Medico-legal implications for the colon perforation during colonoscopy.

Colon perforation is the most serious complication of colonoscopy, and tends to be considered as malpractice. The aim of this study was to identify the characteristics and causes of medical accidents by analyzing lawsuit cases on colon perforation during colonoscopy. We collected judgment results that were ruled from 2005 to 2015 using the keyword 'colonoscopy' in the 'Korea's Written Judgment Public Reading System' of the Supreme Court, and extracted the cases of colon perforation. Characteristics of medical accidents and the decisions of courts were analyzed from written judgments. Twenty-two lawsuits were analyzed. Most cases were ruled in favor of the plaintiff (n = 20). The allegations against defendants, as filed by the plaintiffs, were performance error (n = 22), improper monitoring after colonoscopy (n = 7), and a lack of informed consent (n = 8). The median compensation was 9335.47 US dollars; this is about 130 times the cost of a single colonoscopy in Korea. The greater the intestinal damage, the greater the amount of compensation (p = 0.016). The time interval from procedure to diagnosis of perforation was most frequently 24 h later (n = 9). It is important to educate patients completely about the symptoms of colon perforation and to guide them to contact medical institutions immediately when symptoms occur. In addition, doctors should explain sufficiently the possibility of perforation before colonoscopy to the patient, and not the caregiver, and get informed consent.

Disparities in endoscopy use for colorectal cancer screening in the United States.

It is well established that disparities exist for colorectal cancer (CRC) incidence rates and death. With screening, death from CRC may be considered a preventable occurrence. Endoscopy (flexible sigmoidoscopy and colonoscopy) is the only modality with therapeutic benefit of removal of pre-cancerous polyps. The Patient Protection and Affordable Care Act mandated that preventive screening services be covered, which includes endoscopy for colon cancer screening. Recent federal rules have eliminated cost sharing for polyp removal during screening colonoscopy in privately insured patients; however, this has not been mandated for Medicare patients. Understanding the current state of disparities in endoscopy use is important, as these policy changes will affect millions of patients. The purpose of this literature review was to summarize the known research on disparities in endoscopy use for colon cancer screening in the United States and highlight areas for future research.

Using NCCN clinical practice guidelines in oncology to measure the quality of colorectal cancer care in the veterans health administration.

Clinical practice guidelines can be used to help develop measures of quality of cancer care. This article describes the use of a Cancer Care Quality Measurement System (CCQMS) to monitor these measures for colorectal cancer in the Veterans Health Administration (VHA). The CCQMS assessed practice guideline concordance primarily based on colon (14 indicators) and rectal (11 indicators) cancer care guidelines of the NCCN. Indicators were developed with input from VHA stakeholders with the goal of examining the continuum of diagnosis, neoadjuvant therapy, surgery, adjuvant therapy, and survivorship surveillance and/or end-of-life care. In addition, 9 measures of timeliness of cancer care were developed. The measures/indicators formed the basis of a computerized data abstraction tool that produced reports on quality of care in real-time as data were entered. The tool was developed for a 28-facility learning collaborative, the Colorectal Cancer Care Collaborative (C4), aimed at improving colorectal cancer (CRC) care quality. Data on 1373 incident stage I-IV CRC cases were entered over approximately 18 months and were used to target and monitor quality improvement activities. The primary opportunity for improvement involved surveillance colonoscopy and services in patients after curative-intent treatment. NCCN Clinical Practice Guidelines in Oncology were successfully used to develop a measurement system for a VHA research-operations quality improvement partnership.

Opening doors for nonphysician colonoscopists.

The current need for colonoscopies is high and steadily growing. Many healthcare facilities are finding that there is a shortage of specialized physicians to perform this procedure. By training nonphysician providers who have previously screened for colorectal cancer and performed colonoscopies safely and accurately, this shortage can be eliminated.

Complications in colonoscopy: analysis of 7-year physician-reported adverse events.

INTRODUCTION: The number of malpractice claims against physicians and health institutes in Israel is increasing continuously, as in the rest of the Western world. This trend became a serious financial burden. AIM: In this study we analyzed reports of gastroenterologists on colonoscopy adverse events to the medical malpractice insurer, as well as complaint/demand for compensation from patients represented by lawyers, between 1 January 2000 and 31 December 2006. METHODS: All the reports of physicians associated with colonoscopy adverse events from health institutes covered by Madanes Insurance Group were analyzed and summarized using a specially designed questionnaire. Clinical and epidemiological details about the patients, procedures, and adverse events were coded into an excel sheet, discussed, and evaluated. RESULTS: One hundred and two cases of colonoscopy adverse events were reported. There were 48 cases of men (47.1%) and the average age was 69.9±12.90 years. In this period of time 252 064 colonoscopies were performed by the institutes in the sampling frame, and the number of adverse events was on average 4.0 (between 2.8 and 6.2) for 10 000 colonoscopies. The difference between the years was not statistically significant. Perforation occurred in one of 2864 procedures, bleeding in one of 29 007 procedures, and respiratory complications in one of 50 412 procedures. CONCLUSION: This is the first study in Israel based on physicians' reports of colonoscopic adverse events. The picture is optimistic, as the rate of complications is low, and the data encourage early detection and reporting.

[Alleged malpractice claims related to gastrointestinal endoscopy. Analysis of casuistics over 22 years]. / Reclamaciones por presunta negligencia relacionadas con endoscopia digestiva. Análisis de una casuística de 22 años.

We reviewed the records of patients filing alleged malpractice claims related to gastrointestinal endoscopy to the Professional Responsibility Section of the Medical Council of Catalonia from 1987 to 2009 to determine the frequency of medical errors or substandard care in the practice of this procedure and the result of complaints according to whether malpractice might have been involved or not. There were a total of 66 complaints, 46 (70%) after colonoscopy, 12 (18%) after endoscopic retrograde cholangiography and eight (12%) after gastroscopy. In 18 (27%) cases, we considered malpractice to have been probable, due to lack of informed consent in four, delayed treatment of complications in six, substandard sedation in five, misdiagnosis in two and substandard practice in one, which would justify the complaints. Of the 48 cases we considered not to have involved malpractice, a guilty verdict was secured in one and an out-of-court settlement was reached in six with regard to the disproportionate and permanent harm experienced by the patients. Among the 66 claims, an out-of-court settlement was reached with the complainant on 19 occasions (28.7%) and a civil or penal trial was held in 39 (59%), resulting in a guilty verdict in only 10% of cases. In eight cases (15.3%), the complainant took no further action after receiving the response of the Professional Responsibility Section. The number of complaints progressively increased over the study period. There were a greater number of complaints in private clinics than in public hospitals. Endoscopists with more than one complaint were more frequently found guilty or reached an out-of-court settlement than those with only one complaint against them (100% versus 28%). Analysis of complaints of alleged malpractice is useful to identify areas requiring improved patients safety and to reduce the number of these complaints.

Risk management and legal issues for colonoscopy.

This article reviews potential risk areas and legal issues in quality and colonoscopy. These include issues about open access colonoscopy, informed consent for colonoscopy, missed colorectal cancer, problems related to anticoagulation or its withdrawal for colonoscopy, procedural problems with sedation, failure to follow up appropriately, and failure to identify and warn of high genetic risk.