Even though the doctor told the man to continue with antibiotics after his scrotal surgery, the patient never filled the prescription. 
  
Dr. E was a well-respected urologist whose pragmatic approach and wide experience gave him a reputation as the “go-to” man when things got tough. As a result, he often found himself used as a “superconsultant” on difficult cases, struggling with critical clinical situations that did not always have a positive outcome.
 
One such case involved a 64-year-old patient who underwent hernia surgery for a right-sided indirect inguinal hernia. There was a small congenital sac, which had enlarged over the years and contained adherent omentum. A general surgeon performed a conventional hernia repair, and the man did well postoperatively, except for the development of a large tender swelling in the ipsilateral scrotal sac.

Dr. E was called in for a consultation. Transillumination and a scrotal ultrasound confirmed the presence of epididymal swelling and scrotal fluid, and aspiration produced a cloudy, serous fluid that to Dr. E suggested an early infection of the surgical area. He recommended exploration and drainage, together with antibiotics.

he patient then made an unusual request: while exploring the testicle, could Dr. E also remove an undescended testicle on the other side? Dr. E, in what he later regarded as a mistake, promised that he would.


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The next day, he drained the scrotal sac of semipurulent mate-rial, examined the testicle (which appeared to be somewhat swollen and discolored), and then removed the undescended testicle through an inguinal incision on the other side. He took great care to avoid cross-contamination between this clean area and the presumed infection in the other scrotum.
 
His efforts were partly successful, in that the patient’s inguinal incision showed no sign of infection. The left scrotum, however, developed a raging postoperative infection two days after discharge, on the third postoperative day. The patient was readmitted and started on clinda-mycin. After a week on antibiotics, Dr. E performed another exploration of the left scrotum and removed a gangrenous testicle and epididymis. After that, the scrotum healed quickly and the patient was discharged.
 

Blocked blood supply

The patient and his family consulted a lawyer, who had the chart reviewed by an expert urologist. When the report criticized Dr. E for damaging the testicle’s blood supply during surgery, thus creating an ischemic testicle and a nidus for infection, the lawyer filed a malpractice suit against Dr. E and the hospital.
 
During depositions, the plaintiff expert testified on video from his distant office. He said the post-operative infection resulted from inadequate treatment of the fluid collection and damage to the blood supply of the testicle. The defense expert, who was local, argued that the infection was a recognized risk of hernia surgery and was present before the drain-age operation. He pointed to a prescription for antibiotics, which had been given the patient upon his discharge from hospital, that he had not filled or taken. At trial, the patient admitted that he had not filled the prescription. The plaintiff’s expert substituted his videotape deposition for an actual court appearance.
 
The next day, the defense lawyer presented in person. Dr. E made an impressive witness, stating his records of the case in a calm manner and explaining each step in his decision making process to the jury. He also underscored the pertinent fact that the patient had been noncompliant with his instructions. Dr. E was followed by the urology expert for the defense, who asserted that the infection was a recognized complication of surgery and that the patient should have continued the antibiotic treatment for it to be effective. The jury deliberated for two days, but couldn’t agree on a verdict. The case was tried again a year later, and that jury found in favor of Dr. E.