The need for immediacy
Mark Bowman on the need for immediate treatment when an injury occurs.
This article first appeared in Personal Injury News on 27 March 2010.
- 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.
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).
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.
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.
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 firstname.lastname@example.org.