Malpractice Suits for Postcolonoscopy Cancer
Malpractice Suits for Postcolonoscopy Cancer
When a patient develops colorectal cancer within a few years of colonoscopy it sometimes results in a malpractice action against the colonoscopist. This often results from an impression on the part of the patient, the patient's attorney, and some expert witnesses that colonoscopy is a guarantee of protection against colorectal cancer. Although it is always troubling to be sued, and some doctors are emotionally devastated by the process, malpractice suits alleging missed cancer are (in my experience) very difficult for the plaintiff to win, and a series of measures can further greatly increase the chance of a defense verdict. Colonoscopy is generally a poorly documented procedure in the absence of video recording, and no one involved in the medical-legal case can be certain that the colonoscopist performed a careful examination. Therefore, the case usually revolves around other documentation (or the absence of it) that supports a careful examination, the size of the tumor at diagnosis and the interval since the baseline colonoscopy, and the knowledge and performance of the defending doctor and the expert witnesses.
In this article I review issues commonly encountered in malpractice suits centered on this issue, make recommendations for avoiding these suits, and discuss medical evidence that can be used by the defense when a suit proceeds. These recommendations represent both my understanding of the medical literature on colonoscopy and missed cancers, my own experience in performing colonoscopy, and my experience as an expert witness.
Introduction
When a patient develops colorectal cancer within a few years of colonoscopy it sometimes results in a malpractice action against the colonoscopist. This often results from an impression on the part of the patient, the patient's attorney, and some expert witnesses that colonoscopy is a guarantee of protection against colorectal cancer. Although it is always troubling to be sued, and some doctors are emotionally devastated by the process, malpractice suits alleging missed cancer are (in my experience) very difficult for the plaintiff to win, and a series of measures can further greatly increase the chance of a defense verdict. Colonoscopy is generally a poorly documented procedure in the absence of video recording, and no one involved in the medical-legal case can be certain that the colonoscopist performed a careful examination. Therefore, the case usually revolves around other documentation (or the absence of it) that supports a careful examination, the size of the tumor at diagnosis and the interval since the baseline colonoscopy, and the knowledge and performance of the defending doctor and the expert witnesses.
In this article I review issues commonly encountered in malpractice suits centered on this issue, make recommendations for avoiding these suits, and discuss medical evidence that can be used by the defense when a suit proceeds. These recommendations represent both my understanding of the medical literature on colonoscopy and missed cancers, my own experience in performing colonoscopy, and my experience as an expert witness.