Perforated Colon [Colonoscopy]
Case #105
A 77-year-old man was referred for a screening colonoscopy.
He was a state senator with a long political career.
He had a history of polyps (tubular adenoma) and diverticulitis.
The colonoscopy was relatively uneventful.
It was done by a colorectal surgeon.
A polyp at the cecum was removed.
After the patient recovered from sedation, he reported severe abdominal pain.
The surgeon felt that he simply needed to pass gas, and discharged him.
Several hours later, the patient called the endoscopy center to report ongoing pain.
The exact content of their conversation is up for debate.
The patient remembered stating that he had severe abdominal pain, but the endoscopy employee remembers the patient stating that he had pain earlier, but it was resolving now.
2 days later, the patient went to the ED for abdominal pain.
CT showed a colon perforation.
He underwent an emergency operation to repair a sigmoid perforation.
He temporarily had a colostomy that was later reversed.
The patient filed a lawsuit against the surgeon who did the colonoscopy and the endoscopy center.
The defense hired an expert as well.
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The plaintiff’s expert charged $4,000 for a half-day deposition.
The defense objected to this fee, and asked the judge to lower it.
The plaintiff argued that reducing expert witness payments may discourage doctors from acting as expert witnesses.
The judge determined that $750/hr was an appropriate fee.
The lawsuit went to a jury trial.
The jury found that the defendant was not negligent.
MedMalReviewer Analysis:
Miscommunication is a frequent theme in malpractice lawsuits. In this case, there was a dispute about the conversation between the patient and the endoscopy center. A patient with severe abdominal pain many hours after a colonoscopy needs to be sent to the ED. If this had clearly been communicated to a physician, he likely would have been given better advice.
Physicians who work as expert witnesses need to remember that their fees are not guaranteed. Opposing attorneys can request permission from the judge to pay reduced rates. In this case the expert witness thought he was going to be paid $4000 and instead was paid $2250 for a 3 hour deposition.
Every time I’ve seen an attorney request to reduce a physician’s fees, the judge has granted the request.
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