Patient sues after radiation therapy damages bladder

A 51-year-old South Carolina man underwent a laparoscopic robotic prostatectomy performed by his urologists. The urologist who had instructed the patient’s physicians in the use of the robot was also in attendance to observe and provide guidance in using the robotic instruments.

A month later, the patient had a follow-up examination in the urologists’ office, and at that time his PSA was elevated. He was referred to a radiologist, and tests showed that some prostate tissue had not been removed. The urologist referred the patient for radiation treatment. The radiation injured the patient’s bladder and it had to be removed. An artificial bladder was implanted and the patient now requires daily self-catheterization.

The man sued the urologists who performed the surgery, their medical group, the hospital, and the urologist who observed the operation, claiming negligence in performing the robotic prostatectomy.

The primary urologists and their group settled for a confidential amount prior to trial. The hospital was dismissed, leaving only the urologist who observed the operation as the defendant. The patient alleged that this physician was supervising the procedure and as such was in a physician-patient relationship with him and should have seen that all the prostate tissue was not removed.

The urologist denied having a patient-physician relationship. He also said he did not have a medical license in South Carolina, had no privileges to perform surgery at the hospital, had no contact with the patient, and did not review the patient’s medical records. He contended his only role in the operating room was to observe and advise the operating urologists on their technique. He only had an “outside” view of the procedure, not a robotic 3-D visualization, and could not have seen any remaining tissue. He argued his function was primarily proctoring the other urologists on the use of the robotic equipment. The jury found in favor of the urologist.

LEGAL PERSPECTIVE: In any medical malpractice case alleging negligence, four elements must be established for successful prosecution of the tort claim. First, a duty to the patient must be found. A legal duty exists whenever a hospital or health care provider undertakes care or treatment of a person. Second, the plaintiff must show there was a breach of that duty and that the provider failed to meet the relevant standard of care. Third, that breach of duty must be shown to be a direct and proximate cause of an injury to the patient, and fourth, the patient must prove he suffered damages-economic and/or noneconomic-from the alleged negligence.

In the case above, the patient tried to keep the observing urologist in the case as another source of payment by claiming a physician-patient relationship existed, thus establishing he had a legal duty to ensure the care was within the accepted standard. The physician was able to show he had no direct care of the patient and was only supervising the use of the robotic equipment by the other urologists. The jury found there was no physician-patient relationship and so no duty was owed to the patient by this doctor. Without establishing a duty, it was not necessary to consider the other elements and a defense verdict was rendered.

Claim that heat treatment for urinary retention caused complications

A Pennsylvania man was 70 years of age when he went to a urologist in 2007. He had difficulty urinating and felt that he was unable to empty his bladder. He had lab work drawn, a uroflow bladder scan, a cystometrogram, and ultrasound. The ultrasound on the day of the visit revealed a small cyst in the middle segment of the man’s left kidney.

A prostate ultrasound was also performed, which revealed a moderately enlarged prostate with a significant amount of residual urine. The likely cause was identified as bladder neck obstruction. Five days later, a bladder scan revealed a residual urinary volume of 663 cc, and urodynamics testing showed detrusor instability during filling. The patient tried conservative treatment, which did not reduce his symptoms.

A month later, he underwent cystoscopy and internal urethrotomy with a holmium laser. The cystoscopy revealed a stricture in the proximal pendulous urethra, which was incised with the laser. It also showed trilobar hypertrophy with obstruction in the prostate, heavy trabeculation in the bladder, a hypotonic quality in the bladder, and moderately large bladder diverticulum on the left posterior wall. The urologist then recommended TherMatrx (American Medical Systems, Minnetonka, MN) treatment to an area of the prostate.

The next month, the patient returned to the office for the heat treatment, which was administered by a nurse. The patient claimed that the treatment worsened his condition and required the use of catheterization to empty his bladder on a permanent basis.

The man sued the urologist over the TherMatrx treatment and claimed that he was not provided with information on the risks and complications associated with the procedure. He also alleged lack of informed consent and negligence in having a nurse perform the procedure. The expert witness for the patient alleged that TherMatrx therapy did not have established effectiveness for residual urine in excess of 200 cc and that the treatment was proper only when the prostate was between 30 cc and 100 cc, and the patient’s prostate volume was 27.05 cc. Additionally, he argued that TherMatrx therapy was for patients with normal bladder function, but the urologist had found his bladder to be hypotonic.

The physician claimed that the patient was seeking an alternative to surgery for his enlarged prostate and that TherMatrx was the only option available for him. The physician maintained that the patient had been informed that he was not an optimal candidate for the therapy but that it might provide some improvement, which would avoid surgery. He also claimed that the patient was informed of the risks associated with the therapy and that a nurse had assisted him with the treatment, which had been administered without problem or difficulty.

Further, the physician argued that the treatment had not harmed the patient, but was simply unsuccessful. It was also argued that the procedure had not caused the need for catheterization, as the patient had needed catheterization prior to the procedure. The man subsequently underwent successful prostate surgery. A defense verdict was returned.UT

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