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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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Doctor's office

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

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I had a colonoscopy on March 08, 2019 and am seeing my doctor on April 05, 2019 because I still have abdominal pain and back pain. I had a very small amount of bleeding and had no polyps removed nor biopsies taken. I never had any pain before I went in for the procedure. I also had a reaction to the supplemental oxygen that no one told me could be a reaction or even that any reaction was possible to receiving supplemental oxygen. The gastroenterology department where I had my procedure done does 20 to 25 colonoscopies a day with 2 doctors. I wonder if with this assembly line type of health care there is going to be an increase in medical mistakes.

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I appreciate the 2 new comments. These tests that are recommended have so many pros and cons that one doesn’t know which way to turn. I still struggle about getting a colonoscopy, afraid to get one but also afraid not to. The main reason I have cancelled 2 appointments is because the CT scan didn’t show anything. So I wonder why at 78 years old the gastro doc would still advise me to get one? Some sites I read said it’s not usually done after 75.
But my friend who is 84 had one scheduled last year and the prep made her sick, she passed out in her bathroom and luckily her son had spent the night to take her to the colonoscopy the next morning. She ended up in the hospital for 3 days with low electrolytes. She said she’ll never sign up for it again.
In the meantime, I’m not doing anything and I feel fine.
Thanks for all the comments!

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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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Thanks for sharing, Carol. I’m sorry that your elderly uncle had died. I wonder if his doctor should have left well enough alone. As you noted, he was very healthy and not on medication. So, rhetorical question—what on earth did his doctor order a colonoscopy for? Is it just for profit because your uncle has good medical coverage? You’re right about covering missteps and errors. They only protect themselves to avoid lawsuits, whereas patients are on their own to sort out what’s really necessary procedure.

