legal / ethical question

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Regular Member

Date Joined Oct 2010
Total Posts : 175
   Posted 12/30/2010 3:28 PM (GMT -6)   
for those following my saga, pls recall I was to have had an RRP today, but the surgery was postponed so that I could treat a case of infected testicle/prostate.

Had the surgery been performed today, sepsis would likely have occurred and death is a frequent result of surgical sepsis.

Here's what happened and as always, your thoughts are most appreciated.

Dec. 20th, pre-op physical with local GP. "my balls hurt", I say, GP says to contact my urologist ASAP, which I do. The doc is booked, but the female (oh great) PA (as in not a real doc) can see me the next day, Dec 21.

She checks me out and says the pain is probably stress related. They ask for a pee sample, I say no can do, should told me before I came. She says, no problemo, go home and yer good to go for the operation.

Today I get to Danbury Hospital. Plenty of good nurses and people are pro's and friendly. I mention the "ache" to my nurse and as my surgeon shows up, he asks for a pee sample. (He said he would take it with a catheter, I told him he would either sedate or kill me first). I get a sample and viola, 20 minutes later, the hospital lab says I have a significant infection and the operation is postponed.

I think given my pain, the urology office should have DEMANDED a pee sample. I could have spiked a fever tonight of 107 and be dead by tomorrow morning.


52 yr old, newly diagnosed. PSA 3.5, Gleason 6 with 3 of 4 top nodes (0%;1%;10%;1%) cancerous. Bottom 2 floors are clean.
Da Vinci surgery scheduled for 12/30/10

Regular Member

Date Joined May 2010
Total Posts : 264
   Posted 12/30/2010 4:23 PM (GMT -6)   
Since you asked...

I agree they should have not let you leave without the sample. To request it then say it is no problem if you don't comply was not smart. I agree they should not have let you leave without your urine sample.

On the other hand, you were the one who knew the sample was requested and probably was requested because an infection may have been present, so I wonder why you didn't stick around till you built up enough urine to comply? If it were me, even if the PA requested the sample, then said don't worry about it, I would have volunteered to stick around until I could comply with the urine sample.

Good luck on getting the infection cleared up and good luck on your surgery
Here are some of my stats:
Father diagnosed with PC at age 72 - wasn't contained to prostate when found in 1992.
My PSA rose from 3.2 to 5.1 over the course of 1.5 years with Free PSA at 25% for the last two tests.
DRE showed no evidence of tumor but Uro thought my prostate was a little large for someone my age
PCa diagnosed 4/6/10 after biopsy on 4/1/10
1 out of 12 biopsy samples was positive with 5% of biopsy sample cancerous
Gleason 3+4
Da Vinci surgery on 6/1/10
Pathology report shows cancer confined to prostate and all other tissue clean
PSA tested on 7/15/10: Zero Club membership card issued (trial membership with 90 day renewal)

Veteran Member

Date Joined Jul 2009
Total Posts : 504
   Posted 12/30/2010 4:52 PM (GMT -6)   
Hi GtoDave

Not sure what you mean by legal, when you say you "Could" have or "Likely Would have" seems to me that their wrongdoing has caused you any harm.

Its like saying in a near car accident "hey you cut me off doing 90 and I could have been killed" I'm going to sue ?

Malpractice is very very hard to prove, even if you had contracted a Sepsis infection, they can be cured in most cases and in the vast majority of cases it never gets to a complete body infection state aka Sepsis

Your URO PA asked for a Pee sample. you said no, how would you have liked them to demand it, cuff you to the John till you peed ?

It is unfortunate what happened but that kind of stuff and worse happens each and every day

So the balls in your court, you now know there is a problem with your GP and you Uro PA, what will you do ? Stay with them ? If you do , you now know that you need to be much more assertive with them

Elite Member

Date Joined Oct 2008
Total Posts : 25394
   Posted 12/30/2010 4:57 PM (GMT -6)   
Dave, on the point of law, you were asked for the pee sample by the uro, and you said no, regardless of the reason, made you non-compliant by default. Never get a case out of that.

Just thankful it was caught before you went into surgery, it could have been disaster afterwards.

Good luck as you clear that up and rescedhule the next operation date.

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

Veteran Member

Date Joined Jul 2010
Total Posts : 3895
   Posted 12/30/2010 4:59 PM (GMT -6)   
You knew from the get-go that the female PA was NOT the best situation..Stuff happens...The system worked..You are none the worse for wear...
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT, Dec

Regular Member

Date Joined Oct 2010
Total Posts : 175
   Posted 12/30/2010 5:17 PM (GMT -6)   
Friends, not my intention to sue. No harm, no foul here.

