NO PERFORMANCE IS BETTER THAN IMPROPER PERFORMANCE. MALPRACTICE AND LIABILITY IMPLICATIONS OF CONTRAINDICATING A GASTROINTESTINAL ENDOSCOPY PROCEDURE

E. Toader, G. G. Bălan, D. B. Iliescu

Abstract: Digestive endoscopy procedures are performed in millions of cases worldwide each year, and the appropriateness of indications is relatively well defined by guidelines or professional societies’ recommendations. Nevertheless, endoscopists are facing situations when performance of a procedure should be refused due to either inability to achieve proper quality indicators or lack of reasonable risk/benefit ratio. Such circumstances may trigger patient insatisfaction, and furthermore may lead to malpractice and medical litigation. The aim of our study is to assess the medico-legal implications of procedural refusal in digestive endoscopy and to find proper solutions and indications for endoscopists. Google Scholar was searched for reported keywords and a review of the relevant publications was performed. Despite the multitude of guidelines and recommendations, the indications for digestive endoscopy procedures are still not clearly defined. Contraindications are inconsistently reported. Quality indicators and timing of procedures vaguely defined. Therefore, even if refusing to perform a procedure may seem a feasible alternative in particular situations, it may trigger legal liability consequences. Endoscopists should be aware of such consequences and local position statements are encouraged.
Keywords: upper digestive tract bleeding, gastroscopy, colonoscopy, surveillance, colon preparation