Virginia Patient Awarded $500,000 After Doctors Mocked Him While Unconscious During Colonoscopy

220px-Operating_theatreA year ago, we discussed a bizarre case where a colonoscopy patient (identified only as “DB”) is suing over abusive comments made about him by his doctors . . . while he was under anesthesia. “DB” had failed to turn off his cellphone which continued to record comments of the doctors ridiculing him, his body, and his character. While the alleged defamation did not leave the operating room (that is until his lawsuit), he alleged that it was still defamation and Dr. Tiffany Ingham and others for $1.35 million in damages for defamation, infliction of emotional distress and illegally disclosing his health records. Well, after a three-day trial, a Fairfax County jury ordered the anesthesiologist and her practice to pay him $500,000.

On the tape, Dr. Tiffany Ingham is recorded addressing his unconscious body: “And really, after five minutes of talking to you in pre-op I wanted to punch you in the face and man you up a little bit.” She also reportedly called him a “big wimp” and a “retard.” In addition about ridiculing his alma mater of Mary Washington College, she is quoted as saying more menacing things about firing a gun up his rectum and suggesting that they falsely note on his chart that he had hemorrhoids.

The staff is portrayed as exhibiting all of the decorum and professionalism of an Animal House fraternity with Ingham as the resident Bluto. Some members reportedly jokes about a rash on DB’s penis and how he looks like he has syphilis. Ingham, who comes off particularly badly, is quoted as saying “It’s probably tuberculosis in the penis, so you’ll be all right.” They all discussed avoiding DB after the surgery. As discussed earlier, defamation does not require contemporary knowledge and indeed it is often discovered later by the victim. Moreover, it only requires publication to other individuals, not widespread disclosure or publication.

The jury appears to have rejected any argument that this was merely juvenile humor or even opinion. Clearly they are expressing their opinion as to his being a “wimp” or “retard.” Dr. Ingham, 42, could not be reached for comment and she no longer appears to work out of the Aisthesis anesthesia practice in Bethesda, Md. State licensing records indicate she has moved to Florida. The gastroenterologist who performed the colonoscopy, Soloman Shah, 48, was dismissed from the case, but he is shown engaging in the juvenile comments.

The jury awarded the man $100,000 for defamation — $50,000 each for the comments about the man having syphilis and tuberculosis — and $200,000 for medical malpractice, as well as the $200,000 in punitive damages.

110 thoughts on “Virginia Patient Awarded $500,000 After Doctors Mocked Him While Unconscious During Colonoscopy”

  1. Here’s something the apologists for the Virginia doctors’ hostility and callousness may want to chew on:

    JAMA (Journal of the American Medical Association) COMMENTARY

    “Is US Health Really the Best in the World?
    Barbara Starfield, MD, MPH


    “The fact that more than 40 million people have no health insurance is well known. The high cost of the health care system is considered to be a deficit, but seems to be tolerated under the assumption that better health results from more expensive care, despite evidence from a few studies indicating that as
    many as 20% to 30% of patients receive contraindicated care.
    (1) [emphasis added]

    “In addition, with the release of the Institute of Medicine (IOM) report “To Err Is Human,”(2) millions of Americans learned, for the first time, that an estimated 44,000 to 98,000 among them die each year as a result of medical errors. [emphasis added]

    “The health care system also may contribute to poor health through its adverse effects. For example, US estimates (8-10) of the combined effect of errors and adverse effects that occur because of iatrogenic damage not associated with recognizable error include:

    • 12,000 deaths/year from unnecessary surgery
    • 7,000 deaths/year from medication errors in hospitals
    • 20,000 deaths/year from other errors in hospitals
    • 80,000 deaths/year from nosocomial infections in hospitals
    • 106,000 deaths/year from non-error, adverse effects of medications

    “These total to 225 000 deaths per year from iatrogenic causes. [emphasis added] Three caveats should be noted. First, most of the data are derived from studies in hospitalized patients. Second, these estimates are for deaths only and do not include adverse effects that are associated with disability or discomfort. [emphasis added] Third, the estimates of death due to error are lower than those in the IOM report.(1)

    “If the higher estimates are used, the deaths due to iatrogenic causes would range from 230,000
    to 284,000. In any case, 225,000 deaths per year constitutes the third leading cause of death in the United States, after deaths from heart disease and cancer.” [emphasis added]

    I leave it to the imaginations of prospective patients of medical doctors whether an attitude such as manifested by the Virginia MDs is more, or less, likely to contribute to the injury and death toll cited by Dr. Starfield.

    Good luck to the apologists for those doctors. They’re going to need it.

    1. My God, hospitals kill more people than guns. Geez, who’d a thunk it? Don’t tell ninian, he’ll have a stroke.

  2. @ JT on the Virginia Medical Doctors’ Hostility and Callousness

    The comments on JT’s original column and this update are more revealing of the personalities of the commenters than a Rorschach Ink Blot.

