A 68-year-old California man with a diagnosis of prostate cancer underwent a surgical procedure to remove all of the prostate gland and some of the tissue around it. During the operation performed by his urologist, a surgical stapler misfired and caused a 1-inch tear in the rectal wall. This caused bleeding necessitating a blood transfusion. The urologist repaired the tear with a two-layer closure and placement of cadaveric fascia.
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Following the operation, the patient was able to urinate almost normally, but developed a rectal fistula as well as a bladder neck contracture and now has erectile dysfunction.
The patient sued those involved with the operation, alleging they failed to consult a general surgeon. The patient claimed the urologist could not distinguish between the prostate and the rectum, resulting in the rectal tear, and that he should have called a surgeon before attempting the repair. The patient further alleged that the use of cadaveric tissue aided in the breakdown of the repair and development of the fistula.
The physician argued that the standard of care was met, that this was a known complication of the procedure and the patient accepted the risk, and that despite the complications the operation removed all the cancer, and the patient’s cancer is cured. A defense verdict was returned.
LEGAL PERSPECTIVE: In this case, the patient also made a lack of informed consent allegation regarding the “non-nerve-sparing” aspect of the operation. Often, this additional claim is made and supported by a lack of documentation in the medical record of any informed consent discussion. Here, however, the urologist successfully defended this claim by arguing that the “non-nerve-sparing” aspect was discussed by showing that a risk/benefit discussion took place with both the patient and his wife on two separate occasions. It is prudent to document this risk/benefit discussion in the chart and include alternative treatment options, and that the patient consented to the operation.