Patient’s bowel perforated during robot-assisted RP

Dawn Collins, JDA 59-year-old Virginia man was diagnosed with prostate cancer in 2012 and assigned a Gleason score of 7. The treating urologist discussed the treatment options with the patient and, when the patient opted to explore surgical treatment, he referred the patient to another urologist. 

Related - The malpractice suit: Why expert witness selection is crucial

This urologist advised the patient to undergo radiation rather than surgery, due to his complex medical history, which included diabetes, hypertension, failed gastric bypass, sarcoidosis treated with steroids, arrhythmia, diverticulitis, sleep apnea, hernia repair, and obesity. These conditions increased the risk of complications, especially the risk of bowel injury from adhesions that may have formed after his previous abdominal operations.

The patient opted for surgery and underwent robot-assisted laparoscopic prostatectomy in 2013. During the operation, the urologist repaired a bowel perforation caused by the initial trocar insertion. He also inspected the bowel for further injuries and found none.

The patient was kept in the hospital under careful monitoring for 3 days and discharged by one of the urologist's partners when he appeared clinically stable. The patient felt well until the sixth postoperative day, when his condition worsened and he returned to the emergency room. He then underwent surgery to repair another bowel perforation that was lateral to the original repair, which was healing and intact. He suffered a prolonged hospitalization, further surgeries, and a difficult postoperative course due to his multiple medical conditions and poor wound healing.

Also see: Patient sues, alleges delay in testis Ca diagnosis

The patient sued the urologist, alleging that he should not have performed surgery on the patient, and that the second bowel perforation should have been detected and repaired during the original operation. He also claimed he should not have been discharged from the hospital in 3 days.

Please continue to the next page for the verdict.

The urologist argued that the patient’s conditions were not contraindications to the minimally invasive surgery. He claimed bowel perforation is a known complication and that the second one was most likely undetectable on the day of surgery. The jury returned a defense verdict.

Read - You’ve been sued for malpractice: What happens next

LEGAL PERSPECTIVE: In malpractice cases where the patient suffers a complication that is a known risk of the procedure, there is often a claim that the patient had not been informed that this complication was a risk, and had he known he would not have chosen to undergo the procedure. This claim is often supported by a lack of adequate documentation of a discussion of the risks and benefits to a procedure with the patient in the medical records. In this case, however, the urologist was able to show in the medical chart that the patient’s medical conditions had been discussed and that he was well informed of the risks associated with the procedure and had signed an informed consent.

It is prudent to document a risk/benefit discussion with the patient, including treatment options and the patient’s ultimate choice for his care.

Failure to diagnose UPJ obstruction

A 43-year-old Massachusetts man went to his urologist in 2008 to follow up his complaint of severe flank pain he had earlier in the month. The physician diagnosed a possible ureteropelvic junction (UPJ) obstruction and abnormally high creatinine levels.

A month later, another follow-up visit with the urologist was done and the patient was advised to undergo a vasectomy. The patient went to another physician, who again informed him his creatinine levels were high and ordered a follow-up lab test that the man had drawn 2 months later.

Three weeks later, the physician called the patient and indicated that it was urgent that he present to a hospital for further tests. A computed tomography scan done another month later revealed that the man had a UPJ obstruction, and he underwent surgery to remove the blockage. He lost 90% of his left kidney function.

The man sued the urologist and his group and the second physician, alleging that the urologist failed to diagnose the obstruction and the second physician failed to monitor his condition in a timely manner after ordering the lab tests.

Related: Partial nephrectomy results in bowel injury, lawsuit

The urologist argued that it was his belief that the patient had left his care and had not seen him or been informed of the man’s condition after his second visit. He also alleged that the patient failed to follow up even when a third physician, his internist, had urged him to see the urologist. The jury determined that only the urologist’s negligence led to the patient’s loss of kidney function and awarded the patient $170,044. The second physician received a defense verdict.

Next: Alleged failure to diagnose declining renal function

Alleged failure to diagnose declining renal function

A 25-year-old man went to a urologist in Florida with a complaint of blood in his urine. Nothing abnormal was found, and 2 years later the urologist treated the man for a urinary tract infection. The urologist advised the patient to have imaging studies of the kidneys, and a kidney stone was found. At that time, the patient informed the urologist that he was taking mesalamine, prescribed by another physician. The urologist performed surgery to remove the stone a month later.

Also by Dawn Collins, JD: Extracapsular prostate cancer leads patient to sue

About 18 months later, the patient was diagnosed with acute renal failure and end-stage renal disease due to the use of mesalamine.

The man sued the urologist and claimed he failed to diagnose the renal failure knowing he was taking mesalamine, and failing to treat him in a timely manner. The jury returned a defense verdict.

More on Malpractice:

Mesh cystocele repair leads to perforated bladder

Nephrectomy gone wrong leaves patient paraplegic

Unnecessary kidney surgery proves costly

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