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Mark Bowman on the need for immediate
treatment when an injury occurs.
This article first appeared in Personal Injury News on 27
March 2010.
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Key points:
- Penile fracture sustained during
intercourse
- Mr M left with permanent erectile
dysfunction and chordee, resulting in him being unable to perform
penetrative intercourse.
- With appropriate treatment, both
conditions would have been minimised, and penetrative intercourse
would have been possible.
The event
Mr M and his partner had been out for
a few drinks on the evening of 13 November 2006. They returned in
the early hours of 14 November 2006 and proceeded to have sexual
intercourse. The time was approximately 03.00.
During intercourse, Mr M sustained an
injury to his penis whilst his partner was on top of him. He felt
his penis bend to one side and felt immediate pain. He could not
continue with intercourse and fell asleep.
Mr M woke later that morning and went
to the toilet. He saw that his penis was badly bruised and swollen
and that blood was being discharged. He was too embarrassed to
attend hospital and therefore asked his partner to call NHS
Direct.
Call to NHS
Direct
Mr M’s partner called NHS Direct at 09.26 that morning. She
spoke first to a health adviser and then to a nurse adviser. the
health adviser, on transferring the call to the nurse adviser
explained that Mr M had bruised his penis and that blood was coming
out of it following intercourse.
Mr M’s partner informed the nurse
adviser that Mr M had injured his penis and that it was bruised and
swollen. She also specifically asked if it was possible for a man
to fracture his penis and was told that it was not. The nurse
adviser stated that Mr M should see his GP before the conclusion of
the next day (15 November 2006).
GP appointments
Mr M proceeded as advised and saw his GP on the afternoon of 15
November 2006. He was prescribed antibiotics and told to come back
in a week. Mr M reattended on 21 November 2006, at which point he
was still suffering from considerable bruising, scrotal haematoma
just below the base of the penis, continued pain and episodes of
bleeding.
Following the appointment, Mr M was
telephoned by his GP and advised to go the urology department of
Guy’s Hospital. Mr M’s GP admitted that it would have been better
had she referred Mr M immediately at the first appointment of 15
November 2006.
On being seen at Guy’s, Mr M was
finally advised that he had fractured his penis. He was given an
outpatient appointment with the urology team for two weeks
later.
Injuries
sustained
At the follow up appointment it was noted that Mr M was unable
to obtain a full erection.
In addition he had reduced rigidity in the corpus cavernosa (the
erectile tissue that contains most of the blood during erection)
and in the glans (head of the penis). He had significant scarring
at the base of the shaft.
He was advised about medication (Viagra and MUSE) as well as the
possibility of using a penile pump to help obtain a full erection.
He was given a follow up appointment for six months time.
Subsequent appointments confirmed that Mr M was unable to obtain
a full erection and that he had a degree of chordee (downward
curvature of the head of the penis). He had obtained no assistance
from medication, nor the penile pump.
He was therefore unable to perform penetrative intercourse and
his relationship with his partner, by whom he had two children,
declined before terminating. M
r M suffered from depression and began to self-harm, requiring
treatment at A&E on more than one occasion. Mr M was informed
that the only treatment available to him was the insertion of a
penile prosthesis, which itself carried a significant risk of
infection.
Mr M did not want to undergo such a procedure and was therefore
left with permanent erectile dysfunction.
Claim v GP?
On being instructed by Mr M,
investigations initially centred on his GP. Breach of duty was
admitted immediately, on the basis that Mr M should have been
referred to hospital on 15 November 2006.
Causation evidence was obtained from a
Consultant Urologist, who advised that by the time Mr M was seen by
his GP it was too late for any effective treatment. There was
therefore no claim against the GP.
The expert evidence was that Mr M
would have needed to have been seen within approximately 12 hours
of the injury being sustained in order that it would be possible
for him to undergo immediate surgical repair of the outer coat of
the corpus cavernosa.
Such surgery would have eliminated
excessive scar formation at the site of the injury and would have
ensured that Mr M’s erectile dysfunction and chordee were less
severe than that which was subsequently sustained. Mr M would have
been able to perform penetrative intercourse.
Claim v NHS
Direct?
Having obtained expert evidence on
causation, investigations centred on the care provided by NHS
Direct. Further expert evidence was obtained from a former employee
of NHS Direct, who believed that the nurse adviser should have, had
she provided appropriate advice, advised that Mr M attend A&E
immediately. A letter of claim was served on NHS Direct, who denied
all allegations of liability.
Proceedings were therefore served. At
this point the NHS Direct admitted breach of duty but denied
causation.
NHS Direct’s position was that it was
in fact possible for Mr M to receive appropriate treatment up to 48
hours from the time of his injury, and therefore, even though their
advice was negligent, had it been followed, and had Mr M’s GP
provided appropriate advice, then Mr M would have received suitable
treatment. Notably, NHS Direct did not add Mr M’s GP as a Pt 20
defendant in spite of their position.
Settlement
Despite the denial of causation, discussions took place between
the parties, and following negotiations, the claim settled in the
sum of £40,000, such sum accounting for Mr M’s injury and the
psychiatric treatment indicated.
Mark
Bowman, is an associate in our medical negligence department. For further
information or to discuss a possible medical
negligence claim please contact Mark on
020 7861 4043 or email mark.bowman@ffw.com.