Failure to spot gangrene leads patient to file suit

February 2, 2013

A delayed diagnosis leads to gangrene and legal issues.

A 38-year-old Maryland man went to an urgent care center in 2008 with a rectal cyst that had expanded to his testicles. He was referred to a nearby emergency room, and a computed tomography scan indicated the presence of free air in the testicles. He was admitted to the hospital under the care of a urologist. The next day, antibiotics were started and the following day an infectious disease consult was ordered due to concern that Fournier’s gangrene had developed.

Several hours later, he was taken to the operating room and extensive infection and damage were discovered. The patient underwent multiple repair surgeries and lost most of his scrotum and part of his penis. He has limited sexual function and extensive scarring.

The patient sued those involved with his care and claimed they were negligent in the delay to diagnose gangrene infection. The jury agreed and awarded him $1,530,313.

LEGAL PERSPECTIVE: In this case, the patient was seen by three urologists over the course of his hospitalization, and all were named in the lawsuit. He claimed that they all failed to suspect a gangrene infection for a period of 58 hours, which resulted in the damage he suffered. He specifically alleged the initial CT scan should have alerted the doctors to suspect gangrene was developing, and a diagnosis at that time would have avoided the extensive infection that required him to lose so much tissue.

In the doctors’ defense, the defense argued that free air noted on the CT scan was most likely indicative of cellulitis, not gangrene, and that the patient had no symptoms of Fournier’s at that time. They also countered the patient’s claim that his outcome would have been better if diagnosed earlier and claimed that the debridement procedures would have been the same, and multiple repairs and subsequent scarring would have led to the same result. The jury, however, believed the delay to diagnosis was below the standard of care and found two of the three urologists negligent. The initial award was reduced to $763,000 due to Maryland’s limits on non-economic damages.

Nephrectomy necessary after kidney damaged during surgery

A 57-year-old Virginia woman was diagnosed with polycystic kidney disease at the age of 25 years. She lived a normal life without significant difficulty with her kidneys, experiencing no obstructions, stones, or blood in her urine.

In the spring of 2009, the woman was diagnosed with uterine cancer. She was referred to a gynecologic oncologist, who recommended a hysterectomy. A urology consult was also requested by the gynecologic oncologist, and a recommendation was made that some of the kidney cysts be drained while the patient was opened for the hysterectomy. The urologist was the first surgeon to operate, performing decortication and removal of what he believed to be a large cyst on the right kidney. The urologist stripped off the walls of one very large cyst and tacked the edges open with sutures. He placed a Jackson-Pratt drain in the center of the defect. The oncologist then took over for the oncologic portion of the surgery.

The urologist, however, had operated on the wrong location. The surgery had been performed on the pelvis of the right kidney, leaving the kidney with a gaping hole and a severed ureter. The plaintiff continued to drain large amounts of urine through the Jackson-Pratt drain for 2 months before being referred to another facility. A magnetic resonance imaging scan showed that the drain was going into the right kidney and terminated at the upper pole of the kidney.

The woman then underwent an exploratory laparotomy, intraoperative nephroscopy, and a right nephrectomy. The right ureter was found dissected from the kidney; the pole of the kidney where the ureter attaches to the kidney was gone; and there was a large cavity where the renal pelvis had been.

The woman sued the urologist and claimed that he should have performed a retrograde pyelogram to determine exactly the nature of the anatomic structures to be operated on. A $500,000 settlement was reached.

Ureter avulsion following kidney stone procedure

A 59-year-old Tennessee man was diagnosed with a kidney stone in 2000. His urologist performed surgery to break up the stone with a laser and retrieve the remnants with a basket. The patient had trouble urinating, and a stent was placed in the ureter a couple of weeks after the initial procedure. The stent was removed 1 month later, but the patient continued to have problems. He went to a second urologist, who diagnosed a complete avulsion injury to the left ureter from the first procedure. The patient ultimately had his left kidney removed.

The man sued the first urologist, alleging negligence for failing to recognize the injury in a timely manner and failing to perform imaging studies to discover the injury when he had complaints following surgery so it could have been successfully repaired.

The urologist claimed the initial surgery was performed properly and that the injury to the ureter was not severe. A pyelogram done a week before a subsequent procedure showed the ureter mostly intact. He maintained that minor injury was a known complication of the surgery and that the stenting procedure was an appropriate treatment. He also maintained that it was the subsequent treating physician who had severely injured the ureter. A defense verdict was returned.UT


Ms. Collins is an attorney specializing in medical malpractice in Long Beach, CA. She welcomes your feedback on this column at dawncfree@gmail.com.