Allegation
Settlement was the best solution for the defendant urologist due to varied opinions among defense experts, a lack of sufficient documentation of the informed consent discussion, and a challenging venue.
The Case
The patient, a 41 YOWM (6'3", 212 lbs.), presented to the defendant urologist for a vasovasostomy. The morning of the procedure, the patient filled out a history form and signed the consent for the vasectomy reversal. At 11:00 a.m., the patient took a 5 mg tablet of Valium® in the office. He received another 5 mg tablet of Valium at 11:35 a.m. The patient’s oxygen saturation was noted at 97% and his pulse was 67 bpm. He was draped and prepared at 1:15 p.m. His BP was 123/65 and his pulse was 67 bpm. The defendant urologist administered local anesthesia using a mixture of Marcaine™ 0.5%, lidocaine Hcl 2%, and lidocaine Hcl with epinephrine 2%. The procedure began at 1:50 p.m. and was completed at 6:25 p.m. At 6:40 p.m., the patient received 20 mg of predinsone; he had previously received a prescription for tramadol for post-op pain. Twenty minutes later, he left the office in good condition.
The defendant urologist evaluated the patient the following day. He noted the patient did well over night, but that the scrotum was showing some slight ecchymosis around the penis and upper scrotum that morning. Both Penrose drains were removed. Three days later, the patient noticed small bubbles near his stitches and was experiencing pain and drainage on both sides. He called the office and the office manager returned his call.
One month later, the patient presented to his prior urologist who had performed his vasectomy. The patient told the urologist that the recent procedure took six hours, and was very painful and emotionally traumatic. The examination revealed the testes were descended, and there was no induration located cephalad to the testicle at the site of the vasovasostomy. There was no evidence of infection. The urologist recommended the patient follow up with the defendant urologist.
The defendant urologist spoke with the patient on the phone five weeks after surgery, who indicated he had some discomfort, burning on the right side, and that there was more swelling on the right side than the left. The defendant urologist scheduled an appointment for three days later. The patient canceled the appointment and rescheduled. Two days after that, the patient did not show up for his rescheduled appointment and was unable to be reached. This was the last interaction the defendant urologist had with the patient.
Three days after missing his rescheduled appointment with the defendant urologist, the patient returned to his prior/primary urologist. The patient continued to see the primary urologist over a period of 23 months with complaints of testicular pain. Over the course of treatment, the patient returned to his primary urologist 14 times. Upon examination, the primary urologist noted that the patient had mild to moderate improvement in his scrotal pain. He also noted the vasovasostomy sites showed less induration and no evidence of hematoma. There was still tenderness at the anastomotic site.
At subsequent visits, the primary urologist noted bilateral testicular pain, which was more pronounced during sexual activity, and no visible scrotal swelling. The right hemi-scrotum was tender at the anastomotic site and there was a significant sized sperm granuloma. The left hemi-scrotum showed a sperm granuloma and mild tenderness. Ultimately, the primary urologist performed a bilateral excision of the sperm granulomas in conjunction with a bilateral vasectomy. The patient continued to experience pain. He and the primary urologist discussed performing a vasovasostomy or a spermatic cord block to reduce pain. The patient elected to try a spermatic cord block.
Expert witnesses for the patient alleged that the defendant urologist breached the standard of care by performing the surgery under local anesthesia and by providing too much anesthesia. Another expert stated the failure to assess, describe, obtain consent, and detail the length of the procedure is a departure from the standard of care required when using anesthesia during a surgical procedure.
While some defense experts were supportive of the treatment provided by the defendant urologist, they had concerns regarding informed consent for the use of anesthesia. Due to lack of unanimous support from defense experts, a difficult venue, lack of good documentation, and the defendant urologist’s wishes, the case was settled for a confidential amount.
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