  3. This will teach slime-ball doctor’s to keep this unprofessional trash to themselves…glad these vermin were sued…and the patient had a sweet little windfall…surprised they didn’t settle it out of court…they wanted a trial and got the shaft even worse…stupid insurance carriers got worked…enjoy!

  4. Post operative Cognitive Decline following General Anaesthesia

    Here is a paper from Scientific American which discusses this condition.

    Hope this is helpful.

    Colonoscopy: I had one of these procedures just with iv fentanyl analgesia so I could watch it on the monitor fully conscious. It wasn’t too uncomfortable. I hope this information is reassuring.

    As a general rule doctors try to avoid general anaesthesia unless it is specifically indicated.

  5. Mortality Risk of Anaesthesia in Elderly

    According to this paper the risk increases after 75yrs and is 0.5% which is 1:200

    It us important to back up data with references and I would be grateful if you could post the reference for loss of brain function of 30% at 65 yrs. I will continue to look for this

  6. Wow…and anyone wonders why a colonoscopy is one of the least desirable elective procedures one can have? Ain’t it bad enough you have to sit for 4+ hours on the stool drinking a G-d awful jug of colonic the day before? Then pass gas like a freight train afterwards? The procedure itself is fall of the log easy on the patient, but the prep sure sucks…not from pain,l but tedium and feeling like a bloated cow for a while. Fortunately I am not due for another for 6 years…since the last one show no abnormalities. Yay!!

    Next, I gotta go with forgotwhoiam on the “listening in” bit regarding restaurants. Now those guys on a bad day can make a real mess for you 😀 If they don’t like you for any reason it can be downright dangerous. One reason that I like the outfits that let you see the cooking being done.

    As for doctors, and the anesthesiologist you meet but momentarily, I want their focus on the procedure and my best outcome…not some anomaly on my weenie (yee gawd) or whatever, which I assure anyone is total unremarkable. Fortunately I have had no bad experiences with doctors and their staff in surgical procedures and for that I am grateful…and I usually tell them so in recovery. That said, I am v-e-r-y careful who to & where I go for medical care. After two cancer remediations I’d say I’ve been on the money so far.

    1. Aridog – I do not react well to anesthesia and have avoided taking a colonoscopy for that reason. I have just found out that those who are over 65 have a 30% chance of permanent brain function loss during surgery. I just turned down another surgery because of that.

      If you are over 65 do not have any elective surgery done where they put you totally under. They are working on new procedures but they are not available yet.

  7. Bam Bam

    And you are not unreasonable.

    But people work best in a less hostile environment. That’s all I’m trying to say.

    And if working as a doctor resembles working in a bear pit, doctors will opt out and care will be more difficult to access. This may already be happening.

    The doctor in this blog got her just desserts but the bumper sticker I once saw in the USA says it all: “Support a Lawyer Send your kid to Medical School” – a great slogan and it made me laugh…..

    I know you want lots of things – so do I – but wanting something doesn’t necessarily make it happen.

    The best chance for promotion of good medicine is to support the efforts of your doctors when you can. They are human too… treat them like you would like to be treated. A little mutual respect would not go amiss.

    i.e. more carrot and less stick.

    If patients show little trust in their doctors, they may not want to treat them. Why risk a law suit from a more aggressive or demanding patient?

    There is a risk of backfire and I am only urging the creation of a good doctor patient relationship. This is difficult to procure in an atmosphere of mistrust.

    The best way to do this is in my experience is to invite the patient to join your team. Involve them in decisions let them understand the difficulties when you try to do your best. Show that you care. Be truthful if you can’t help admit it. You build a relationship of trust with the patient. If something goes wrong apologise and put it right. But above all show them that you are human.

    You can’t teach this to a doctor. They have empathy or they don’t. ….

    1. ninianpeckitt – nice of you to advice us on our health care system. However, how about cleaning up the NHS. It is killing people daily.

      1. It’s my pleasure !

        You are absolutely right that since the introduction of a managed market system of health care imported from the USA in the 1980s the British NHS has collapsed. And this collapse has been spectacular with a massive increase in service delivery costs.

        It is no longer an example of the Socialised Medicine System so admired and peddled by Don Berwick. And I have corresponded with him on this matter to emphasise that his concept of NHS care no longer exists. But it did exist at one time.

        Doctors are doing things to facilitate effective reform and are being targeted for their efforts. Our General Medical Council is under police investigation and it is clear they are underpinning the targeting of doctors by the NHS – targeting that is admitted by government.

        Your doctors need the support of the public if they are to perform well – not divisive criticism, which makes good medicine harder to achieve.

