He accidentally severed a woman’s right ureter and unsuccessfully managed the crisis. The result: A lawsuit and a $9 million verdict.
Dr. R, 32, graduated as the top resident in his urology program. He turned down an opportunity in academia to join an established group practice in his hometown. Ironically, his stellar academic credentials worked against him when he was sued for malpractice a year later.
The patient was a 32-year-old woman who was referred to Dr. R’s group for recurrent UTIs that arose from vesicoureteric reflux. Dr. R was familiar with the reimplantation procedure used to correct this condition, but this case would be the first time he performed it in private practice.
Surgery was scheduled the next day. The operation went smoothly until Dr. R encountered severe fibrotic adhesions behind the bladder, and he accidentally severed the right ureter as it
passed through the pelvis to the retroperitoneum.
As he stared at the cut end, the full horror of what had happened struck home. Dr. R panicked. He implanted the left ureter into the bladder in an oblique fashion, as he had been taught, but when he came to the right ureter, he found it was too short. Unable to find the distal end of the cut ureter amid the dense fibrosis, he hesitated a moment, then implanted it directly into the superior wall of the bladder. Although he knew that continued reflux was a possibility, he hoped for the best and felt lucky to get out of the situation as easily as he did.
The patient was discharged. After a slow recovery, she decided to stay home and care for her two small children. A year and a half later, she returned to her job as a health aide.
But the woman suffered repeated UTIs, as she had before the surgery. A new voiding cystourethrogram showed no sign of reflux in the left ureter, but it did indicate reflux up the right ureter from the bladder.
The infections and bladder irritability were so bad that the woman was occasionally incontinent. Once she “lost her urine” on the kitchen floor in front of her small children. This incident, which her lawyer emphasized at trial, helped attain a huge verdict.
The woman’s family physician referred her to another urologist, who asked for the operative record and then explained what had happened during Dr. R’s surgery. The patient had not been aware of the details. She was advised that her kidney showed signs of chronic infection and damage and that it might need to be removed. Facing mounting medical bills and anticipating the need for long-term medical care, the patient decided to sue Dr. R.
Her lawyer called for the woman’s chart and had it reviewed by an expert urologist. He quickly came back with a report that blamed Dr. R for the woman’s ongoing problems. The plaintiff’s lawyer then filed a lawsuit.
During depositions, the woman described the increasing difficulties that she had expected the
surgery to fix and her disappointment when her UTIs continued. Dr. R admitted he knew he had made a mistake when he cut the ureter, but said he had hoped that the reimplanted right ureter would not allow reflux.
The plaintiff lawyer grabbed onto this statement and made it a central point of his case. During the trial a year later, he told the jury: “The defense is asking you to believe that Dr. R—a top graduate in his urology residency and known to be a highly intelligent man—was unaware that what he did with the severed ureter would not work, when we have heard from [the plaintiff’s expert urologist] that it could never work. You must judge for yourself.”
He then moved on to list the damages the woman had suffered, pointing to her deep humiliation during the incontinence episode in front of her children. Deeply affected by this, the jury came
back with a verdict for $9 million for the patient’s pain and suffering. Interestingly, the woman did not claim any lost wages.