Dawn Collins, JD, also writes about a lawsuit in which a patient sued over an alleged failure to diagnose Fournier's gangrene.
Dawn Collins, JDA 27-year-old Michigan man presented to a hospital emergency room following a bar fight during which he had been hit in the head with a brick. The emergency room team assessed the patient from head to toe and admitted him to the hospital, noting his left testicle was swollen. An ultrasound was performed the next day.
It was determined that his swollen testicle was consistent with an injury during the fight and he was discharged 2 days later with instructions to follow up with a trauma clinic. The patient presented to the trauma clinic 9 days after his discharge.
The clinic noted his testicular contusion and swelling. He was told to take it easy and return to the clinic if the swelling worsened or did not resolve. The patient, however, did not return for almost a year, although he claimed he still had swelling in his testicle during that time. At this time, he complained of flank pain and vomiting.
Imaging revealed he had a left testicular mass and an 11.6-cm complex retroperitoneal lesion in direct contact with the aorta anterior to the left kidney, compressing the kidney and resulting in mild left-sided hydronephrosis. He was diagnosed with Stage III testicular cancer. His testicle was ten times larger than it was a year earlier, according to his physician's report. The patient underwent an orchiectomy, and the pathologist’s final impression was metastatic germ cell tumor. Chemotherapy and radiation were recommended, and subsequently he had a nephrectomy to remove the retroperitoneal mass.
Also from Dawn Collins, JD: Partial nephrectomy results in bowel injury, lawsuit
The man filed suit against the hospital and the physicians who initially treated him, including the general surgeons. He claimed that they violated the standard of care when they failed to diagnose and appropriately treat his testicular cancer during his initial treatment a year earlier. The man claimed that the chemotherapy he underwent, as well as the surgical removal of his testicle and abdominal mass, caused him to be infertile. He argued that this would not have occurred had the cancer been diagnosed and treated in a timelier manner.
The physicians contended that the patient received standard-of-care treatment and the ultrasound performed a year ago was negative for a mass or tumor. They further contended that the patient was monitored and was advised to return if the swelling did not resolve. They concluded that his testicular swelling a year ago was consistent with trauma and unrelated to his later diagnosis of testicular cancer. They also argued that the patient was non-compliant with chemotherapy and failed to return when his symptoms did not resolve. The jury rendered a defense verdict.
LEGAL PERSPECTIVE: This case was problematic for the plaintiff in that while he claimed that if cancer had been considered when he was first seen, tumor markers could have been ordered and the correct consults obtained in a more timely manner and thus the cancer found at an earlier stage without metastasis, he did not return to the clinic as instructed when the swelling did not resolve for almost 1 year. He also refused to follow the diet/drinking instructions in the hospital, refused to stop smoking and using marijuana, was noncompliant with the chemotherapy treatments recommended, and refused to undergo a second course at all. It may be that the jury took into account the contributory negligence by the patient and delivered a verdict finding no cause of action for negligence against the physicians.
A California man in his 40s presented to a urologist for urinary tract issues. He also complained of fever and an inability to urinate. The patient had presented to an urgent care center 5 days earlier, where he was prescribed an antibiotic for a urinary tract infection. The urologist prescribed tamsulosin (Flomax) to improve his urinary stream.
However, 2 days later the patient called the urologist complaining of considerable pain. The physician prescribed pain medication and allegedly told him to come in the following day if he was still in pain. A few days later, he presented to an urgent care center and was referred to an emergency room. He was then diagnosed at the hospital with potentially life-threatening Fournier’s gangrene. He underwent surgery that left him with a groin deformity, although he was abIe to survive the disease.
The man sued the urologist, alleging that he failed to diagnose the condition. He further alleged that the physician was negligent in his treatment and in prescribing the antibiotics. His expert urologist opined that the urologist did not take a sufficient history of the patient and that prescribing the pain medication was inadequate. The expert further opined that the physician should have told the patient to present to the ER or his office to see what was causing his pain. He concluded that the medical records were inadequate in documenting the patient’s complaints and symptoms.
The defense counsel contended that the patient’s disease is a rare condition that is mostly seen in immunosuppressed individuals or in patients with uncontrolled diabetes. The defense’s urology expert opined that there were no violations of the standard of care, assuming that the patient’s chart was accurate as to what occurred during his examination. He also opined that the diagnosis at the time was appropriate under the circumstances. It was his opinion that the antibiotics prescribed at the urgent care center must have masked the disease by suppressing it, as there were no blatant signs of the infection at the time the patient was examined by the urologist.
The defense argued the patient had no permanent issues, that he and his wife had two children prior to the events, and he was still potent and could engage in sexual activity. The jury rendered a defense verdict.
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