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Only an Accident: Fatal Colonoscopy Leaves Family Stunned and Unpaid

Only an Accident: Fatal Colonoscopy Leaves Family Stunned and Unpaid

Picture of William Heisel

Duane Middleton died too young.

He was 54 when he died in February 2010. A New Yorker transplanted to Maryland. He left behind a wife, five children and three grandchildren.

We know that much from his obituary in the Gaithersburg Gazette.

The obituary didn’t mention the cause of death, but his death certificate did. It said his death was accidental and that it was caused by acute peritonitis due to perforation of the cecum during a colonoscopy. It also listed hepatitis C, cirrhosis of the liver, hypertension, and chronic renal insufficiency as other significant conditions contributing to his death, indicating that Middleton was not in perfect health at the time of his death.

But what killed him? And does the accidental nature of his death entitle his family to any compensation?

His insurance company and the U.S. District Court of Maryland say “no.” The reasoning behind this no may make perfect sense to attorneys, but it may feel like a trip to “Alice in Wonderland” for patient safety advocates. I first read about the case on a blog by the plaintiffs’ law firm, Belsky, Weinberg & Horowitz, and had to read it twice because it didn’t seem to add up. The story shows how hard it can be for patients and their families to make a case for themselves.

I’ll try to explain what happened as best I can in a series of posts.

Here’s how it started.

Middleton suffered from multiple conditions, as noted on his death certificate, and his liver was in such bad condition that he had been placed on the waiting list for a liver transplant. His family had a history of colon cancer, and in the prep work for the transplant, a physician recommended that he undergo a colonoscopy.

For better or for worse, colonoscopies are among the most common procedures performed in the United States, as Elisabeth Rosenthal explained in The New York Times recently. As with most procedures that involve something being inserted into your body, the procedure came with a warning. But the chances of someone becoming fatally wounded during a colonoscopy are very small.

Should Middleton and his wife, Sherri, have assumed that he might die as a result of the procedure? And should they have decided to forgo the colonoscopy? There’s a much larger question raised by Rosenthal’s New York Times story about whether all of these colonoscopies are necessary, too.

In a study in JAMA Internal Medicine in 2011, Dr. James Goodwin and colleagues found that colonoscopies were overused in Medicare patients. They wrote:

Less attention has been paid to possible overuse of screening colonoscopy. Overuse is important for several reasons. First, screening colonoscopy can have adverse effects, including hospitalization and death. Too frequent performance of the examination may shift the benefit to risk ratio by increasing complications without additional benefit. Second, colonoscopy screening is costly; it is important to restrain expenditures for unnecessary procedures. Third, colonoscopy is a limited resource, in terms of facilities and practitioners. Identifying and decreasing overuse of screening colonoscopy should free up resources to increase appropriate colonoscopy in inadequately screened populations.

Let’s linger for a minute on that first point.

Yes, complications can occur because of colonoscopies. But the study cited by Goodwin clearly shows that they are rare. The 2006 study by Dr. Theodore Levin and colleagues examined records from 16,318 members of the Kaiser Permanente health system who underwent a colonoscopy between January 1994 and July 2002. Out of 16,318 patients they found just 10 deaths within 30 days after the colonoscopy and, of those, they only could attribute one to the procedure.

So, Middleton had every reason to feel that if he underwent the procedure, he certainly wouldn’t die as a result. And he must have believed it was necessary, too. He underwent the procedure. During the colonoscopy, the lining of his colon – known as the cecum – was torn.

He died seven hours later.

Part 2: Insurance company says, Tough luck, accidents happen

Part 3: How judges read the fine print on a medical fatality


Image by Todd Frantom via Flickr


Comments

Picture of <span class="username">Guest (not verified)</span>

I really appreciated you drawing the issue of routine screening colonoscopies to our attention. I will research this procedure more as a result of this study.

Picture of <span class="username">Guest (not verified)</span>

I noticed the insurance company blamed the patient partly by saying 'bowel preparation was poor.' That should be the topic of a consumer health report. The toughest part of the colonscopy these days is the prep, which is based almost entirely on patient effort and discipline to accomplish a very difficult, unnatural set of tasks. Your whole body tells you to stop doing what you're doing, and you have to keep doing it. Many patients fail to follow through. How much does this contribute to the failure rate of colonoscopy in terms of not just perforation, but failure to diagnose cancer?

