Wrong antibiotic leads to $250K lawsuit

Editor’s note: Urology Times welcomes Acacia Brush Perko, Esq. of Reminger Co., LPA as a new Malpractice Consult columnist. Her column will alternate with Malpractice Consult articles written by Brianne Goodwin, JD, RN. We also extend our gratitude to Dawn Collins, JD, for her astute and insightful columns over the past several years.

A 58-year-old male steel worker sought treatment from his urologist for kidney stones. A culture revealed that he suffered from a Pseudomonasaeruginosa urinary tract infection. The urologist prescribed tetracycline.

However, the patient continued to experience symptoms for 2 months. He then presented to his primary care physician, who changed the antibiotic treatment. By that time, however, the infection had spread and caused systemic damage. As a result, the patient underwent surgical removal of his left testicle and a damaged portion of his prostate via a transurethral resection.

The patient then brought a malpractice action against his urologist, claiming medical negligence. The plaintiff claimed his urologist was negligent in prescribing tetracycline, which the plaintiff said was the wrong antibiotic to treat the infection indicated by the culture. According to the plaintiff, tetracycline was known to be ineffective against Pseudomonas aeruginosa. The plaintiff claimed that his urologist should have followed the culture sensitivities and prescribed one of four appropriate antibiotics to treat the infection.

Also see: Specimen errors carry large consequences

Because of the urologist’s failure to do so, treatment was delayed, the infection spread, and ultimately resulted in the loss of plaintiff’s left testicle and a part of his prostate, the plaintiff said. The plaintiff claimed approximately $90,000 in past medical specials and $25,000 in past wage loss.

The defendant urologist maintained that he did not breach the standard of care and that his treatment was appropriate.
After a 4-hour deliberation, an Ohio jury returned a $250,000 verdict for the plaintiff.

Next: Complications following kidney stone removalComplications following kidney stone removal

A 60-year-old married retired male underwent kidney stone removal and placement of an arterial stent. Following the stent placement, the patient was prescribed heparin to prevent clotting at the site of the stent. The patient continued to suffer hemorrhaging at the stent.

Shortly after the procedure, the patient developed a clot and died of a pulmonary embolism. The patient was survived by his spouse and several adult children.

The patient’s estate brought a medical malpractice and wrongful death claim against the defendant urologist, pulmonologist, and cardiologist, who all treated the patient shortly before death. According to the plaintiff, the defendants breached the standard of care by failing to timely diagnose and treat the arterial bleed, failing to recognize the signs and symptoms of the bleed, failing to order appropriate testing, and failing to take steps necessary to stop the bleed.

Read: Wrong testicle removed during surgery

The defendants contended that the patient had a venous bleed caused by the administration of heparin and that the patient died as a result of a recognized risk of the procedure. All defendants maintained that they met the appropriate standard of care, and that the patient’s symptoms were appropriately and timely diagnosed and treated.

After 3 hours of deliberation, an Ohio jury returned a defense verdict.

LEGAL PERSPECTIVE: In an Ohio medical malpractice claim, the plaintiff must prove by a preponderance of the evidence the existence of a standard of care within the medical community, a breach of that standard of care by the defendants, and proximate cause between the medical negligence and the injury sustained. The Ohio Supreme Court has determined that proof of the recognized standards of care, and breach of the standard of care, must be established by expert testimony to a reasonable degree of medical probability. In defense, a defendant physician can offer expert testimony supporting his care and treatment. Thus, a medical malpractice trial often produces a battle of the experts.

Consider the above cases, which were each presented to an Ohio jury. While both involved treatment for kidney stones, one resulted in loss of a testicle and the other resulted in a bleed out and death. The reader may find it surprising that the testicle loss resulted in an award to the plaintiff, while the death resulted in a defense verdict.

In the wrong antibiotic case, the plaintiff’s counsel reported that the defendant’s infectious disease expert conceded that tetracycline was ineffective against Pseudomonas aeruginosa. In addition, the defendant’s urology expert testified that he himself did not use tetracycline to treat Pseudomonas aeruginosa. Although the defense maintained that treatment was appropriate and not a breach of the standard of care, this testimony likely tipped the scales in the plaintiff’s favor.

Conversely, in the kidney stone complication case, the defense experts testified that the patient had a venous bleed caused by the administration of heparin, and that the patient died as a result of a recognized risk of the procedure. This known complication and recognized risk likely moved the jury to find for the defendants.