Failure to Diagnose Ulcerative Colitis
During a three week trial, Wingate, Russotti, Shapiro & Halperin partner Jason Rubin settled a medical malpractice case involving the failure to diagnose ulcerative colitis, resulting in toxic megacolon, bowel perforation and the need for colectomy with ileostomy.
Our client, a 46 year old woman who had recently been diagnosed with hyperthyroidism, presented to the emergency room of defendant hospital on October 30th with complaints of nausea, vomiting, severe diarrhea, tachycardia, tachypnea and shortness of breath. She was diagnosed with severe hyperthyroidism, was admitted to the hospital and was started on a course of medications (PTU, Inderal and hydrocortisone). Over the ensuing three days, her hyperthyroidism improved significantly, yet she still had persistent, severe diarrhea. Accordingly, a gastroenterology consult was requested and performed on November 2nd. It was the opinion of the gastroenterologists that the diarrhea was secondary to hyperthyroidism and that it may take a bit longer for it to resolve. The plan was to continue to treat plaintiff's hyperthyroidism and if the diarrhea persisted, a colonoscopy would be performed.
On Saturday November 4th, plaintiff was seen by a covering gastroenterologist. She continued to have significant diarrhea and complained of bright red blood per rectum. An abdominal examination revealed mild diffuse abdominal tenderness. Additionally, a stool study indicated that there were many white blood cells in the stool. Despite these findings, no further workup was performed and in fact, our client was not seen by a gastroenterologist the following two days even though she continued to have profuse diarrhea.
On November 7th, our client experienced severe abdominal pain. A physical examination revealed rebound tenderness and guarding. A CT scan was performed which revealed toxic megacolon (distention of the colon) and perforation. She then underwent an emergency colectomy with ileostomy (removal of the colon and creation of a surgical opening in the abdomen to allow waste to pass from the small intestine into a bag). Examination of the surgical specimens by a pathologist revealed that she had severe ulcerative colitis throughout the entire colon. Plaintiff had a stormy post-operative course, developing sepsis and acute respiratory distress syndrome as a result of the perforation of the bowel. She also developed severe muscle weakness which required months of physical therapy to resolve.
At trial, Jason claimed that the gastroenterologists at defendant hospital were negligent for not performing a sigmoidoscopy or colonoscopy on November 4th and thereafter, as the plaintiff exhibited several signs and symptoms of bowel inflammation including bright red blood per rectum, mild diffuse abdominal tenderness while on steroids, white blood cells in the stool and a rising white blood cell count. Additionally, Jason claimed that the gastroenterologists failed to follow their own plan to perform a colonoscopy if the diarrhea persisted, which it did despite the resolution of hyperthyroidism. He argued that an endoscopic examination of the colon on November 4th or thereafter would have led to a diagnosis of ulcerative colitis prior to the perforation of the colon and had the diagnosis been made earlier, our client could have been treated with corticosteroids in therapeutic dosages, preventing the need for a colectomy.