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My nightmare started Aug 12, 2013.
Prior to what took place yes I had Arthritis, pain in all my joints, but I was being treated and lived my life putting my best foot forward, I owned my dream restaurant, NEVER EVER missed a day of work!!
One night I was perfectly fine one minute, The next minute I dropped to the floor and started vomiting, for no reason, I couldn’t stop, I went into the ER, received IV, Morphine for pain & IV Zofran to stop the vomiting. The Doc recommends I spend the night to replace my fluids, also due to my age they scheduled a routine upper & Lower Colonoscopy to be preformed at there sister hospital approximately 190 mile away, that’s the first time I heard the words I was complained?
A week later my husband and I took the 190 mile drive to do this so called routine colonoscopy .
I was walking into the hospital and suddenly stopped, I looked right in my husbands eyes and said I didn’t want to go through with it, I told him my interVoice was telling me to turn around and run!
I remember telling him if it’s not broke why fix it? My husband assured me it was only pre-surgery nerves . If he only would of listened to me. Who would of thought these things could happen?
I was the Doctors last colonoscopy of the day, The Doctor looked like he just wanted to fall asleep! I should of , could of, but didn’t want to look like a nut case if I ran! Besides I told myself Doctors are supposed to care about people that’s why they took the oath to help people, to have feeling, surely if he was to exhausted he would reschedule, Right?
Here I go, They put me under, next thing I remember is being woke up & told they removed a 6 mm polyp in the distal descending colon Resected & Retrieved, One 3 mm polyp in the sigmoid colon, Diverticulosis in the sigmoid colon & descending colon, Mucosa vascular pattern in the entire colon to be biopsied.
Then to eat a cookie & drink some juice, I didn’t hesitate, after all I was thinking this was a piece of cake, I felt fine & I hadn’t eaten in two days,
We were going to the Rose Garden after leaving the hospital for my that - a - girl - dinner.. Nope!
As we were walking out of my room to the elevator I told my husband something was wrong, he asked if I wanted to go back to the nurse & I remember thinking how embarrassing this all was, I felt as if my rectum was leaking and I only wanted to get back to my motel room so I can lay down. We got to the car and the pain was getting unbearable, by the time we got to the Motel I was vomiting. Still I only wanted to crawl into a fetal position and try to sleep, I guess from the anesthesia that was still in my blood I passed out from the pain I have no idea .
Not even an hour later when I woke I looked up at my husband and told him that he had better get me to the hospital because I felt like I was going to die .
We went to the ER finally when they took me to a room a doctor came in, we told him about my earlier procedure and how I started to feel right after .
After an IV was inserted they took me in for an MRI and put dye into my IV so they could see what was going on . Everything happened so fast the doctor came back in and held my hand looked at me looked at my husband and said that I was leaking inside I had a cloudy mass floating around my colon and if I did not have surgery I would die . A routine colonoscopy here I am being rushed into surgery but not really understanding the depth of what was about to happen to me.
4-5 hrs later I’m being taken to Intensive care, I remember being so absolutely in shock, This was supposed to be a 20 minute procedure for a colonoscopy, Not at all! I remember I having a feeling that I desperately needed to urinate, The nurse said it’s ok, you have a catheter, when I looked down to my horror I saw not only a Catheter but drainage tubes full of a bloody liquid.
As soon as the nurse left the room for a minute I looked at my husband and said I wanted to see what they did. To my fright they had cut my belly from my mid belly about 3 inches above my belly button, down & around my navel, down to my pelvic area. My stomach was stuffed with a blue wound vac, to suck up any body fluids that happened to leak out. 3-4 days later back into surgery all my intestines taken out & cleaned, but back in, I was stapled up, back to my room. I was so ill I don’t remember how the pain pump got pushed. My sweet husband sat at my side while I slept and when I’d start crying in my sleep he would push it for me. I’ve never felt pain like this ever, not ever Child birth.
After 3 very long weeks I was finally able to go home! I was so excited!!
That didn’t last long, Two days later the vomiting & pain started up, I went to my little hospital & they ran a test and took me by ambulance 190 miles back to were this all began.
This time I was there just short of two weeks, but something was happening, the doctors diagnosis stated changing, They were labeling me as someone who looks to have surgeries, They said the only reason they performed the first surgery was because I requested Exploratory surgery there was nothing wrong with me this is what my nightmare really begins, These Doctors are all friends sad but true.
From 2013 - 2016 I was in and out of that hospital, Recommended that I swollen a camera to see if I have a blockage,my Doctor said it would be good New, or bad news, if the camera passes they can read the film and know what’s causing my problem. If it doesn’t pass and tuns out they definitely will know we’re and if I have a blockage. But if this happens they would have to open me up to retrieve the camera. The camera ran it’s self out inside of me, They did nothing. Again about two weeks later I got violently ill, back to the hospital, I told them something was wrong I could feel it. They assured me I’d passed that camera! I repeatedly tried to tell them I’d strained my poo & never found a camera.
Back and forth to the hospital MRI after MRI, I asked to have a referral to the Mayo, my doc agreed, she was good friends with the doctor I was scheduled to see, They were to put me into this big machine to find out what was going on, or to prove I was a hypocrite!
In between the Mayo visit I was rushed by ambulance again, this time my husband couldn’t join me right away because of a snow storm. This very rude doc came in and told me there was nothing wrong but they would do a lower colonoscopy to be sure, OMG when I woke up I’d never felt so much muscle pain like someone punched me in the stomach! Then the doctor came in & said there was nothing wrong again, unknown to me the nurse had called my husband and told him I needed to see a psychiatrist because I had some deep mental problems, Physically there was nothing wrong with me. My blood pressure was 196/105, maybe because they would listen to me. But they literally kicked me out of there hospital!
