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Difficulty: HardMedical Errors and Malpractice

A 68-year-old man undergoes a screening colonoscopy. A 15-mm sessile polyp is identified in the sigmoid colon and removed via snare polypectomy. Four hours after discharge, the patient presents to the emergency department with severe, diffuse abdominal pain, tachycardia, and rigidity. An upright chest radiograph shows free air under the diaphragm. The patient is taken for an emergent exploratory laparotomy, which reveals a 1-cm perforation at the polypectomy site. The surgical team notes that the bowel wall in that segment was severely thinned due to extensive underlying diverticular disease. The patient undergoes a partial colectomy with a temporary colostomy. He requires a 14-day hospital stay and misses two months of work.

The patient subsequently files a medical malpractice lawsuit against the gastroenterologist. During discovery, independent expert witnesses for both the plaintiff and the defense review the case. They unanimously agree that the gastroenterologist utilized the correct technique, applied appropriate electrocautery settings, and acted in complete accordance with accepted medical standards for polyp removal. The risk of perforation was explicitly discussed with the patient and documented in the signed informed consent form.

Based on these facts, which of the following best describes the most likely outcome of the malpractice claim and its primary legal rationale?

  1. The defendant will prevail because the plaintiff cannot establish a breach of duty.Answer
  2. B
    The defendant will prevail because the signed informed consent document constitutes a legal waiver of liability.
  3. C
    The plaintiff will prevail because performing a polypectomy in the setting of diverticulosis is an absolute contraindication.
  4. D
    The plaintiff will prevail because the hospital failed to conduct a post-event Failure Mode and Effects Analysis.
  5. E
    The plaintiff will prevail because the underlying diverticular disease acted as an epidemiological confounder.

Answer

The defendant will prevail because the plaintiff cannot establish a breach of duty.
Medical malpractice is a legal tort that requires the plaintiff to prove four distinct elements: a duty of care was owed, the physician breached that duty (deviated from the accepted standard of care), the breach directly caused an injury, and the patient suffered damages. In this scenario, the physician-patient relationship establishes duty, the procedure caused the perforation (causation), and the patient required surgery and missed work (damages). However, independent experts agreed the physician followed accepted medical standards perfectly. Because there was no deviation from the standard of care, there was no breach of duty. A known complication of a procedure, when performed correctly, does not constitute negligence. Therefore, the physician will prevail.

Step-by-Step Solution

1
Analyze the four elements required for a successful medical malpractice (negligence) claim.
The four elements are: Duty, Breach of Duty, Causation, and Damages.
All four elements must be proven by a preponderance of the evidence for a plaintiff to win a malpractice lawsuit.
2
Evaluate the clinical vignette to determine which elements are present.
Duty exists (physician-patient relationship). Causation exists (the procedure caused the perforation). Damages exist (surgery, hospitalization, lost wages).
Applying the facts of the case to the legal framework.
3
Determine if a breach of duty (deviation from the standard of care) occurred.
The vignette explicitly states expert witnesses agreed the physician acted in complete accordance with accepted medical standards.
Because the standard of care was met, there is no breach of duty. The complication was a known risk, not a result of negligence.
4
Conclude the legal outcome based on the missing element.
Since breach of duty cannot be established, the malpractice claim will fail, and the defendant physician will prevail.
A bad outcome or known complication does not constitute malpractice in the absence of a deviation from the standard of care.

Key Concept

To establish medical malpractice (negligence), a plaintiff must prove four elements: duty, breach of duty (deviation from the standard of care), causation, and damages. An adverse outcome or known complication does not constitute malpractice if the standard of care was met.
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Medical Errors and Malpractice

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