Gastroenterology
Ref. # 02348

A 73 year old Ohio woman with a long history of irritable bowel syndrome and a seven-day history of constipation was evaluated in the ER. She was treated with magnesium citrate and discharged. She returned the next day with severe cramping. An abdominal X-ray series showed distention of the transverse colon; a sigmoidoscopy was concurrent with a partial obstruction. The patient then required a barium enema to make a more accurate diagnosis. Instead a colonoscopy was performed and it revealed a high-grade partial obstruction of the distal descending proximal sigmoid colon. Records of the colonoscopy note: a 50-cm stricture was found; dilation with air was attempted; and perforation occurred. The patient underwent emergent colectomy/colostomy and expired seven days later after a stormy course. A medQuest gastroenterologist reported that although perforation is a known complication of colonoscopy, in light of the high-grade obstruction it was below the standard of care to perform a colonoscopy, a high-risk procedure, rather than a barium enema.

Gastroenterology
Ref. # 80148

A middle aged Louisiana woman complained to her primary care physician of abdominal pain, weight loss and diarrhea. Treatment consisted of 60mg of prednisone daily. The pain persisted for more than a month, when the patient was referred to two gastroenterologists. An upper endoscopy showed distal gastritis. A CT scan showed a fatty liver and calcification of the abdominal aorta. A colonoscopy showed diverticulosis. During the next months the primary care physician performed multiple blood tests and X-rays and documented that the patientÀ s sedimentation rates and white blood cell count were elevated. Another upper endoscopy showed villous flattening of the small intestines and mild diffuse gastritis. For the following nine months the patient underwent numerous and frequent evaluations by her primary care physician as before. The patient became extremely ill and was diagnosed with acute cholecystitis. A CT scan showed hemangiomas of the liver. One month later the patient was admitted to the ER for nausea and vomiting. She was discharged then readmitted for a laparoscopic cholecystectomy, which showed chronic cholecystitis with stones. Upper endoscopies one month and three months later showed gastritis and small ulcers. One month later the patient was readmitted and underwent an upper endoscopy, which was negative. A colonoscopy revealed diverticulosis and a questionable stricture. A barium enema showed spasm. The patient was discharged with no diagnosis. One month later the patient was referred to another gastroenterologist, who diagnosed ischemic bowel disease. The patient underwent surgery and did well. A medQuest gastroenterologist reported the primary care physician and initial two gastroenterologists negligently failed to diagnose ischemic bowel disease over the one and a half year period despite multiple diagnostic evaluations. The patient's pain and suffering and subsequent medical care were preventable.

Gastroenterology
Ref. # 92908

A 42 year old New York man, a Vietnam veteran, suffered from post-traumatic stress syndrome, vertigo, deafness, and hypertension, requiring periodic hospitalization for recurring psychosis. Two years earlier he was diagnosed with asymptomatic hepatitis C. He was admitted to the VA hospital for catatonia, during which evaluation showed proteinuria and evidence of mild renal insufficiency. One month later he was again admitted for fatigue. Work-up revealed a new anemia, which required a transfusion. In the subsequent days, the patient experienced progressive renal insufficiency, drug rash, left cerebellar infarct, seizure, and a hypertensive crisis. The patient was diagnosed with cryoglobulinemia. During transfer to the ICU, the patient was moved from the stretcher and the endotracheal tube became dislodged. Reintubation was unsuccessful despite surgical means and the patient expired. According to the attorney for the deceased's estate, the cause of death was variously stated as active hepatitis and cirrhosis, and as an iatrogenic event resulting from a dislodged airway. A medQuest gastroenterologist specializing in liver disease reported the autopsy showed no evidence of malignancy or signs of decompensated liver disease. The attending health-care providers negligently placed the patient at risk during the transfer, making feasible the dislodging of the tube. With appropriate medical care, including dialysis, plasmapheresis, and other therapies, the patient would have had a very reasonable long-term survival.