Did on-call’s refusal to provide consult lead to loss of testicle?

Dawn Collins, JDA 16-year-old Massachusetts boy presented to the hospital emergency room with complaints of intense right-sided testicular pain for over 2 hours. He was diagnosed with testicular torsion by an attending nurse practitioner.

The on-call urologist was informed of the diagnosis, but declined to come to the ER and consult with the patient because the ultrasound was not available after 11 p.m. The urologist suggested the boy be transferred to another hospital.

The teen was then transferred to a second hospital, where an evaluation revealed right scrotal erythema and swelling. The testicular lie felt transverse and tender to palpation. No right cremasteric reflex was observed, and the left scrotal sac appeared normal and non-tender.

A testicular ultrasound revealed diffuse diminished flow throughout the right testis, highly suggestive of testicular torsion. A left-side varicocele was also noted. The on-call urologist was consulted by phone and exploratory surgery was ordered. The patient underwent surgery, but the right testicle could not be saved. A right orchiectomy and a left orchidopexy were performed. A $750,000 settlement was reached.

Next: Legal perspective from Ms. Collins

LEGAL PERSPECTIVE: In medical malpractice cases, a medical expert witness is required to offer an opinion that the medical care in question was below the accepted standard and caused injury to the patient. Most states allow discovery and deposition testimony of expert witnesses prior to trial, but in a few states the expert witness’ identity and opinion are announced at trial.

Also see: Patient sues after arterial injury during nephrectomy

In some states, a medical expert witness statement must be submitted in order to file a lawsuit. In this case, the patient went to an attorney and an expert urologist opinion was obtained. The urologist opined that the original urologist on call had deviated from the standard of care when he refused to come to the hospital and examine the patient. The expert stated that testicular torsion is a clinical diagnosis made by history and physical examination, and the average qualified urologist should have been competent to diagnose the torsion by physical exam alone.

He also opined to a reasonable medical certainty that had the urologist complied with the standard, he would have confirmed the presence of the testicular torsion and done an orchidopexy in a timely manner, and these actions possibly could have saved the patient’s testicle. The parties reached the settlement agreement prior to the filing of a lawsuit.

Delayed prostate cancer diagnosis

An 80-year-old South Carolina man was diagnosed with prostate cancer in 2013. He had undergone two prostate biopsies performed by his urologist prior to 2010. Both of the biopsies were reported as negative for cancer. A third biopsy result reported the cancer had metastasized. He underwent treatment for the cancer but died in 2015.

Read: How continuous treatment rules can make lawsuits thrive

Prior to his death, the man filed a lawsuit against the urologists involved and their group, alleging that a biopsy should have been done in 2010, at which time the cancer would have been diagnosed earlier and he would have undergone successful treatment.

The urologists argued that all treatment provided was appropriate and within the standard of care, and the jury returned a defense verdict.

Next: Bladder perforation during hysterectomy

Bladder perforation during hysterectomy

A Michigan woman in her 30s underwent a hysterectomy performed by her gynecologist. During the procedure, the patient’s bladder was perforated and the gynecologist attempted to repair the bladder. Eventually, a urologist was called to complete the repair, which required downsizing the bladder.

Also see: Could necrotizing fasciitis have been diagnosed sooner?

The patient experienced infections and scar tissue in the bladder from the repair, and had other problems from the small bladder. She underwent an additional operation to alleviate the scarring, and it was noted that the ureter had been transplanted during the hysterectomy and original repair surgery.

The patient sued the gynecologist and urologist and claimed they improperly repaired the bladder, failed to inspect the area before closing, and allowed a fistula to form because of the improper repair.

The physicians maintained that no fistula developed, no care was below the standard, and that the perforation was recognized and repaired in a timely manner. A defense verdict was returned.