MS COLLINS is an attorney specializing in medical malpractice in Long Beach, California. She welcomes feedback on this column via e-mail. Click on the envelope icon to email.
The plaintiff claimed that the urologist should have performed TURP.
In 2013, a 69-year-old man in Washington underwent an open retropubic prostatectomy to treat his BPH. During the operation, a laceration to the rectum occurred, as well as obstruction of the blood supply to the bladder neck and penile nerve damage, resulting in some urinary stress incontinence. He required three major reconstructive operations, 15 other procedures, more than 60 days in the hospital, and 100 doctor visits as a result of his complications.
The man sued his urologist and the urologist’s practice, alleging medical malpractice and lack of informed consent. He claimed the urologist selected the wrong surgical approach, which led to his negligently lacerating the rectum. The patient contended that a minimally invasive transurethral resection of the prostate (TURP) should have been performed rather than the open procedure, and if it had been he would not have suffered the injuries and complications. He also argued that the urologist failed to identify the rectal injury during surgery and had he recognized it, he would have performed an immediate repair.
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The urologist contended that the proper surgical approach was utilized, and the AUA guidelines supported the decision to perform an open prostatectomy instead of a TURP due to the size of the patient’s prostate. He also argued that failure to recognize the rectal laceration intraoperatively was not below the standard and is a known complication for that procedure.
At the conclusion of a 3-week trial, the jury deliberated for 6 hours and found that the urologist and his practice were negligent in the treatment provided to the patient, and that such negligence was a proximate cause of the patient’s injuries and damages. The jury further found that the urologist failed to obtain informed consent for the open simple retropubic prostatectomy, but such failure was not a proximate cause of the patient’s injuries and damages. The jury determined that the patient's damages totaled $8 million.
LEGAL PERSPECTIVE: In this case, it is not reported how the jury came up with $8 million for an award of damages to the patient, but when the patient has a significantly complicated post-injury course, as this patient did, it is difficult for jurors to see that such complications can occur without negligence by someone. The case subsequently resolved pursuant to a confidential agreement, most likely to avoid an appeal and allowing the patient to recover something in the end.
Next: Failure to diagnose and treat occluded abdominal aorta blamed for deathFailure to diagnose and treat occluded abdominal aorta blamed for death
An 81-year-old Arizona man presented to a urologist for evaluation of a mass on his kidney. After several office visits and further evaluation, the urologist recommended and preformed laparoscopic nephrectomy. He noted severe atherosclerosis in the patient’s abdominal aorta and renal artery.
The patient was seen by a critical-care specialist and several nurses over the next several hours, but then suddenly lost movement and sensation in his legs. The anesthesiologist believed it was due to the still-running epidural anesthesia. The paralysis continued throughout the night despite termination of epidural anesthesia.
In the next morning, it was determined through further testing that the patient likely had an occluded abdominal aorta secondary to his severe atherosclerosis. He was transferred to another hospital and underwent surgery but died a few days later. An autopsy revealed that he had severe atherosclerosis throughout his abdominal aorta, with evidence of clot formation that predated the nephrectomy, with no evidence of any intraoperative injury.
Nevertheless, a lawsuit was filed against the urologist on behalf of the patient’s estate alleging the urologist fell below the standard of care when he failed to obtain the patient’s informed consent and that he failed to provide appropriate postoperative care by failing to diagnose the occluded abdominal aorta earlier. The urologist denied the allegations and at the conclusion of a 5-day trial, the jury returned a defense verdict.