I still needed to get to the Mayo, Maybe they would believe me, But 1 week prior to that visit to the Mayo Clinic I got violently Ill again, This time the doctor from my local hospital sent me down to the X-ray department, as I was being wheeled back to my room the X-ray technician asked me if by chance I swallowed anything metallic? I said no why? Because your glowing inside, then I remembered, the camera I had swallowed, they told me I had passed 5 months prior.
The Doctor called the hospital 190 mile away were this all began with my upper & lower GI, the leaking of my intestines after they almost killed me. He told them he was calling in regards to me, but as soon as they heard my name the doctor on the other end of the phone wouldn’t let him say a word, the doctor on the other end of the line, the doctors I believed in, put my life in there hands, Trusted with my life, said “We have done all we can for her, we don’t want her back here!!” Then hung up on the doctor who was trying to let them know they made a huge mistake!
The hospital that had me swallow that camera, that said it was all in my head, I was making it all up.
Totally incredible! There it was on film the lost camera just sitting between my small and large intestines, four + months of MRI’s vomiting severe pain, All from that day when my nightmare began,
I did go to my appointment at the Mayo, Remember earlier I told you my Doctor was friends with the one at the Mayo. When I arrived I found y doctor to be very pleasant, we talked a little then she told me about that machine they were going to use on me, I said but what about the camera inside of me, she Proceeded to tell me that there was no camera inside of me, my husband spoke up and said didn’t you look at the X-ray from the hospital we brought you? She said that she hadn’t but had the other records & examined them already , we asked if someone had a camera would they want in that test, she said absolutely not, that’s when my husband told her she had better look at the Disk we brought her.
She was in complete shock! There it was the camera, did I finally find a doctor who believed in me ?
Doctors stand by each other sometimes, I believe after Everything I had to drink, after two Double ballon surgery’s at The Mayo just make it passes or went into bidding. It’s on the film but they supposedly never found it. Mystery, Still instead of the truth being told, she diagnosed me with Cyclic vomiting syndrome. Then to make thing worse she told me to stay in the room, in walks a doctor & his team to talk to me about hernia surgery that I never asked for! Why would I do that? They are all covering up for each other, then the Doc at Mayo came back and asked if it were ok if she call the doctor who said it was all in my head ( camera) and let her know. I should of said No! But not me, although I did ask what her response was, it was only “ Are you kidding me”
I have Not been back into a hospital, I lost all of my confidence from all of this, I lost my business, I couldn’t work because I kept getting sick, I’m deathly afraid of those Doctors! One was so exhausted that when he did my lower colonoscopy he nicked my colon, it was a chain of reactions after that.
I do understand I was lucky enough to live it, although after being called crazy being told I need antidepressants and my illness was all in my head. Beware of what Some Doctors will do, but to everything they did to me I’ll never be the same confident person I was. I was diagnosed with something I do not have, it’s recorded that I was hyperventilating that’s why I was vomiting. Really hard to breathe when your body is spasming because you can’t stop vomiting, because there’s a camera inside you.
All of this started in 2013 and continued until 2016-17.
When I start feeling nauseous I have zofran odt to this day to stop it before or it gets worse.
Ive talked to my doctor a burst into tears because of those words, were don’t want her here!! I have nightmares! What happens if I get really sick like that again, I have no where to go because of those words, we’ve done all we can for her, we don’t want her here!!!!
I was supposed to have rotator cuff surgery, & a torn meniscus but I’m frightened.
My heart goes out to anyone who has been treated by a Doctor or Doctors who believes it’s ok to make mistakes and not own up to it, that twist and delete the real facts to make them look good, they have Destroyed your life, Something needs to be done, My nightmare began when I didn’t walk out of that hospital before my colonoscopy when he told us how many he had already preformed.
I never recovered, Statue of Limitations when does that run out when it’s all related?
No one & no one’s families should ever have to suffer from any of this.
To me to treat a patient like it’s there fault when a doctor makes a mistake is criminal!!!!
Remember every life is precious.

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I had a colonoscopy several years ago in Cape Cod, MA. Immediately following the procedure I was in terrible pain and was told by the MD that he ruptured my colon. He also said that I might wake up from the surgery with a colostomy.
After waiting several hours for the doctor while I screamed in pain, the surgery was started. Thankfully I woke up with no bag. But it ended up being the biggest ordeal in my life. The incision couldn’t be closed so I had a 10inch incision wide open with packing, etc. I laid on my couch for 6 weeks with visiting nurses changing the dressing, etc. I developed c. Dif. From the Cipro and pneumonia. I was in my 50s when this occurred. I couldn’t eat anything when I came home from hospital. I couldn’t even put food in my mouth. I went down to 113 lbs from 140. Mentally I was incredibly depressed. I felt so lousy and I didn’t have the energy to get better. I wished I had died because I had no stamina, but thankfully I didn’t. It’s been about 7 or 8 years since the ordeal and I have had 2 colonoscopies since. White knuckled ones. It was the worst experience ever. I am so damaged from the experience . Plus I lost my only income cause I couldn’t work and eventually had tosell my house. There was no compensation of any kind. It took a good year out of my life.

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