Would a 2-year window since a hemorrhoidectomy without informed consent negate a potential malpractice lawsuit for a patient with a history of Crohn's disease who has developed a fistula?

Legal Considerations for Malpractice Claims in Crohn's Disease Patients Post-Hemorrhoidectomy

The 2-year statute of limitations may not protect against malpractice claims if the fistula represents a newly discovered injury, as most jurisdictions apply a "discovery rule" that restarts the limitations period when the harm becomes apparent, and lack of informed consent claims may have separate limitation periods or be considered distinct from negligence claims. 1

Understanding the Statute of Limitations Framework

The statute of limitations for medical malpractice varies by state, but the critical issue here involves two distinct legal concepts that may extend or restart the limitations period:

The Discovery Rule

• Most jurisdictions apply a "discovery rule" where the statute of limitations begins when the patient discovers (or reasonably should have discovered) the injury, not necessarily when the original procedure occurred 1
• If the fistula developed as a delayed complication and was only recently discovered, this could constitute a "new" injury that restarts the limitations clock 1
• The development of a fistula in a Crohn's disease patient after hemorrhoidectomy represents a recognized serious complication that may not manifest immediately, potentially triggering the discovery rule 1, 2

Informed Consent as a Separate Claim

• Lack of informed consent may be treated as a distinct tort separate from medical negligence in many jurisdictions, potentially with its own statute of limitations 1
• In some states, informed consent claims are derivative of negligence and require the same limitations period; in others, they stand alone and may have different time limits 1
• Critically, an informed consent claim can be valid even if the surgical technique was performed correctly and met the standard of care 1

The Crohn's Disease Context Strengthens the Case

The specific clinical scenario of performing hemorrhoidectomy on a patient with Crohn's disease without proper informed consent creates particularly strong grounds for liability:

Established Contraindications

• Hemorrhoidectomy in Crohn's disease patients carries well-documented risks of poor healing, fistula formation, and chronic non-healing wounds 1, 2
• The European Crohn's and Colitis Organisation explicitly states that "the most conservative approach should be adopted to avoid soft tissue damage and prevent extensive scarring" in perianal Crohn's disease 1
• Concomitant perianal procedures in Crohn's patients "can lead to chronic, non-healing ulcers" 1

Standard of Care Violations

• The standard of care requires thorough informed consent discussion including risks specific to Crohn's disease patients, alternative treatments, and the option of no treatment 1
• Failure to disclose the elevated risk of fistula formation in a Crohn's patient undergoing hemorrhoidectomy likely violates both the "reasonable-patient" and "reasonable-physician" standards of informed consent 1

State-Specific Variations to Consider

Without knowing your specific state, be aware that:

• Some jurisdictions use a "locality" standard requiring experts to demonstrate familiarity with local standards of care 1
• The applicable standard may be either "reasonable-patient" (what a reasonable patient would want to know) or "reasonable-physician" (what physicians customarily disclose) 1
• Out-of-state expert witnesses may need to demonstrate familiarity with your state's local standard of care 1

Critical Pitfalls in This Scenario

• The continuous treatment doctrine may apply if the patient remained under the surgeon's care, potentially extending the limitations period 1
• If the fistula represents a "continuing harm" rather than a discrete injury, some jurisdictions may view this as ongoing negligence 1
• The presence of Crohn's disease as a pre-existing condition makes the informed consent failure more egregious, as the risks were predictably higher and should have been explicitly discussed 1, 2

Practical Legal Exposure

The malpractice exposure here involves multiple potential claims:

1. Negligence in performing a contraindicated procedure (hemorrhoidectomy in Crohn's disease without compelling indication) 1, 2
2. Lack of informed consent (failure to disclose elevated risks specific to Crohn's patients) 1
3. Potential "discovery rule" application if the fistula was not immediately apparent 1

The development of the fistula as a delayed complication likely reopens or extends the window for legal action, particularly if it can be demonstrated that the patient could not have reasonably discovered the full extent of injury within the original 2-year period. 1