Other cases discussed in this edition of "Malpractice Consult" include cecum perforated during prostatectomy, injections fail to improve Peyronie's disease, and dementia diagnosis blamed on urologic procedure.
Dawn Collins, JDAn Illinois man underwent surgical implantation of a penile prosthesis in 2005 after a lengthy history of erectile dysfunction and many unsuccessful attempts at conservative treatment. He was 65 years of age at the time of the operation, which was performed by his urologist.
After 2 years of pain complaints and an erosion of a cylinder component of the prosthesis, the device was surgically removed by the same urologist. The patient's pain initially improved, but then worsened. Five months later, the rear-tip extenders from the implant extruded through the right side of the penile glans.
The patient sued the urologist and claimed that he was negligent in failing to remove all of the prosthetic components.
The medical expert witnesses in the case all agreed that extrusion was an unexpected outcome and a defense verdict was returned.
LEGAL PERSPECTIVE: Although the standard of care in the removal of penile implants would require removal of the rear-tip extenders if infection were present, the physician in this case testified that the rear-tip extenders had not been removed in this patient because there were no signs of infection. The urologist also pointed out to the jury that the patient’s internist testified that the patient was being examined in the office when the extenders extruded, while the patient had testified that the extrusion had occurred at home. Most juries dislike contradicting testimony from those on the same side and tend to give less credence to those witnesses, especially when there should be no confusion if the events were correctly documented in the patient’s chart.
A 76-year-old Nevada man underwent a robot-assisted laparoscopic radical prostatectomy performed by his urologist in 2009. Immediately after the procedure, he developed complications, an infection with extremely elevated white blood cell count, and fecal drainage from an abdominal drain. A perforated cecum was diagnosed. The patient had a rocky postoperative course, with sepsis, respiratory failure, and renal insufficiency eventually leading to his death about 6 months later.
The urologist and his group were sued. The claim was that the urologist perforated the cecum and it was not recognized in a timely fashion, causing the complications that eventually led to the patient’s death.
The defense argued that perforation is a known complication and that it was treated appropriately. The jury returned a defense verdict.
Injections fail to improve Peyronie’s disease
A 62-year-old South Carolina man went to a urologist with complaints of penile pain and was diagnosed with Peyronie’s disease. The physician treated the patient with a series of 12 injections of verapamil.
The patient sued the urologist after his treatment, claiming he suffered an increasing deformity during the treatment and entered photographs taken during erection into evidence.
The urologist argued that the patient did not inform him of any problem with the injections or worsening condition during the treatment. He also claimed there was no guarantee of a cure for Peyronie’s disease. A defense verdict was returned.
Dementia diagnosis blamed on urologic procedure
An 88-year-old man went to a California urologist in 2009 with active bleeding from his urinary tract and blocked urine flow for 3 to 4 days. He was scheduled for transurethral resection of the prostate and inspection of the bladder to remove a blood clot. The patient was somewhat confused after surgery and was eventually diagnosed with dementia.
The urologist, anesthesiologist, and hospital were subsequently sued, with the plaintiff alleging that the administration of general anesthesia for the operation caused a small stroke that led to dementia. The patient claimed the anesthesiologist should not have used general anesthesia but should have provided regional or epidural anesthesia. He also claimed that a preoperative history and physical by an internist should have been obtained for clearance for him to undergo a surgical procedure.
The urologist settled for a confidential amount prior to trial. The anesthesiologist was dismissed from the case and the matter went to trial against the hospital. The hospital argued that the surgery was uneventful and that the patient had stable blood pressure and oxygen saturation during the operation and did not suffer a stroke. Hospital officials also claimed there were no records or scans taken after surgery showing a stroke occurred. The hospital additionally maintained that a preoperative history and physical by an internist was not required in that the urologist had performed a sufficient history and physical.
The hospital also argued that the patient had a 3-year decline in mental function preceding his dementia diagnosis and that his confusion immediately after the operation was similar to experiences of elderly people following surgery. A defense verdict was returned for the hospital.UT
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