Picture of <span class="username">Guest (not verified)</span>

My mother-in-law died a long and horrible death in ICU from a colonoscopy. She was in the hospital for anemia and the first thing the doctor told us was that she needed a colonoscopy. Because we thought we were doing the best thing for her, we talked her into it. She was monitored during the cleansing process so this was not the problem. Her bowel was perforated and she was rushed into surgery. She died 2 weeks later after being sedated most of that time. She died from infection throughout her body. People are not told that they can have a virtual scan of the colon. They are given many excuses why this is not as effective, but I believe more cancer would be detected with a scan rather than depending on the visual surface of the colon by a human. Once I began telling our story I found out how much this really happens. It is much more than we are told. It is all about money. Many Gastros would be without a job because this test is their biggest money maker. Common sense says that this is the only screening test that is this invasive. Why is that? They scan for all other cancers, then examine further if there is a need.

Picture of <span class="username">Guest (not verified)</span>

My mom died two months ago after having a colonoscopy. I took her in to have it done and five days later she was dead! I'm sorry for your loss!!! I never thought it would turn out like this but I guess that's my fault for not thinking it could happen to her. I sure do miss her and I if I hadn't taken her for that stupid colonoscopy she would still be here.

Picture of <span class="username">Guest (not verified)</span>

I had a colonoscapy on Nov23/2015 on Nov 25 I was rushed in to emergency surgery due to a perferated bowel, I had no pre existing conditions. I had severe peritinites and almost died. I am a 46 yr old male with no underlying conditions. I just had my reversal of a hartmans procedure which I had to get in order to live.

Picture of <span class="username">Guest (not verified)</span>

Same thing. I'm in perfect health, go in for a screening, 3 days later rushed into hospital. 3 days after that, surgery (on Christmas eve). What fun for my family. (I was out of it. Didn't know the date.) 4 months later- reversal surgery.

Picture of <span class="username">Guest (not verified)</span>

My partner had a colonoscopy and her bowel was perforated. She had emergency surgery was sedated and put on life support but died 5 days later . This procedure was done in an attempt to straighten a loop in her bowel. she was 58 years old.

Picture of <span class="username">Guest (not verified)</span>

My condolences to those who have lost their loved ones. Thank you as well for taking the time to share your stories. Now I'm certain to not convince or pressure my husband to get a colonoscopy. Perhaps we will go with the simple test first. The complications and possible fatal results from a colonoscopy is frightening!

Picture of <span class="username">Guest (not verified)</span>

I had my first one one month ago. As per ANY procedure death can happen. But death can also happen and misriable by colon cancer. Mine went well but did exactly as doc said for prep. Sorry to hear about the deaths related to procedure. Speaking Sole for myself. I do not have control of when or how I peave this earth. But when it is mt time I am ready to go. That is the most important thing realized for me.
Chris Milow

Picture of <span class="username">Guest (not verified)</span>

Having colonoscopy in a few days! Have been fretting about it. You are right! If that is my time there isn't a thing I can do about it! I know that but seemed to be forgetting! Thanks for the reminder! Fretting about it won't change a thing. Funny thing is.... I know that my life-span has quite a ways to go( just that inner sense of things that we all have but few choose to recognize) I know the procedure will go without incident. Glad yours went fine.

Picture of <span class="username">Guest (not verified)</span>

That may be so, but it doesn’t mean we throw all caution to the wind. God is providential in that He sometimes allows a tragedy to happen, just as he brings us all blessings. But, in the end, it will all work out for good. We will physically die of something, someday; I get that. However, God gave us common sense and instinct to preserve our life until our appointed time. So, the goal is to assess every situation to weigh what is right, safe, and important. But, always trust in the Lord that it will turn out fine. If one is not at high risk of getting colon cancer, then a colonoscopy is not direly necessary. No need to pressure and intimidate those who choose a less invasive test. Besides, many doctors don’t push colonoscopy as much as they used to due to its risks and possible death. The procedure was a money-maker for the medical practice which is why it was frequently recommended.

Picture of <span class="username">Guest (not verified)</span>

On 9/11/09 I called an ambulance and I was rushed to the nearest hospital for hemorrhage two days after I had a colonoscopy. I lost so much blood that I was passing out on the table in the emergency room. Iive in a rural area and the Doctor in charge informed me that they had no surgeon available and they were at a loss as to what to do. I was given blood, and sent by ambulance to the next nearest hospital. Thank God I still had my wit's about the situation and after an hour at the next hospital, where they didn't know what to do about me, (the Doctor was a complete idiot) and the male nurse helped me to get transferred to yet another hospital! During the ambulance ride to the next hospital (mind you my family had gone home by now .. what the hell?) The ambulance STOPPED in the middle of the spillway (50 mile bridge) to assist some one who may have been in an accident (NEVER mind that I was bleeding to death) and finally took me to the hospital where the Gastroenterologist gave me the colonoscopy!! I was given 4 to 6 pints of blood, protonics, and was required to prep for ANOTHER colonoscopy!!! Then the Doctor had the nerve to tell me it was a virus!!! I thank God and Jesus Christ for keeping me alive and healing me!! Can you believe it? Three hospitals and three ambulance rides!!! This all happened on a Friday and I went back to work on a Tuesday!! I should have had my head examined!!! I should have gotten a lawyer!!!!!!! This is not a safe procedure!! I thank God I am alive!! I was 49!!

