Sued . . . for overtesting

Interesting case. A doctor is sued for overtesting (defensive testing, if you will). Complications from a questionably-indicated colonoscopy leads to aspiration pneumonia and death:

When 59-year-old Judith Dill went to Naples Community Hospital for bilateral total knee replacement surgery in 2003, the operation was successful and she was beginning to walk.

But while still recovering in the hospital, she felt nauseated and began vomiting days, prompting a consultation with a gastroenterologist. He recommended an endoscopy, which found no problems.

Three days later, a week after the knee surgery, he performed a colonoscopy.

Dill vomited violently, aspirating fluid into her lungs, and the operation stopped, but within days the fluid led to infection, Adult Respiratory Distress Syndrome. She died 11 days later, on April 23, 2003, after her husband and two daughters agreed to take her off life support.

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  • Anonymous

    You mean the ever elusive “defensive medicine” doesn’t stop lawsuits from being filed?

    Are there any articles of faith/nonsense left for physicians to hold on to?

  • Mike

    Hey anonymous, read the article. It WASNT defensive medicine. The guy thought she needed it or else he just wanted to bill for a colonoscopy. Either way, he’s being punished for not telling the future.

    Oh lawyers, when will you share your magic crystal ball with us to predict who will have a rare outcome and who won’t. Oh geniuses and empathizers of mankind. Please help the deluded and evil doctors. Save us from ourselves.

    “Kill all the lawyers”. As true in Shakespeare’s time as it is today.

    And I feel bad for the husband. If it was my wife, I’d be devastated. But no test has zero risk. Jesus, why doesn’t anyone get this fact.

  • different anon

    “But no test has zero risk. Jesus, why doesn’t anyone get this fact.”

    They do. Read the article.

    The husband’s argument is that in this situation the risk of action (test) was greater than the risk of inaction (no test).

    The doctor’s argument is that the risk of rupture was greater than any risks in not performing a colonoscopy.

    The doctor was obviously proven wrong in his assessment of the risks of doing nothing as there was no blockage.

    The question is whether it was negligent not to made the “correct” decision in light of the following: (a) the pertinent info he ignored by never consulting the radiologist, (b) the other relevant information he DID have; WHICH IS WEIGHED AGAINST (c) the inherent risk of the procedure.

    So far (from the article):
    1 J.D. and 1 M.D. = yes
    1 J.D. and 1 M.D. = no

    Seems a fair question nonetheless . . .

  • Anonymous

    I think there will be more of these type lawsuits as the public become more aware of the practice of defensive medicine. Once they realize that the Drs. practice it not for patients protection but for their own, drs. better watch out.

    This is not a good alternative for Drs. to be taking. Kind of like biting the hand that feeds you.

  • Anonymous

    Then it’s damned if I do overtest/overtreat, damned if I don’t. Sounds like docs can’t win. We should just quit. Who needs the specter of a lawsuit hanging over their heads every day anyway?

  • Mike

    Hey Different anon, we dont “consult” radiologists. They read X rays. And guess what: they arent always right. And he wasnt “obviously” proven wrong. How would he know without putting the camera in. Now you’re saying he should have KNOWN there was 100 percent chance of no obstruction, even though clinically he felt there was a risk.

    Aspirating at a colonoscopy is a rare thing. But it has nithing to do with the decision to do the test.

    If only we could be as prescient as the lawyers.

    If the GI doc had been right, then the radilogists would have been sued for getting it wrong..

    You guys just dont get it. THE PATIENT HAD A BAD OUTCOME!! END OF STORY!!! No lawsuit should occur. And yet it does. But I’m sure we’
    re just making it all up and there are no frivolous lawsuits, because Mr Spector says so.

  • Anonymous

    Given the number of times we hear physicians’ complain of poor reporting on medical issues, how are you so sure that this reporter got the issues in this lawsuit correct and there was not malpractice? Does it suddenly become easier for journalists to get it right if there’s a lawsuit filed?

  • different anon

    Mike:

    I don’t care what you call it -chatting, rapping, asking, consulting (the term in the article) – GET THE FRIGGING INFO and read it yourself and factor it into your decision-making.

    The before/after distinction was the one I explicated. This is the stuff of risk/benefit trade-off and complex decision-making.

    When I say “obviously proven wrong” I am referring to the presence of some perceived risk of inaction (Is it ACTUALLY there or not?). This dos not mean that the overall decision to look was “wrong.” If every expert and doctor on earth agreed that all the signs/symptoms/data pointed to a blockage and a very very heavy risk of rupture, but there in the end of the day there was not, they would have all been WRONG as to the presence of the blockage, but the risk analysis would have been “correct” because the risk of inaction (based on the available info) outweighed the risk of action.

    Lets say that a doctor walked up to me on the street and told me he “clinically felt” that I need to be scoped “just to make sure.” Sure, “How would he know unless he looked?” would be technically accurate, but silly. My response would be that we’ll just wait and see (an alternate that would clearly be justified) and if the window of concern passes . . . we know I was right and he was proven wrong – after the fact. More importantly, the doctor’s cost-benefit decision-making would have been “flawed” ex ante because “no test has zero risk.”

    Now compare that with this statement: “Aspirating at a colonoscopy is a rare thing. But it has nothing to do with the decision to do the test.” Well it should, given that “no test has zero risk.” Which is it? The statements are logically incoherent unless you are only talking about the specific risk of aspiration. If you are talking of the overall risk inherent in any such procedure (as I would hope), then it sure as hell better have something to do with that decision. That is not me practicing medicine, that is bloody logic.

    Obviously this is a professional judgment call, but the question at issue is whether it was reasonable at the time to order the test given all the factors discussed (regardless of outcome).

    To not properly assess and/or factor these risks (as determined by some professional standard – before the fact) may or may not = “malpractice,” but it sure as hell is just crappy and illogical decision-making.

    To address some specifics: “How would he know without putting the camera in. Now you’re saying he should have KNOWN there was 100 percent chance of no obstruction, even though clinically he felt there was a risk.”

    No. I said no such thing as I have tried to explain and it worries me that a doctor can not understand the distinction. Just because he “clinically felt” there was a risk DOES NOT per se make it reasonable, especially if no other doctor would have “clinically felt” that risk.

    Please try to “rationally” interpret my words and the logic of my argument rather than “clinically feeling” them.

  • Anonymous

    If it’s not mechanical bowel obstruction on clinical exam, plain films and CT, how useful is colonoscopy in arriving at the diagnosis? The patient has to be prepped for the procedure,drink gallons of Polyethylene glycol and this patient had been vomiting. And I thought you have to put an NG tube to decompress that bowel.
    So if this patient might have mechanical obstruction, maybe she should have had a plain film of the abdomen prior to the colonoscopy to see if all that fluid she drank was in the stomach and proximal small bowel raising the risk of aspiration. I am wondering if they considered mesenteric artery embolism or mesenteric vein thrombosis which can present with ileus. But then we have the benefit of hindsight.
    I have been an ER doctor for 20 years and I have not seen any of the patients I have admitted undergo a colonoscopy to r/o bowel obstruction if the films and CT were negative. Now, some underwent exploratory laparotomy even with negative tests and this was a judgement call made by the surgeon. Is there an expert out there who can enlighten me in the utility of colonoscopy to diagnose bowel obstruction in a patient with intractable vomiting?

  • Anonymous

    Alot of what Dr. Marks said was lies. I was there and I know what happened and she did not need to die.

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