Circumcision requiring revision surgery prompts lawsuit

Other cases discussed in this column include ureter damage during hysterectomy, failure to follow up on kidney mass, and incontinence following pelvic organ prolapse surgery.

Dawn Collins, JDA Michigan neonate was circumcised by the obstetrician the day after he was born and the procedure was described as “routine.” The infant’s mother first told the obstetrician of a problem when the child was 18 months old, claiming that the child’s first words were “mommy penis hurts.” He underwent a revision surgery at age 2½ years to remove the redundant foreskin left from the first circumcision.

A lawsuit was filed and claimed that the child was in pain every day until the revision procedure because of the redundant skin that was not removed during the original circumcision.

Also by Dawn Collins, JD: Patient sues after stapler misfire leads to rectal tear

The obstetrician argued that the initial circumcision was routine, and that redundant foreskin can be left behind even with a properly performed circumcision. A defense verdict was returned.

Ureter damaged during hysterectomy

An Illinois woman underwent a total abdominal hysterectomy in 2009. The woman sued the gynecologist involved and alleged that she damaged the left ureter during the operation. A urologist subsequently attempted two unsuccessful stent insertions in the damaged ureter followed by ureteral re-implantation surgery.

The gynecologist contended the ureter injury is a known complication that can occur in the absence of negligence. The jury returned a defense verdict.

LEGAL PERSPECTIVE: In malpractice cases where a known complication is alleged to have been the result of negligence on the part of the caregiver(s), the usual issues at trial are the recognition and appropriate management of the complication. If the injury is recognized in a timely manner and the standard of care is met in treating the complication, including involving other physicians-as in this case a urologist-these cases can be successfully defended.

Next: Failure to follow up on kidney mass

Failure to follow up on kidney mass

A 68-year-old Illinois man underwent a computed tomography scan that revealed a mass on his kidney. It was just short of 1 year later when stage IV renal cancer was diagnosed, and the man died 7 months later.

A lawsuit was filed against the radiologist and the hospital and claimed that while the radiologist reported the mass, he failed to follow up or communicate the need for further evaluation. The hospital settled for $1.5 million.

Pelvic organ prolapse surgery blamed for incontinence

A 52-year-old Virginia woman went to a gynecologist in 2009 for a second opinion regarding a diagnosis of Stage II anterior pelvic organ prolapse, high transverse fascial defect, stress urinary incontinence, and distal rectocele. The gynecologist performed a robotic supracervical hysterectomy/colposacropexy with tension-free transvaginal tape and perineal repair.

Read: How surgical time-outs may (or may not) lower litigation risk

The patient required a catheter to void while in the hospital and was still unable to void 5 days after discharge. She was diagnosed with persistent urinary retention during a postoperative visit to her physician. A mid-urethral sling procedure was performed a few days later, but she continued to have voiding problems. The gynecologist suspected a neurogenic component to the problem and referred her to a neurourology specialist who was a member of the doctor’s medical group. Continued intermittent catheterization was recommended by the neurourology specialist.

The patient continued having voiding problems and developed symptoms of a urinary tract infection. She then went to her original gynecologist, who performed a sling revision, cystoscopy, and removed all of the mesh he could find. She underwent additional treatment and had improvement in her voiding.

The patient sued the gynecologist who performed the robotic operation and alleged negligence in failing to offer further surgery to improve her postoperative condition. The woman also claimed that the gynecologist should have referred her to a physician outside of her medical group.

The gynecologist denied any negligence and argued that further dissection in the presence of a neurogenic bladder carried a high risk of incontinence. She also claimed that the patient was told of the risk of urinary retention prior to the procedures performed and that she had signed an informed consent prior to the surgery. A defense verdict was returned.