These audio clips are excerpts from conversations between a gastroenterologist, an anesthesiologist and a medical assistant during a colonoscopy. This was entered as evidence in a lawsuit filed by the patient for defamation and medical malpractice. (The Washington Post)

These audio clips are excerpts from conversations between a gastroenterologist, an anesthesiologist and a medical assistant during a colonoscopy. This was entered as evidence in a lawsuit filed by the patient for defamation and medical malpractice. (The Washington Post)

Sitting in his surgical gown inside a large medical suite in Reston, Va., a Vienna man prepared for his colonoscopy by pressing record on his smartphone, to capture the instructions his doctor would give him after the procedure.

But as soon as he pressed play on his way home, he was shocked out of his anesthesia-induced stupor: He found that he had recorded the entire examination and that the surgical team had mocked and insulted him as soon as he drifted off to sleep.

In addition to their vicious commentary, the doctors discussed avoiding the man after the colonoscopy, instructing an assistant to lie to him, and then placed a false diagnosis on his chart.

“After five minutes of talking to you in pre-op,” the anesthesiologist told the sedated patient, “I wanted to punch you in the face and man you up a little bit,” she was recorded saying.

When a medical assistant noted the man had a rash, the anesthesiologist warned her not to touch it, saying she might get “some syphilis on your arm or something,” then added, “It’s probably tuberculosis in the penis, so you’ll be all right.”

Tiffany M. Ingham (Maj. Dale Greer/Kentucky Air National Guard)

[Listen to clips of doctors trashing the patient]

When the assistant noted that the man reported getting queasy when watching a needle placed in his arm, the anesthesiologist remarked on the recording, “Well, why are you looking then, retard?”

There was much more. So the man sued the two doctors and their practices for defamation and medical malpractice and, last week, after a three-day trial, a Fairfax County jury ordered the anesthesiologist and her practice to pay him $500,000.

The plaintiff, identified in court papers only as “D.B.,” wanted to maintain his anonymity and did not want to comment about the case, said his attorneys, Mikhael Charnoff and Scott Perry.

The anesthesiologist, Tiffany M. Ingham, 42, could not be reached for comment, and her attorney, D. Lee Rutland, did not return messages seeking comment. Ingham worked out of the Aisthesis anesthesia practice in Bethesda, Md., which the jury ruled should pay $50,000 of the $200,000 in punitive damages it awarded. Officials there did not return a call seeking comment. Ingham no longer works there, an Aisthesis employee said, and state licensing records indicate that she has moved to Florida. An anesthesiology practice in Tavares, Fla., said she no longer worked there. Calls to a number believed to be Ingham’s were not returned, and there was not an answering machine or voicemail at that number.

[Opinion: Nurses make fun of their dying patients. And that’s okay.]

On the opening day of the trial last week, the gastroenterologist who performed the colonoscopy, Soloman Shah, 48, was dismissed from the case. Court documents state Shah also made some insulting remarks — “As long as it’s not Ebola, you’re okay,” Shah was recorded saying during the rash discussion — and did not discourage Ingham from her comments or actions, which included writing on the man’s chart that he had hemorrhoids, when he did not.

These audio clips are excerpts from conversations between a gastroenterologist, an anesthesiologist and a medical assistant during a colonoscopy. This was entered as evidence in a lawsuit filed by the patient for defamation and medical malpractice. (The Washington Post)

Neither Shah, who did not return a message left at his office, nor the lawyers on either side would comment.

[A movement is afoot to put cameras in operating rooms]

The lawyers also would not discuss whether Ingham or Shah faced disciplinary action from the Virginia Board of Medicine. No actions are listed against either on the board’s Web site.

A spokesperson for Aisthesis said in a statement Thursday: “We apologize to this patient and regret the distress and suffering that this most unfortunate incident caused. The anesthesiologist involved is no longer with our practice. Once we learned of this incident we assured that every anesthesia staff member reviewed and reiterated their pledge to abide by our professional organization’s code of ethics.”