But am I annoyed? You bet!

As the patient, I presume the medical pro's I entrust with my care have my best interests at heart. It is my opinion that if a urine sample is important, a doc will tell me to produce one, even if an hour of waiting is involved. When I'm told to go along my merry way, I trust (or did) that advice.

The overarching point here is that we are all in charge of our own care. I let it slip and should have been more demanding of a pain diagnosis before showing up for surgery. My bad.

I plan on putting of the surgery now for a few months, and no doubt, finding a new doctor.

My question really then, is how others would react or respond, short of legal action.

52 yr old, newly diagnosed. PSA 3.5, Gleason 6 with 3 of 4 top nodes (0%;1%;10%;1%) cancerous. Bottom 2 floors are clean.
Da Vinci surgery scheduled for 12/30/10

Veteran Member

Date Joined Jan 2006
Total Posts : 654
   Posted 12/30/2010 5:43 PM (GMT -6)   
At the end of the day, they are all just people and no matter how important the outcome of their work is to other peolple, after a time we all can get desensitized to what we are doing and at that those times it takes an excectional person to perform like their job is important. It's the old " I did it 999 times but the 1000th killed someone"
So we have two people that did their job like it wasn't important. First and formost your GP, he was the person who was primarly responsible for pre op approval? and of course the uro's pa. GP should have done a pee test no matter what and sending you out for the hurting ball did not relieve him from the basic and primary work of the clearance. The ball, that should have been an additional hurdle not a primary hurdle. Bad work! Your uncooperativeness should not matter. If your uncooperativeness resulted in them not being able to clear you, they should have refused clearance.
I feel for you as having to go through another countdown. Good luck.
ps, we are in charge of our care but these people really screwed the pooch. not your fault at all.

Post Edited (knotreel) : 12/30/2010 3:46:29 PM (GMT-7)

Veteran Member

Date Joined Dec 2008
Total Posts : 822
   Posted 12/30/2010 6:10 PM (GMT -6)   

If I'm going to hire someone to do a lot of expensive remodeling to my house, I do a thorough check of his references. Same with the doc/medical center for surgery. Maybe you did that, I don't recall, but it does seem like what happened is causing you to re-assess your opinion of the team. It isn't a bad idea to check out other options. Hope there are some good ones for you.

Diagnosis at 53. PSA 2007 about 2; 2008 4.3
Biopsy Sept 2008: 6 of 12 cores pos; Gleason 4+3 = 7
CT & Bone scan neg
Da Vinci at City of Hope Dec 8, 2008
Rad prostatectomy & lymph node dissection
Cath out on 7th day, in on 8th day, out again 14th day after neg cystogram
Path: pT2c; lymph nodes neg; margins involv; 41 grams,
PSA 1/08, 4/09,7/09, 10/09, 11/09,2/10 <0.01, 10/10 0.1

Regular Member

Date Joined Nov 2009
Total Posts : 43
   Posted 12/30/2010 6:23 PM (GMT -6)   
The fact that you suffered no harm entails that you have no legal case.

But if the surgery had gone through and you developed sepsis, you would have a case. Your doc should not authorize surgery while there is the suspicion of infection. If you do not cooperate, that means he cannot rule out infection, and cannot authorize surgery. Your mistake in refusing to cooperate does not get the doc off the hook. It was irresponsible of him to rely on the PA's judgment for such matters, if that is what he did.

Veteran Member

Date Joined Dec 2009
Total Posts : 1268
   Posted 12/30/2010 7:17 PM (GMT -6)   
I would have given the original pee sample.  But then I can always pee!
I agree about getting another doctor.  If you don't trust the team that is going to be operating on you it is best to move on to someone else.
No matter which way you choose to go, Good luck and best wishes!

Forum Moderator

Date Joined Sep 2008
Total Posts : 4278
   Posted 12/30/2010 7:37 PM (GMT -6)   
Dave, I'll be a little more sympathetic.  I agree that the PA screwed up big time.  Yeah, we have to be assertive re our treatment but when she said "no problemo" you had every reason to trust that you got good medical advice.
Having said that, I totally agree with your ditching your doctor.  While you most likely have no legal case, you probably should let him know why he has lost your business.  Maybe it will prevent some other poor soul from a disaster.
Finally, I don't recall your original thought process re treatment but with your stats you have other options besides surgery.  Have you spoken with a radiation oncologist and/or prostate oncologist?  Maybe you should,,,
Tudpock (Jim)
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey:

