Missed follow-up leads to stage IV renal cancer, death

A 53-year-old Massachusetts man went to an emergency room in 2004 with sharp right lower quadrant pain radiating to his back. A computed tomography scan was ordered, which was interpreted by a radiologist. A 3-mm distal right ureteral stone was revealed, and a lobulated contour in the left kidney was noted and found to be abnormal. A renal ultrasound was recommended.

The patient was discharged home from the emergency room before the formal radiology report was completed. He later went to his urologist, who had a copy of the CT report in his chart. The urologist ordered a urinalysis and told the patient to continue taking the pain medication for the stone and to return in 2 weeks.

The patient did not keep the 2-week follow-up appointment. Almost 3 years later, the man was diagnosed with stage IV renal cancer, and he died from the disease about 2 years after diagnosis.

A lawsuit was filed against both the urologist and the radiologist involved in the treatment of the kidney stone, claiming that he was not informed of the abnormality on the left kidney noted on the CT scan and the recommendation for follow-up.

The urologist claimed that he told the man that the area in his left kidney required further testing and could be cancerous.

LEGAL PERSPECTIVE: The man died during the prosecution of this malpractice suit so it went forward on behalf of his estate. Prior to his death, the patient prepared an affidavit in which he stated that the kidney stone had passed prior to the 2-week follow-up appointment and that since he was not informed about the left kidney abnormality, he felt it was unnecessary to keep the appointment. The affidavit was presented and the defendants ultimately settled the malpractice case for $1.5 million. This most likely points to the fact that there was no documentation in the record to support the physician’s claim that he did inform the patient of the CT scan results. With no note that the patient was notified and the affidavit stating he was not told, it would have been difficult for the defense to overcome the claim if the case went forward. Continue to next page for further cases.

Sepsis following cystoscopy

A 74-year-old New York man underwent a cystoscopy performed by his urologist in 2008. A prophylactic antibiotic was administered prior to the procedure. Afterward, the patient was informed that infection was possible and that symptoms of chills, fever, and/or rigors should be reported.

The patient had severe pain on urination after the procedure and called the urologist, who recommended use of an over-the-counter pain reliever. He also instructed the patient to report any worsening pain. The next afternoon, the man developed symptoms of chills, fever, and vomiting. He was transported to a hospital, and an infection and septic shock were diagnosed. He then developed bedsores and pneumonia and was hospitalized for 3 weeks and was in inpatient rehabilitation for 18 days.

The man sued the urologist and claimed that he failed to ensure that the cystoscopy was performed in a sterile environment and failed to recognize and address the infection. The patient claimed that his infection was caused by a strain of Escherichia coli that was resistant to most antibiotics and that it originated in the urologist’s office. He argued that he should have been immediately hospitalized when he complained of pain.

The physician maintained that pain is common following a cystoscopy and that immediate hospitalization would not have resulted in a different treatment or outcome. He contended that the infection could have predated the cystoscopy and the endoscopic instruments were sterilized, but may have just exacerbated an  infection already present. A defense verdict was returned.

Failure to perform 12-sample prostate biopsy allegedly allowed spread of cancer

A Missouri man, now 76 years of age, was referred to a urologist after his primary care physician noticed an elevated PSA in 2004. He underwent a biopsy of the prostate, and eight samples were obtained. A pathology report found all eight samples benign. The patient continued to have elevated PSA levels, so the urologist performed a second biopsy 5 months later, which resulted in negative findings.

A year and 3 months later, the patient went to a physician in another state with an elevated PSA level, and a 12-section biopsy was done with one sample suspicious but not diagnostic for cancer, with the others being negative.

The patient returned to his previous urologist, who repeated the biopsy with six of eight samples in the region of the suspicious area reported as benign. His PSA levels continued to be elevated, and over 5 years, the man had a total of 52 biopsy sections taken, all negative for cancer.

In 2009, the patient attended a meeting where a positron emission tomography scan was suggested as a tool to aid the diagnosis of prostate cancer. When he contacted his urologist, he was told PET scans were not helpful, but he recommended obtaining a second opinion. A few months later, the man underwent a 12-sample biopsy and a transurethral resection of the prostate by a different urologist, and the pathology report showed cancer. It had spread to the bladder neck, so the patient was treated with radiation and hormone therapy. His cancer is in remission.

The man sued the original urologist and alleged that he should have taken 12 samples in his biopsies instead of eight, and that a TURP should have been used after so many negative biopsies and continuing elevated PSA levels.

The physician argued that the form of cancer the patient had was difficult to find and that he was followed appropriately. A defense verdict was returned.

Alleged failure to follow up on pyelography

A 53-year-old New York man went to a radiologist in 2005 after his urologist had requested a pyelography. The patient had undergone the implantation of a catheter that allowed drainage of the left kidney, which had been obstructed by a stone.

The obstruction was mostly resolved, but debris remained in the kidney. The pyelography was intended to locate the debris. The radiologist delayed performance of the pyelography and obtained a culture of the left kidney, then capped the catheter that the urologist had implanted in the kidney.

During the next 3 days, the patient suffered chills, fever, and hematuria. The radiologist received the results of the culture, which revealed an infection. The results of the culture were not communicated to the urologist. After 3 days, the patient went to a hospital and was diagnosed with a methicillin-resistant Staphylococcus aureus infection of the urinary tract. He required a lengthy course of treatment.

In the lawsuit against the urologist, the man claimed that the infection was due to the radiologist’s capping of the catheter. He also claimed that the urologist should have advised that the catheter should not have been capped, and the urologist should have more closely monitored the radiologist’s treatment.

The urologist claimed that the radiologist had not disclosed that the pyelography was not performed, nor that he had capped the catheter. A defense verdict for the urologist was returned.UT

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