After 67-year-old Hurshell Ralls went into surgery for bladder cancer, he came out of surgery missing more than he ever expected. His penis and testicles were gone.
"My wife had to hold my hand in the bed there. And she said 'Honey it's over. They got all the cancer.' And she waited a few minutes and then said 'But they had to remove your penis.' And I was one mad dude, you know," Ralls said on ABCNEWS' Good Morning America.
Ralls, a mechanic, says doctors never warned him or his wife that amputation of the penis and testicles might have been part of surgery before he went in for the procedure in November 1999. Ralls filed a negligence lawsuit against the Clinics of North Texas in Wichita Falls, and the doctors who operated on him. The civil case is set for trial Aug. 25.
"It was never even discussed. And I felt like he ought to have at least told us that this might be a possibility so that we could have talked it over even before he was admitted to the hospital," said Thelma Ralls, his wife. In a February deposition, Ralls' doctor said that he determined the cancer had spread to the penis while he was removing Ralls' bladder. Doctors did not send a tissue sample to the lab until after the surgery. A Dallas doctor who examined cell slides later found that Ralls did not have penile cancer.
The Ralls' case may sound outrageous, but for cancer patients across the country, medical errors are something they — and many other hospital patients — face with alarming frequency.
The Robert Wood Johnson Foundation reported in 2001 that 95 percent of doctors have witnessed a major medical mistake, and that many of them involved cancer. When Johns Hopkins reviewed tissue samples from thousands of cancer patients around the country, they found one out of every 71 cases was misdiagnosed.
Both Breasts Removed, No Cancer
Frank Barerra is another cancer patient who was the victim of an error. He was actually in surgery, about to have his prostate removed, when a call came from the pathology department — there had been a mistake. His slides showed no cancer.
"You can imagine — it was like waking up from a bad dream," Barerra said. "It never occurred to me that a pathology lab could just bungle a decision like that."
Last January, Good Morning America interviewed Linda McDougal, who was misdiagnosed with breast cancer. McDougal was given a double mastectomy at the United Hospital of St. Paul, Minn., in May 2002. After the surgery, McDougal was told that she actually had no signs of cancer.
"My surgeon walked in and said that she had bad news, and she had no other way of telling us other than to put it on the table. And that I didn't have cancer," McDougal said. "And my immediate reaction was, great, you got it all. And then she said, you don't understand. You never had cancer. And it was instant shock. I couldn't even react to it."
When McDougal appeared on Good Morning America, the hospital that did the operation offered an apology. Dr. Laurel Krause, a senior pathologist at the hospital said that two patient slides at the hospital were inadvertently switched.
"We deeply regret what happened, and wish we had made that clear at the time," Krause said. "At the time, Linda was very angry, and justifiably so."
But to victims of medical errors, sometimes an apology can't make up for what they've lost.
"I really felt like they played God and took it in their hands and decided to do it," Thelma Ralls said. "This is Hurshell's life, and my life. And to me they destroyed our sexual life."
Understand Your Doctor
Dr. Rache Simmons, a breast cancer surgeon with Weill Cornell Medical Center in New York, said that there are steps that patients can take to protect themselves. First of all, patients should listen carefully to their doctors, and all of their options and recommendations. If you don't understand your doctor, get a new one, she advises.
"Part of being a good doctor is being able to communicate with your patients," Simmons said. "If you don't understand your doctor, and you've asked him or her to explain it again and your still don't get it, find another physician."
Patients who are told they need surgery should also seek out a second opinion. It makes good sense, and almost all health plans will pay for it. If the opinions disagree, call your health plan and ask if they will pay for a third. If they won't go with your gut on whether to proceed with the surgery, Simmons said.
Once the decision is made, all patients should bring a family member or friend to a pre-surgical appointment to write down information and ask questions.
"I give out hand-outs and videos at my practice because, as a breast cancer surgeon, it's hard for anyone to be calm enough to take in all the information at the appointment," Simmons said.
Ready for the Worst
It is also important for patients to designate someone as their health care proxy before surgery, Simmons said. The patient-appointed proxy can carry out the patient's wishes while the patient is under anesthesia.
Before going into surgery, patients sign a consent form, which they should read very carefully before signing. The form will describe exactly what the doctor is allowed to do, and whether a doctor will be allowed to proceed if more serious conditions are found.
"It really boils down to a consent issue. So we as doctors can only do what's in the consent form," Simmons said.
Another important document that patients should consider is a living will, which can protect a patient's rights and wishes while they are under anesthesia, in case the unexpected happens. Doctors need to know what they should do in terms of extraordinary life-saving measures.