This case takes place in New York and involves a female patient who underwent a colonoscopy with a colorectal surgeon. The surgeon thought there might have been a polyp, but it was not removed, nor were there any steps taken to positively identify the abnormality. The interpretation in the report was a normal colon with no recommendation of a follow up. A year later, the patient presented to a physician with blood in her stool and a colonoscopy was recommended. A mass was identified and a gastrointestinal biopsy was taken that revealed aggressive colon cancer. The patient eventually died from the cancer after it has metastasized. It is alleged that the colorectal surgeon deviated from the standard of care when he failed to properly remove the polyp and biopsy it, and when he failed to order an additional colonoscopy within a year to ensure the area was free of cancer.
Question(s) For Expert Witness
- 1.) How often do you perform screening colonoscopies?
- 2.) What is the standard follow up for patients with the findings mentioned in this summary?
- 3.) Could earlier diagnosis have improved the prognosis for this patient?
Expert Witness Response E-008572
I perform colonoscopies 2-3 times a week. If I were concerned that there was something suspicious, I would biopsy it. If the biopsy came back normal but I was still suspicious I would bring the patient back in a short interval such as 6 months to a year. If the polyp or abnormality was in the same region that the colon cancer was then most likely earlier diagnosis would have helped. I would have to look at the records.
Expert Witness Response E-008438
I perform screening colonoscopies every week. An early diagnosis, and more importantly removal of colonic adenomas are both crucial preventive measures. Based on your description I am not sure whether a biopsy was taken. Further recommendations are based on the biopsy result. There are many important aspects that can influence outcome of this case. ( e.g. was there a good prep, how well the physician described the procedure, did the endoscopist inform the patient about a legitimate miss rate during a colonoscopy, how long it took etc.)