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. Though the remarks by Ingham and Shah perhaps did not leave the operating room in Reston, experts in libel and slander said defamation does not have to be widely published, merely said by one party to another and understood by the second party to be fact, when it is not.

“I’ve never heard of a case like this,” said Lee Berlik, a Reston lawyer who specializes in defamation law. He said comments between doctors typically would be privileged, but the Vienna man claimed his recording showed that there was at least one and as many as three other people in the room during the procedure and that they were discussing matters beyond the scope of the colonoscopy.

“Usually, all [legal] publication requires is publication to someone other than the plaintiff,” Berlik said. “If one of the doctors said to someone else in the room that this guy had syphilis and tuberculosis and that person believed it, that could be a claim. Then it’s up to the jury to decide: Were the statements literal assertions of fact? The jury apparently was just so offended at this unprofessional behavior that they’re going to give the plaintiff a win. That’s what happens in the real world.”

One of the jurors, Farid Khairzada, said that “there was not much defense, because everything was on tape.” He said that the man’s attorneys asked for $1.75 million and that the $500,000 award was a compromise between one juror who thought the man deserved nothing and at least one who thought he deserved more.

“We finally came to a conclusion,” Khairzada said, “that we have to give him something, just to make sure that this doesn’t happen again.”

The colonoscopy took place in Shah’s surgical suite on April 18, 2013, according to the man’s lawsuit. While being prepped for the procedure, the man apparently told Ingham that he had passed out previously while having blood drawn and that he was taking medication for a mild rash on his genitals.

Because he was going to be fully anesthetized, the man decided to turn on his cellphone’s audio recorder before the procedure so it would capture the doctor’s post-operation instructions, the suit states. But the man’s phone, in his pants, was placed beneath him under the operating table and inadvertently recorded the audio of the entire procedure, court records show. The doctors’ attorneys argued that the recording was illegal, but the man’s attorneys noted that Virginia is a “one-party consent” state, meaning that only one person involved in a conversation need agree to the recording.

The recording captured Ingham mocking the amount of anesthetic needed to sedate the man, the lawsuit states, and Shah then commented that another doctor they both knew “would eat him for lunch.”

The discussion soon turned to the rash on the man’s penis, followed by the comments implying that the man had syphilis or tuberculosis. The doctors then discussed “misleading and avoiding” the man after he awoke, and Shah reportedly told an assistant to convince the man that he had spoken with Shah and “you just don’t remember it.” Ingham suggested Shah receive an urgent “fake page” and said, “I’ve done the fake page before,” the complaint states. “Round and round we go. Wheel of annoying patients we go. Where it’ll land, nobody knows,” Ingham reportedly said.

Ingham then mocked the man for attending Mary Washington College, once an all-women’s school, and wondered aloud whether her patient was gay, the suit states. Then the anesthesiologist said, “I’m going to mark ‘hemorrhoids’ even though we don’t see them and probably won’t,” and did write a diagnosis of hemorrhoids on the man’s chart, which the lawsuit said was a falsification of medical records.

After declaring the patient a “big wimp,” Ingham reportedly said: “People are into their medical problems. They need to have medical problems.”

Shah replied, “I call it the Northern Virginia syndrome,” according to the suit.

The doctors argued that the Vienna man did not suffer any physical injury or miss any days of work. The man’s complaint said that he was “verbally brutalized” and suffered anxiety, embarrassment and loss of sleep for several months.

“These types of conversations,” testified Kathryn E. McGoldrick, former president of the Academy of Anesthesiology, “are not only offensive but frankly stupid, because we can never be certain that our patients are asleep and wouldn’t have recall.”

This story has been updated to include a statement by Aisthesis.

More on medical malpractice from The Post:

What went wrong with Joan Rivers’ last medical procedure: Lawsuit

E-mails show attempt to ‘patch up’ a case of medical negligence

How malpractice suits keep my profession honest

Johns Hopkins agrees to $190 million settlement over patients being secretly videotaped

Md. woman wins $2.35 million in malpractice case