No good deed goes unpunished

Posted on October 10, 2008. Filed under: Everything you wanted to know about doctors, Medico-legal issues, Sexual issues |

“Doc, I just cain’t get a hard-on by no-ways, and it’s torturin’ my wife and a-killin’ me.” The man was from the “redneck” area of Louisiana, a society very different from the Cajun-influenced culture of “Acadiana”, the site of my practice. He was an evangelical born-again-Christian 54-year-old hypertensive diabetic who had not been able to have sex with his wife for over two years. He had been referred by his family-practice doctor, who managed his diabetes and hypertension, after failing to respond to the pills. Short of traumatic nerve damage, such as is seen in spinal cord injuries, impotent men usually retain the ability to have orgasms. Many are incredulous when they first find that they can ejaculate without ever achieving an erection, but in reality, the two functions are completely separate. Consequently, if erections can be restored, they’re back in business.

There are very few physical causes of erectile dysfunction for which treating the underlying cause improves the erections. For example, normalizing the blood pressure or gaining better control of the blood glucose will not help the problem at all (in fact, getting the BP back to a normal level actually makes atherosclerotic ED worse, since there is less pressure to drive the blood through the narrowed penile arteries). To see where we stood, I tested the man by injecting alprostadil into the muscle of his penis (described here). He developed about 50% rigidity, a level which buckles easily when pressed (such as in the attempt at intromission). As often happened, he was thrilled at what seemed to me to be a terrible result, since he had not been seeing any response at all. He felt certain that self-administered injections were the answer. As another similarly encouraged patient told me, when I opined that the injection-produced rigidity was inadequate: “Doc, I’ve been screwin’ with a limp dick for so long that I’m sure I could shoot pool with a wet rope.”

The man returned in about two weeks, thoroughly discouraged. “Doc,” he whined, “it was like tryin’ to put an oyster in a slot machine.” His doctor had told him he was healthy enough for surgery, if he so chose; he wanted an implant. After accomplishing all the pre-op regimen, I performed the out-patient surgery without trouble, and six weeks later, I released him for conjugal duties. About six months later, I received a note, written by his wife, and signed by both of them, which I saved in his file. It closed with: “God has blessed us so truly by bringing you into our lives. We will never be able to thank you enough. May the Lord always bless you and keep you.” I did mention they were evangelicals, didn’t I? The other thanks I got was a Medicare payment of $700, the allowed charge for the retail-priced $3000 operation; he was eligible for Medicare because his hypertension and diabetes had rendered him “disabled”.

Two years and eleven months later (I’ll get to the reason I remember the time frame so accurately), a city marshall appeared at my front desk, much like the scene described here, in the opening of a chapter of Chasing a Light Beam. His gift was a summons for medical malpractice, the offense being “failure to diagnose”. The plaintiff was the BAC (born-again Christian) described above. It turns out that the BAC’s family doctor, the same one who had referred him to me, had recently made the diagnosis of “familial idiopathic pulmonary fibrosis“; short of a lung transplant, the BAC would be dead within two years. The BAC had been attended to by this doctor for over ten years, and ironically, the same doctor had diagnosed FIPD in the BAC’s now-dead brother several years earlier. According to the complaint, a penile implant surgeon who fails to diagnose FIPD has violated the “standard of care”. Apparently the same is not true for the family doctor of 10 years, since he was not named. And the timing? Louisiana gives a potential plaintiff one year from the time of the discovery of the problem to file litigation, and three years total, regardless of the time of discovery. My involvement with the BAC was conveniently one month short of three years.

Had this case not arisen, I likely would have made it through my entire life without ever having heard the phrase “familial idiopathic pulmonary fibrosis”. A brief survey among my colleagues in the doctors dining room at the hospital turned up only one who knew about FIPD: a board-certified pulmonologist. 

The BAC found an academic program that would accept him for pulmonary transplantation in spite of his age and the many younger candidates slowly smothering. The government paid for his surgery and subsequent care, and he resumed breathing nicely. Eventually, after over two years of depositions and expert opinions, and over $25,000 of defense expenses borne by my insurance carrier, he dropped the malpractice action, without ever going to trial or receiving any settlement. 

Oh, and when it was all over, his wife said the implant was working great!

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    About

    The director of the Sexual Medicine Center leaves penile implants behind, and launches a quest for knowledge about Artificial Intelligence, extended life, and the issues inside the health-care industry.

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