Who’s to blame for man’s loss of kidney function?

A 43-year-old male presented to a urologist to whom he had been referred by his primary care physician. The patient had made an ER visit to a New York hospital due to severe flank pain while traveling from Massachusetts to Rochester, NY.

Doctors at that hospital advised the patient of a probable kidney stone. When the patient met with the urologist, the urologist reviewed the results of a computed tomography scan of the patient’s kidneys that had been ordered by the primary care physician. The CT scan reportedly revealed a possible ureteropelvic junction obstruction. The urologist also took a measurement of the patient’s creatine levels and decided to monitor the patient’s condition. Further, the urologist recommended that the patient consult with a nephrologist.

One month later, the patient returned to the urologist’s office for a follow-up appointment. The second evaluation revealed that the patient’s creatine levels had improved but were still at abnormal levels and indicative of a kidney ailment. Thus, the urologist instructed the patient undergo a vasectomy and also instructed him to schedule a follow-up appointment in 1 year.

The following month, the patient visited a nephrologist, who tested the patient’s creatine levels, the results of which were abnormal. The nephrologist provided the patient a requisition order for another lab test.

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Two months later, when the patient did not hear back from the nephrologist with the lab test results, the patient brought the unused lab requisition order to a lab, underwent tests, and submitted the results to his nephrologist’s office. After 3 weeks had passed, the nephrologist left a message for the patient and indicated it was urgent that he present to the hospital for further tests.

Patient undergoes surgery for UPJ obstruction

One month later, the nephrologist ordered a CT of the patient’s abdomen. The CT scan revealed a ureteropelvic junction obstruction. That month, the patient was referred to a second urologist, who ordered a kidney function study that confirmed the blockage, and the patient ultimately underwent successful surgery to remove the blockage. The patient lost 90% of the function of his left kidney.

The patient brought suit against the first urologist and nephrologist, alleging malpractice. 

The patient alleged that the urologist failed to diagnose the obstruction and failed to meet the medical standard of care. The plaintiff’s medical expert, a urologist, opined that the patient’s left kidney demonstrated probable impairment at the time of first and second exam by the defendant urologist.

Both the urologist and nephrologist denied any violations in the standard of care. They argued that the patient, during his second appointment with the urologist, told the urologist that he was going to visit a Massachusetts hospital for further evaluation of his kidney function and never instructed him to forward any medical records to the hospital. Further, the defense maintained that the urologist was not informed of the patient’s care following the second appointment, and that the urologist was absolved of responsibility to monitor the patient’s kidney issues.

Additionally, the defense contended that the patient presented to a non-party internist, who performed the CT scan. The defense asserted that the internist detected the blockage and told the patient to follow up with his urologist. The defense claimed that the patient’s kidney function was intact at the time of the CT scan and that the patient failed to follow up with his urologist. The defense additionally argued that the patient’s kidney function could have been restored had he followed up with his urologist at the time of his CT scan and results.

The defense’s nephrology expert opined that the patient would be compelled to enter dialysis treatment should his right kidney cease to function. The defense expert opined that the plaintiff could live a normal, healthy life with his functioning right kidney.

Continue to the next page for the verdict.Jury awards plaintiff $172K

After 6 hours’ deliberation, the jury returned a verdict in the plaintiff’s favor. The jury determined that the defendants were negligent but determined that only the urologist’s negligence was the proximate cause of the plaintiff’s loss of kidney function. The jury awarded the patient $150,000, plus statutory interest of $22,044. Thus, the plaintiff’s total award amounted to $172,044 against defendant urologist. The nephrologist received a defense verdict.

Read: Failure to consult urologist at heart of case

LEGAL PERSPECTIVE: In medical malpractice actions, the rules require that the plaintiff prove that the standard of care was breached and that the breach proximately caused the plaintiff’s injuries. Both must be shown by expert testimony. And, each element must be proven against each defendant.

Here, the jury determined that the plaintiff proved his case against the urologist, but not the nephrologist. The fact that the first and second exams with the urologist revealed a possible ureteropelvic junction obstruction and abnormal creatine levels, coupled with plaintiff’s expert testimony regarding  probable impairment at the time of those exams, likely tipped the scales against the urologist and in favor of the patient in this case.