Legal Aspects of Men's Genitourinary Health: Background
Counselor, The largest review of jury verdict cases against urologists showed that the majority of men's health diagnosis-related claims were related to prostate cancer (24%), testis torsion (15%) and testis cancer (9%). The majority of men's health treatment-related claims were related to prostate surgery (13%), penile prostheses (10%), vasectomy (6%) and circumcision (3%). It is estimated that an urologist will be sued twice in the course of his or her career. The patient safety movement will hopefully help to decrease the number of injuries due to medical error; however, many claims are a result of poor communication between the patient and health-care provider. Good communication, careful documentation and a thorough informed consent can help avoid or provide at least some defense against most claims. Prostate Cancer and Testicular Torsion Diseases of the prostate account for a large number of male patient visits to physician offices annually. Over 200 000 cases of prostate cancer are diagnosed annually in the United States. Failure to diagnose prostate cancer is the most common claim of omission error in urologic oncology. Prostate specific antigen (PSA) testing has been available for over 20 years. Claims may arise for failure to perform PSA testing or for failure to act on abnormally elevated PSA values. Likewise, patients with delayed prostate cancer diagnoses will cite any earlier failures to perform a digital rectal exam or failures to act on abnormal exams. PSA elevations secondary to prostatitis should normalize after treatment. Prostatitis refractory to treatment, or persistently elevated PSA values, should prompt a urologic referral. Urologists often perform prostate biopsies on men with abnormal PSAs or digital rectal exams and the results often come back benign. These patients must be counseled that they should continue to undergo regular PSA checks and digital rectal exams as they could in fact still be diagnosed in the future with prostate cancer. Finally, when a prostate biopsy does show malignancy, it is up to the urologist to alert the patient of the results. Pathology results can be misplaced and not come to the attention of the physician. Never tell the patient to just assume no news is good news. One should always document the results and the treatment plan in the chart after calling a patient with any pathology report. It will be the critical piece of evidence should a claim be filed. Testicular torsion is one of the more litigious areas of urologic practice. It is a surgical emergency that often requires swift exploration to avoid loss of the involved testis. Although acute onset of testicular pain in a young male is torsion until proven otherwise, most cases of scrotal-related pain in the office and emergency department are non-surgical conditions. The physical exam can sometimes be challenging with a young male in severe discomfort. Most clinicians diagnose and treat patients with 'classic' onset of symptoms without difficulty. One should consider the diagnosis of torsion even when the patient age, history or physical findings are atypical. Atypical patient presentations are more likely to lead to misdiagnosis, testis loss and potential claims. There are some common pitfalls related to torsion claims. First, failure to timely see and obtain radiographic studies when torsion is suspected. The sensitivity and specificity of high-resolution ultrasound and color Doppler sonography has been reported as 97.3 and 99%, respectively. Despite these reassuring numbers, a false-negative exam is possible. High- resolution ultrasound/color Doppler sonography reproducibility and reliability requires a skilled sonographer. Furthermore, high-resolution ultrasound and color Doppler sonography are not recognized as a 'gold standard' for diagnosing torsion. History, physical exam and clinical suspicion trump questionable objective radiographic findings. Second, if torsion is discovered, (in all but neonatal torsion) a contralateral orchidopexy is indicated and considered standard of care. Many males who develop torsion have considerably elongated spermatic cords in the scrotum (bell clapper deformity). Also, earlier orchidopexy or other earlier scrotal surgery do not rule out the possibility of a testicular torsion. Third, attempts to save an obviously necrotic testis are ill advised. Claims have been filed for subsequent abscess formation, need for debridement and atrophy and even loss of the contralateral testis when this type of salvage has been attempted. Read full article including analysis of additional injuries. Indox Consulting provides access to board certified physicians practicing in all specialties nationwide. Our medical professionals can review your case in a timely, cost effective fashion and support your case through trial with analysis, affidavits and compelling testimony. Call us to discuss your case today.
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