        If a lawyer had his case undermined by his client the result may not be the best outcome. And if he then sues the lawyer for losing the case…. an ineffective culture can be created.

        A return to common sense is required and until that happens a chaos based on distrust will continue. This is especially important now Obama care is here. Big changes are afoot…. the result will depend on the wisdom of its management.

        Just think how you would like to be treated at work in order to enjoy your work and maximise your own performance.

        If you treat your doctors badly you will get bad healthcare

        1. ninianpeckitt – I have heard several of my doctors say they will retire early.

  8. @Professor Ninian Peckitt

    Careful what we wish for?

    Well, let’s see. . .here’s my list:

    I wish to have a medical procedure, like a colonoscopy, performed by a trained, professional who, after meeting me for a few minutes prior to said procedure, will not suddenly decide, while I am unconscious and naked during said colonoscopy, to declare that she ought to punch me in the face and that I need to man up;

    I wish to have a medical procedure, like a colonoscopy, performed by a trained professional who, during the course of said procedure, doesn’t resort to calling me a wimp or a retard;

    I wish to have a medical procedure, like a colonoscopy, performed by a sane and competent professional who, during the course of said procedure, doesn’t declare that she should shoot a gun up my rectum;

    I wish to have a medical procedure, like a colonoscopy, performed by a sane and competent professional who, during the course of said procedure, doesn’t openly suggest that she should falsify my medical records and claim that I have hemorrhoids;

    I wish to have a medical procedure, like a colonoscopy, performed by a sane and competent professional who, during the course of said procedure, doesn’t make jokes about a rash on my penis or wrongly declare that I have syphilis or TB; and

    I wish to have a medical procedure, like a colonoscopy, performed by a sane and competent professional who, during the course of said procedure, remembers that she owes me, the patient, a duty to be fully aware and present while performing a test which carries multiple risks, some which could be potentially deadly.

    Now, is that too much to ask for, Professor? Am I being unreasonable? Greedy? Guess I’m just crazy like that.

    1. Bam Bam

      I have no argument with any of what you say, but it doesn’t seem to be happening at the moment?

      That”s why I posted the blog.

      If life is made difficult/impossible for doctors, their ability to provide good care becomes more difficult/impossible.

      Now Obama care is here and with the president”s court victory reported in the last 10mins, it looks like doctors will be put under more pressure. This will adversely affect standards as you are about to find out.

      Could you work like this?

      So some wisdom is required in medical regulation order to achieve these standards.

  9. The damages were awarded punitively to send a warning to doctors. In this case the doctor has been taught a lesson for behaviour that was quite unacceptable.

    We are all interested in creating an environment for patient safety and I would ask you to step back look at what is happening in the US system.

    Is a doctor going to work better if he looks at the patient or if he has to keep looking over his shoulder for the next assault on his/her competence? Is current regulation actually creating new problems whilst trying to address the old problems?

    Is this this type of monitoring and regulation making medicine safer for patients? Or is it creating an environment where something is more likely to go wrong?

    Is defensive medicine better medicine? Does it save more lives? Or do some patients die because today no doctor dares to treat them?

    Can the healthcare system afford current settlements? Patients are indirectly paying for this in the end and it will only affect the costs of healthcare, which are not always covered by insurance. Will healthcare become unaffordable?

    Can a doctor perform to the best of his/her ability under such a pressure system?

    Could you perform at your best in your own job under a parallel system?

    Are the winners here really just the lawyers? And if this is the case is their role becoming more or an agent provocateur rather than a counsellor? Are they acting primarily for their client or for themselves?

    Is it true that some high risk specialties like obstetrics are now having difficulty in recruitment and that in some States it is difficult to get an Obstetrician?

    There are now some signs that the medical profession is “fighting back”. In the UK, the General Medical Council is currently subject to a recorded crime of perverting the course of justice by the police and this case is now being reviewed by the Crown Prosecution Service. I believe that this is historic. Doctors in Scotland are demanding a judicial review of the conduct of medical investigation. Many senior doctors are taking early retirement and others are migrating to the extent that there is a serious recruitment problem, especially of experienced senior staff.

    This does not bode well for the image of establishment clinical governance and the protection of patients.

    So I think we all need to be careful what we wish for….

  10. Agree with the court and commenters above that the behavior was unprofessional and reprehensible, and also with a monetary reward to the patient. Lucky for him the phone was listening in!

    Anyhow, here’s a tip: you really don’t need Versed or other “twilight” sedation for a colonoscopy. I skipped it, and also told the docs to go low and slow with the fentanyl (narcotic), which was started at 1/3 the usual dose and nudged up to 1/2 because the doc thought I might need it at the “tricky bend”. (Actually I was fine, but whatever.) I watched the scoping on a screen throughout, and even assisted by pressing on my abdomen to keep the device moving along. Oh, and of course I heard every word of the team’s interaction. No post-procedure wooziness, etc. I saw other patients come wobbling out even after a substantial recovery lie-down, and was very happy with my decision. (Also, colon perforations are virtually impossible in an unsedated patient.)

