In this "Malpractice Consult" column, Dawn Collins, JD, also discusses cases involving penile pain following cystoscopy, alleged failure to diagnose kidney obstruction, and death follow stent placement.
Dawn Collins, JDIn 2013, a Washington man was diagnosed with an abdominal desmoid tumor that required surgical removal. The surgeon wanted a urologist to place a ureteral stent at the beginning of the operation.
On the day of surgery, a urology fellow arrived to perform the ureteral stent portion of the operation. In the recovery room, the patient experienced urologic complications, and signs of a urethral injury continued for several days at the hospital and for the next 6 weeks during postoperative appointments.
The patient sought treatment elsewhere at 6 weeks post-op and was immediately diagnosed with an obliterated urethra. Surgical repair consisted of a two-stage process, beginning with skin grafts from the inside of the mouth, then placing the grafts in place of the destroyed urethra. The incision was left open for several months while the skin graft healed. The next stage was closure of the penile incision, with 3 more months of healing required to complete the process. Despite the surgical repair, the patient was left with pain, disability, and disfigurement.
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The patient and his wife sued those involved with the operation and alleged the hospital failed to diagnose or treat the husband’s apparent injury even though medical records stated that the stent procedure had been “traumatic.” They also contended that no consent had been given for the fellow to operate on the patient. The jury found in favor of the patient and his wife, awarding the patient $6 million and his wife $2.5 million.
LEGAL PERSPECTIVE: In this malpractice case, the jury heard evidence that the patient’s wife was an anesthesiologist at the hospital where the operation was to be performed. Prior to surgery, she made specific decisions about which surgeons would operate on her husband and the fellow was not one of them. This led to the accusation of the lack of consent for the fellow to participate in the operation. In addition, during the discovery process of this case it was disclosed that the fellow had used a hemostat to dilate the patient’s urethra when he encountered resistance with the cystoscope. These particular claims, along with the horrific and lengthy repair process described, most likely led the jury to award the plaintiffs the $8.5 million.
Next: Penile pain following cystoscopy
A New Jersey man in his 40s underwent a cystoscopy to examine his urethra and bladder lining. Following the procedure, the patient allegedly experienced pain and inflammation in his penis and was diagnosed with an allergic reaction.
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The man sued those involved with the cystoscopy and claimed they all failed to properly clean the equipment and that failure led to his allergic reaction.
The defendants denied any deviation from the standard of care and maintained the allergic reaction the patient had could not have been foreseen. After deliberating 5 hours at the conclusion of a 13-day trial, a defense verdict was returned.
A 43-year-old Massachusetts man presented to the ER with severe flank pain, where he was diagnosed with a possible kidney stone and referred to a urologist. The urologist determined the patient’s computed tomography scan showed a possible ureteropelvic obstruction. He decided to monitor the patient’s creatinine levels and order a kidney function study if the creatinine levels did not improve. He also recommended the patient consult with a nephrologist.
The next month, the patient returned for a follow-up visit and the creatinine levels had improved but were still elevated. The next month, the patient saw the nephrologist, who also noted the abnormal creatinine levels, gave him orders for another lab test, and advised that he would call the patient with the results.
Sometime in the next 2 months, the patient had the lab work done. Three weeks later, the nephrologist left a message for the patient stating that he needed to present to the ER immediately for further tests. A CT of the abdomen was done and revealed a ureteropelvic junction obstruction. A blockage was confirmed and the patient underwent surgery to remove the obstruction, leaving him with only 10% of his kidney function.
The man sued the urologist, the urologist’s group, and the nephrologist and alleged they failed to diagnose the kidney obstruction and order further testing in a timely manner, which would have saved more of the kidney function.
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The defense asserted they did not violate the standard of care, arguing that the patient had some responsibility for not following orders for tests in a timely manner and also that he saw a non-party internist during the time in question who detected the blockage and instructed the patient to follow up with his urologist immediately, which he did not do. After deliberating 6 hours, a $150,000 verdict was returned.
Next: Death following stent placement
A 19-year-old Indiana college student underwent a kidney transplant and was scheduled to undergo an additional operation to place a stent in the transplanted kidney. Prior to the scheduled surgery, he developed flu-like symptoms with fever, chills, weakness, fatigue, and diarrhea. He was taken by ambulance to the ER the next day for treatment. His hospitalization raised the issue of whether his stent placement surgery should be postponed. The urologist decided that the surgery should proceed and performed the stent surgery the next day.
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During the procedure, the patient became hypotensive and required vasopressors. Later in the recovery room, he went into cardiac arrest. Attempts to resuscitate him were unsuccessful and he was pronounced dead.
The patient’s estate presented the case to a medical review panel. The estate was critical of the urologist’s decision not to delay the non-emergent surgery.
The review panel issued a unanimous opinion that the urologist’s treatment of the patient did not constitute a breach of the applicable standard of care. The urologist denied all allegations. Nevertheless, the estate proceeded to trial and the jury returned a defense verdict.
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