Tim G
Veteran Member

Date Joined Jul 2006
Total Posts : 2366
   Posted 12/30/2010 9:08 PM (GMT -6)   
First, your anxiety is thru the roof--as all of ours have been--when the Day of Destiny arrives for prostate cancer surgery.  Second, doing a urinalysis is standard prior to surgery.  (I had to show that I did not have a UTI a few days prior to surgery.)   The fact that you did not have one, complicated by the fact of your testicular pain, should have stopped your surgery until you were ok'd based on a negative UA.
Your symptoms and complaint were handled poorly by your medical providers and it was lucky for you that you mentioned it prior to going under.  If you don't trust these guys anymore, it may be best to start over again with someone else. Unfortunately you have no legal case for medical malpractice.
Hope you can return to a relatively normal routine again before you have surgery later.  Take care and hang in there.

Steve n Dallas
Veteran Member

Date Joined Mar 2008
Total Posts : 4849
   Posted 12/31/2010 4:02 AM (GMT -6)   
I'm no expert, but I wouldn't have related testical pain to an infection. I too probably would have done what the PA said and went home.
I can generallly squeeze some pee out..but have learned that my URO always takes a sample when I see him so I quit popping into the mens room after driving to his office.

Cajun Jeff
Veteran Member

Date Joined Mar 2009
Total Posts : 4123
   Posted 12/31/2010 7:14 AM (GMT -6)   
GTO, I must put my 2 pennies in here. The Dr did catch it before surgery (good thing) 2 the worst part is you have to go through another count down. (anxiety) 3 gleason 3+3 gives you some time to figure out what to do.

As someone stated I understand wanting to look for another Uro, but he need to finish clearing you infection. At that point you need to tell him how disspaointed you are with the service of his office. You will not be the first to fire your Uro and you will not be the last.

Best of luck for the New Year and do keep us posted.

Cajun jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1% cancer core
10/08 Nerve-Sparing open radicalSurgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clea
r3 month: PSA <0.1
19th month: PSA <0.1
2 year PSA <0.1
Only issue at this time is ED but getting better

Regular Member

Date Joined Mar 2010
Total Posts : 496
   Posted 12/31/2010 11:02 AM (GMT -6)   
I must give a sample every time I come into the uro outer office. VERY FIRST THing. They do not take me to the examining room without it. This is just for regular visits with no complaints. I see men in the waiting room loitering by the water fountain with paper cups in their hands and I know they are waiting and straining for the nurse. The uro office certainly needs to be made aware of this lapse in the most common of policies. Giving a urine sample for the uro office is like blood pressure and pulse for everyone else. SOP. To overlook it in your case shows someone was just trying to get you out the door. Even if you said it was not currently possible they can see others while you drink and wait. And then there is that catheter thing, as the surgeon was well aware of.

Veteran Member

Date Joined Apr 2006
Total Posts : 1732
   Posted 12/31/2010 1:54 PM (GMT -6)   
You're talking about a good ole case of ignorant incompetence. While it isn't illegal, it does imply you might ignore this PA in the future and only schedule appointments with the Doc until his PA goes back to school and gets a real degree. Who says higher education is difficult to achieve? While it is true that Everyone has an off day now and then,  this is a little more than that...she knew you had cancer surgery scheduled. By declining to see her (PA) for a while, you will send a message. Next time, she needs to take that extra step.
Nothing worse than a medical professional who ignores a complaint of acute pain with no known origin. Any acute pain of an unknown cause requires at least a little investigation. Might be nothing or, it may be something. This following has nothing to do with anyone here, but I have a short story; about an EMS call for a man with testicular pain. That was his only complaint.
Something didn't seem right with this man so, I went with my gut and treated him accoring to what I was seeing, not what he was telling me. My "nurse" partner thought I was strange, but she went along with my train of thought anyway. Before we left the scene, we did all of the necessary medical interventions, "just in case", because he looked like every cardiac patient I had ever seen. None of his vitals, nor the ekg indicated heart problems. It was more due to the acute nature and his appearance. Acute alone would not have led me to think cardiac. Added together with a generally lousey appearance, I thought, wow," this guy is NOT having a testicular problem; it's more than that". Most importantly, I asked him to describe exactly what kind of pain, where and how the pain felt and/or if it radiated. He described exactly what I was seeing by telling me the pain was in his testicles yet rose up "then burst" out of his chest! Who's a thunk??? Looks ARE everything!! The gentleman had a triple bypass that day.
Get well quick GTO and best wishes for a speedy surgical recovery.
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