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Only an Accident: Fatal Colonoscopy Leaves Family Stunned and Unpaid

Only an Accident: Fatal Colonoscopy Leaves Family Stunned and Unpaid

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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



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hi carol c, I'm 64 and I haven't done one. at 78, I wouldn't do it. when we get older, our whole physiology changes. we are more fragile. I used to be able to take aspirin. now, my stomach kills me to take. If you are not having any problems, why do it? you can look online and see the colon cancer symptoms. if you see any of that, then do it. the dr is trying to get me to do this and I'm scared. my dad was bleeding and dr said to do a colonoscopy and he had a polyp the size of an egg. even bleeding doesn't mean cancer. they say it's in the family. someone mentioned a virtual scan in these comments and now I wonder if I can do that instead. I am looking into that. a friend of mine told me that I don't eat right. I DON'T. everything is so processed we eat. another friend told me you really don't have to do it unless you are having problems, seeing something abnormal. that was her view on it. they have me scheduled, but I don't know if I want to do it. I started crying. they're gonna put me out. I asked her with what? she said gas up the bowel. what if I'm allergic to it? I had sodium pentathol one time and I puked my guts out. got me so sick. you read it's not usually done after 75. drs have told me, oh you read that online? I'd go with that. at 78, I wouldn't. you've done great so far, so why? zx

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A good friend of mine went into the Phoenix VA Hospital 3 years ago for a colonoscopy. They sent him home and that night his partner woke up in the middle of the night to find him missing from the bed. She walked out of the bedroom to find him lying on the hallway floor outside the bathroom, dead. Cause - you guessed it: bowel perforation. He was only 57 YO. I will never undergo this procedure.

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I’m so sorry about your friend, especially for his partner who found him lifeless. When such an incident as bowel perforation occurs one would think the doctor will notice some bleeding as the camera probe or whatever it’s called is still in there. I suppose if it’s a tiny nick it can be overlooked. Wish they use some type of contrasting dye to detect micro tears so the patient can be monitored instead of being sent home immediately. So far, most of the comments are not favorable for colonoscopy. I’m still apprehensive about going for it, though, I have not completely decided against it. If anything, maybe just do the HomeKit or CT scan to play it safe. For those who survived without complications, please comment and share your experience; tips and advice. What was it like going through the preparations? Apparently, that can also mess up electrolytes. I hear all kinds of negative feedback. Is it just exaggerated stories that some people hype-up?

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Appreciate the above new comments and specifically an answer to mine. This is one procedure that is so controversial it’s hard to make a decision. I’ve opted to not do it. I’ve cancelled 2 already in the past 5 years and the doctors still keep after me to get it done. Most docs and friend can’t believe I haven’t had one since I’m 78 and it is recommended starting at age 50!
It’s just so scary to me. I think the prep isn’t so bad if it’s done with Gatorade and Miralax. Also, a person could take a mineral supplement so your electrolytes stay intact. But after that, you are at the mercy of the doctor. I really liked my gastroenterologist and almost did it. He does several daily so lots of experience. But still....
My uncle had one and died a month later. Yes, he was elderly but very healthy and not on any medication. They said he had a stroke during the colonoscopy but I wonder if it was they’re error during the procedure. Hospitals aren’t beyond covering stuff up!
I did have the CT scan which didn’t show anything but the doc then wanted to still do the colonoscopy.
Anyway, hope you all make the right decision. Good luck to everyone.


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