Picture of <span class="username">Guest (not verified)</span>

Praise God you survived that harrowing experience! But, I don't understand why a subsequent colonoscopy was performed. It sounds like a cover-up for the botched job. So many money-driven, dishonest doctors. To blame a virus as the cause for bleeding was a convenient excuse had you decided to litigate. Glad you're okay with no permanent disability. Thanks for sharing your story. It helps us make decisions wisely. This procedure is the last resort. Too risky just for pre-screening and no family history of colon cancer.

Picture of <span class="username">Guest (not verified)</span>

Yes... thank Great God, Wonderful Jesus, and your Loving Guardian Angel you made it! Not your time! Your post was helpful for me in the sense that a hospital murdered my Mom in 1991. She had the feeding tube ( even though she was awake hungry and had no problem with her digestive system. Then they failed to alternate the feeding tub to the other side like they are supposed to do, which caused a rupture and she drowned in her own blood. They tried to drain the blood but she died 2 days later. She was in the hospital for Addison's disease. That is a dysfunction of the pituitary gland. Medication managed it but every 3-4 years she'd have to go in the hospital for a few days, they'd give heavy doses of the meds., she'd normalize and be good for another few years. This was one of those trips. She never needed a feeding tube. On this occasion they brought her to a hospital closer to home rather than the regular place. I blame myself. I should have questioned them and had her taken to her regular (better) hospital. I was young and naïve and thought they know best! Dumb assess killed her off! Yea they know best! Woke me up! I question everyone and everything now. so that was the last lesson Mom imparted to me. Bothered me the most to think that everyone gets great care except for Mom! But I see by you post that those dumb assess are everywhere!!! Glad you survived! I'm having colonoscopy in a few days. I've got great med coverage so I'm sure I'll do fine!

Picture of <span class="username">Guest (not verified)</span>

My neighbor went in for a routine butt killer. The Doctor did nick his colon, but did not tell his family. He came home that night throwing up blood and everything else. He ended up in several hospital and died 3 months later. Never came home. no stomach, no kidney and everything else feeding tube etc etc.

I would never have one of those, his wife said it was the most painful pain death she never had to indure.
No to Nick Colon
is my thoughts.

Picture of <span class="username">Guest (not verified)</span>

I am 34 years of age. I went in to ask the gastro questions because I have been anemic and having heartburn and diarrhea on and off for about 12 years. I really think it's how I eat, Otherwise I am I good health. Anyways it was my first visit ever with a gastro doc and my first appointment with this guy. I start telling him about my issues and he tells me I have to get a tube with a cam stuck in my buns and my throat. Im thinking I don't freaking thinks so. I continue to listen to this guy and find out he is not the doc but the docs pre screener who signs patents up for colonoscopies or other things. I'm having super bad feelings sitting in the same room now I just want to leave. So before I could leave he has the office schedule the colonoscopy. Um hell no I said, he said why? I said it sounds to invasive! and he says you never had a colonoscopy before? Like I was supposed to have had one or more already. Are you kidding me we don't even know each other yet and he wants to schedule me for their craziest procedure even before checking my poo in a lab first or drawing blood? That's nuts!!! I've been researching this to and I have deep reservations about it. I like Dr. John Bergmans approach to treatment a whole lot better. He can be looked up online or YouTube. I found out that they can't even properly clean this device from one person to another, gross!!!! To many crevasses and has to be cleaned by hand, yucky. The poison used as a cleaning agent is very toxic to our now very vulnerable colons after you prep because the process kills/ flushes all your body's natural flora and fauna leaving your immune system compromised. I don't want that. With a possibility of getting AIDS or hep c from a uncleanable device. Um no not for me not worth the risk. I pray you all do your reasearch and don't do a colonoscopy out of fear or ignorance. And I am sorely sorry for the loss of many of your loved ones but very thankful you are all brave to share to help guide others thank you all!!!

Picture of <span class="username">Guest (not verified)</span>

I never knew this could cause death they know I got lover problems and I still am having it done I have had a scope run down my throat they find bike in my stomach my sister had a colonoscopy still alive so is my ex husband so this is not always true in some cases in having it done.

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