professor in the Geffen School of Medicine at UCLA and an Advanced Therapeutic Endoscopist and Director of Endoscopy at Olive View-UCLA Medical Center. I have publis...
• Similar Summary: It's somewhat difficult to say how often since it's not clear what aspect of this case the question is referring to, but granted it is referring to missed colon polyps that are subsequently detected, ...

Death due to hypotensive shock, severe blood loss, and acute GI bleed. (Case #296)

• Medical Probability: 6 / 10
• Medical Error Summary: It's difficult to answer this question without knowing what exactly is meant by "error". Error in charting? Error in assessment? Error in not respond to a nurse call? If we lump all of these potenti...
• Causation Probability: 8 / 10
• Causation Summary: Hours after the procedure it is reported that the patient was having bloody stools. Note the word "bloody" rather than black or melenic. If a patient with an upper GI source of bleeding (e.g. a duod...
• Expert Summary: I'm the director of endoscopy at my institution. I have published on the subject matter of GI bleeding. I am accustomed to multidisciplinary management, as is sometimes needed in cases like this. I ...
• Similar Summary: Depending on what is meant by "similar to this one", at least once a month.

Missed Polyp (Case #322)

• Medical Probability: 9 / 10
• Medical Error Summary: Granted the bowel preparation was adequate (in this case there does not seem to be reason to think that it was not), failure to identify a polyp of these dimensions (2.6 x 2.0 x1.4 cm) is extremely di...
• Causation Probability: 7 / 10
• Causation Summary: It’s written that “The surgeon noted that "at this point a polyp was found within a cm of the anastomosis and appeared to be acting like a ball valve precipitating the obstruction..” This would ...
• Expert Summary: Colorectal cancer screening, polyp detection, endoscopic resection, and collaborative care with surgeons, radiologists, and pathologists are pillars of my clinical practice and published research.
• Similar Summary: I encounter cases similar to this a few times per year (fortunately my my own cases). This one is somewhat unique in the number of polyps, surgeries, and so forth, but the principles are the same.

23 year old male requiring complete colon resection after chronic colitis. (Case #346)

• Medical Probability: 6 / 10
• Medical Error Summary: There are a few elements of particular interest which may point to a medical error/negligence: -"Prescribed steroids, which were increased after 4 days." If steroids had to be increased after 4 days ...
• Causation Probability: 6 / 10
• Causation Summary: Without having some of the information alluded to in the response to the prior question, it's difficult to determine to what degree there is causation, but overall it seems to me that the outcome (cec...
• Expert Summary: I have clinical and published research experience in the management of inflammatory bowel disease, including severe disease and complications of disease. I'm also a patient advocate and can often spot...
• Similar Summary: I have seen cases where proper/adequate medical therapy of IBD has resulted in serious complications such as toxic megacolon, perforation, emergency surgery, fistulization, etc.

General Surgeon With Upper GI Bleed Requesting Urgent Upper Scope To Be Told By GI To Place Patient In ICU Until The Morning. (Case #409)

• Medical Probability: 9 / 10
• Medical Error Summary: Depending on doctors 1's responsibility and when initial contact was attempted, there may be major deviation/negligence. If doctor 1 was not on call, he/she is not to be blamed; if on call, there is a...
• Causation Probability: 7 / 10
• Causation Summary: Causation depends in large part on the points I mentioned above in the first response/summary
• Expert Summary: I'm a published expert in cases of GI bleeding and maintain a near 50-50 balance of defendant/plaintiff counsel matters, which I've handled at local, county, and federal levels
• Similar Summary: In general terms, several times per month. With these specific facets, less frequently, maybe a few times per quarter

Post cervical laminectomy, possible delayed diagnosis of CSF infection (Case #441)

• Medical Probability: 9 / 10
• Medical Error Summary: Clearly, there was an infection in the CSF. This would not have developed spontaneously in such a case wherein there has been considerable manipulation of the cervical spine; therefore, it was iatroge...
• Causation Probability: 8 / 10
• Causation Summary: See above. Moreover, the delay in diagnosis led to worse/more severe/more complicated infection than what may have developed had the infection been promptly detected and treated. The patient developed...
• Expert Summary: This is a multidisciplinary case involving not only neurosurgery, but also internal medicine (I completed my IM training at Johns Hopkins in 2010), infectious disease, and so forth. I myself have had ...
• Similar Summary: I would say on a near weekly basis I encounter cases of cryptogenic infection/leukocytosis. Various specialties and sub-specialties have to come together to find the source and come up with a treatmen...