  11. I am curious about the “publication” element.
    If no one heard it outside of the OR, other than the defendants, isn’t it missing an essential element?

  12. Juris, Good point. These are the type cases that almost always settle. I have to believe the insurer put 6 figures on the table.

  13. My vet always speaks with kindness directly to me and to my half blind guy. My vet knows that I was a human in a prior life and we in fact communicate by email– on my end with my
    Dogalogue Machine to translate the “woofs” into people yak. I was at an interview at the Pearly Gates on one of my transitions about a hundred years back and there was a guy in front of me who was a veternarian. He told Saint Peter he wanted to come back as a dog. He was granted his wish.
    This lady doctor in the article here will someday have her interview at the Pearly Gates. The episode mentioned in the article will probably come up. She will probably get to come back as a tree frog.

  14. Why in the hell did the defendant (or defendant’s insurer) let this get to a jury?! This case should have been settled well before this got to a jury. And now the defendant’s career is likely over as well. As an attorney, I think she got very bad legal advice. The risk of her career alone should have been enough to make a substantial settlement offer long before trial.

  15. This is interesting to me. I generally lean toward the defense. Although, I found doing work for plaintiff’s, the ones REALLY INJURED, some of the most satisfying work I’ve done. I think the award was excessive. But, I think it is a legit suit, and I think low six figures, say $125k would have been righteous.

  16. @Pogo

    But hims widdle feelings got hurt. My goodness, if people knew how their lawyers talked about them behind their backs! Whew It is nothing for me or my BFF Fabia Sheen, Esq. an attorney, to call our client a “crazy a$$ psycho-b*tch from hell, when talking to the other side trying to reach a settlement. And the lawyers on the other side say the same sort of thing about their client. Its just how business is done.

    Like I said above, the fact that the little p*ssy sued her is proof she was right in her assessment, I hope he takes the money, blows it on drugs, and overdoses

    Squeeky Fromm
    Girl Reporter

    1. Squeeky

      Most of the time, I come down on the side of what you believe, but not here. I don’t want those, who, quite literally, hold life or death in their hands, during a medical procedure, no less, to have the ability to abuse that sacred and important privilege bestowed upon them. Yes, I said PRIVILEGE. Not only is there a duty of care, but I would allege that doctors must be held to the highest possible standard when performing a procedure like this. Don’t compare it to the often antagonistic atmosphere surrounding many legal proceedings involving attorneys, where clients are conscious and fully clothed–ok, well, they should be. This poor schlub was naked and unconscious–how much more vulnerable can you get? A few minutes speaking with the patient, prior to a procedure, where no personalities should be involved, triggered her outrageous behavior? It’s frightening how those that we entrust with our lives, including the lives of our loved ones, could go so off the rails over the least little provocation. Don’t think for a second that the hate that she spewed, regarding this man, doesn’t impact her standard of care. I don’t think the outcome was severe enough. I would’ve yanked her license. Let her stock shelves at Wal-Mart.

  17. Paul, agreed.
    As her boss, I’d have fired her and most of those involved.
    Bad for patients and likely a harbinger of more problems than stupid behavior.

    But defamation? Hardly.
    And $1.35 million in damages? Hardly.

    The lawsuit is frivolous, and entirely retaliatory.
    Just wait, as I said. Microagressions will be litigated similarly.

    1. Pogo – once she said she was going to put that he had syphilis in his medical chart, it was all over for her. That is slander per se. She has a much larger hoop to jump over in a case like that. The defense to slander or libel is the truth so she would have to prove that he had syphilis.

      Porkchop was at the trial but I would think that the only reason they did not settle out of court was either the amount or the phone being on.

  18. I’ve been in ethics classes ranging from an afternoon workshop with the company attorney to a semester long graduate level course, and the advice is always pretty much the same. When in doubt about saying or doing something, imagine yourself on the witness stand explaining what you said or did to a jury. Then, if that doesn’t answer the question, imagine trying to explain it to your mother.

    Doctor got what was coming and hopefully the public will keep track of her behavior vie the Interwebs.

  19. “Glad this doctor got slammed. She’s a toad.

    This seems to be the primary motivation for the loss and the award
    The lawsuit (as with many of the comments here) has little or nothing to do with any actual harm, but instead demonstrates the old desire to knock people down, that is, the aggressive side of envy and the desire for retribution.

    1. Pogo – I think we have discussed the case here in the Phoenix area where a surgeon took a picture of his patient’s artistically tattooed penis during an operation. Besides losing his position at the Mayo Clinic in Scottsdale, money passed hands. A public apology was also made.

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