Louisiana bypass turned circumcision

Merry - posted on 04/07/2011 ( 40 moms have responded )

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6. Lack of consent in Louisiana

The Advocate, Baton Rouge, Louisiana
17 March, 2000
Patient for heart bypass sues over circumcision

By MICHELLE MILLHOLLON
Advocate staff writer

A man who underwent surgery for a bypass at Earl K. Long Medical Center has sued saying the hospital circumcised him without his consent.

The hospital has said the circumcision was a necessary part of the bypass surgery, which was not completed because of complications...

Robert Banks sued the hospital and Dr. Mary Jo Wright on Wednesday in 19th Judicial Court.

Banks says in the suit that he woke up from surgery on Aug. 15, 1995, and discovered he'd been circumcised.

His attorney, Alicia Hoover, says no one ever discussed the possibility of a circumcision with Banks.

"It's troubling," Hoover said. "I don't think anyone who goes in for bypass surgery would ever expect or anticipate (they) would wake up and find that they've been circumcised."

But the state Attorney General's Office has said in court documents that the circumcision was a necessary procedure.

Earl K. Long Medical Center is a state hospital.

The state says in documents filed in response to an earlier suit that a bladder catheterization to monitor kidney function was necessary to the bypass.

A circumcision had to be performed in order to do the catheterization, the documents say.

However, doctors had to close up Banks' chest without performing the bypass because of complications that arose during the surgery.

Hoover says Banks is now too terrified to undergo any further surgeries.

Banks first filed suit in 1996 alleging medical battery.

The state argued he was actually alleging medical malpractice and needed to first go before the state medical review panel.

State District Judge Curtis Calloway ruled the circumcision was medical battery, not medical malpractice.

The 1st Circuit Court of Appeal later reversed the ruling.

The appellate court said Banks' lawsuit involved medical malpractice and would first have to be submitted to the state medical review panel.

Judge Brady Fitzsimmons dissented, saying the surgical team could have awakened Banks and gotten his permission for the circumcision.

Hoover said Thursday that the state medical review panel concluded malpractice had not been committed. That decision cleared the way for Banks to proceed with a lawsuit.

Barry Toups, a state assistant attorney general, said the circumcision was neither medical battery nor medical malpractice.

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Krista - posted on 04/07/2011

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A circumcision had to be performed in order to do the catheterization, the documents say.

That is the biggest crock of horseshit I have ever heard in my life. I hope he sues the living snot out of them.

And part of me hopes that it'll make some people think about all the little baby boys who are also circumcised without their consent. If people are so horrified about it being done to an adult, perhaps they'll stop and wonder why they're so accepting of it being done to a baby.

Mary - posted on 04/07/2011

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As someone who does not operate under the immediate assumption that all doctors/hospitals/healthcare providers are all selfish, unethical and uncaring people who all work with a hidden agenda, I'm left thinking there are HUGE chunks missing from this story. It just doesn't make sense.
I come at this without a predisposed bias (unlike a few of you), as well as some actual knowledge cardiac bypass surgery (did that for 6 years prior to L&D).

As Sara pointed out, it is completely routine to catheterize uncircumcised males. IF the anatomy of the penis is normal, this is a simple procedure that takes, at most, 60 seconds. I do not know of a surgeon, nurse, or anesthesiologist alive who would just electively decide to waste precious moments under anesthesia to do an additional procedure that was not absolutely necessary....especially in the litigious-happy society we live in. I read this, and think - there must have been something really "off" with his penis to have made someone decide this was necessary. In normal circumstances, the patient is put to sleep, and the catheter is inserted by the RN before surgery is started (the docs are usually scrubbing at this point). To me, it is very obvious that there was some major difficulty involved in what is normally a pretty quick and easy thing. I don't for a minute suspect that it was just some Americanized ignorance of the intact penis, or some blase attitude about the importance of the foreskin.

It's also pretty clear (to me) that this is a pretty sick and unstable guy....the fact that they opened him up, and closed again without performing the bypass due to complications sort of screams that out, so the "oh, just wake him up, ask him, and put him back under" is a pretty laughable suggestion (but one which does demonstrate the medical ignorance of anyone foolish enough to ask it).

As well, the fact that the hospital and MD didn't just settle out of court (the more common occurrence in medical lawsuits) also suggests to me that, for some bizarre reason, it was physically necessary to remove his foreskin to catheterize him.

Mary - posted on 04/10/2011

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Dana, I've sort of left this alone for the same reason; It's sort of hard to point out rational, reasonable explanations to those who have already decided what the "facts" are.

I will point this out, though. Insertion of a foley catheter is an absolute standard of care in all patients undergoing cardiac bypass surgery. It is essential in monitoring kidney function. I may not know all of the facts in this case, but I am pretty confident that he was told about this prior to surgery. Now, I am sure that no one, including the surgical team, ever anticipated the need to remove any or all of his foreskin for this normally simple, non-surgical procedure. I'm also pretty sure they did not anticipate whatever other issues they encountered that made performing his bypass impossible either. Sometimes, the human body is unpredictable, and shit happens that is beyond anyone's control.

They did what was necessary to get a catheter in him, before they could ever know that he wouldn't need it. I feel the need to reiterate that cardiac bypass is not performed on healthy adults. This means that anesthesia, in and of itself, is always a risky proposition (but not as risky as walking around with a bunch of blocked arteries!). Therefore, "just waking him up and putting him back under" is not really a viable option. He's not taking a nap; he's intubated and anesthetized.

Is it awful that all of this happened to him? Of course. It is not, however, automatically a case of medical malpractice, battery or negligence.

Mary - posted on 04/07/2011

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Heather, I think you misunderstood that comment about being "foolish"....it was directed at the Judge in the OP who made the suggestion that they could have woken him up to get permission. It was more of a commentary about the fact that it is legal professionals make decisions about medical issues, when the vast majority of them have as much knowledge of medical issues as I do of archaeological excavations. The big difference here is that I do not offer opinions, judgments, nor judicial rulings about them.

Laura, funnily enough, I was working in cardiac surgery from 1992-1997. The bulk of patients requiring bypass are in the 40-80 y/o range. It might surprise you to know that I saw many intact penises on elderly men. Circumcision may have been the norm on infants in the 90's, but it was not true of babies born 60-80 years before that. Some of those "babies" (now adults) were even born at home! It wasn't really until the 1950's that RIC became the "norm", with rates as high as 90%. So yes, any health care provider dealing with the adult/elderly population of the 1990's was seeing a good number of intact penises.

[deleted account]

Earl K. is literally a 15 minute drive from my house. I wouldn't take a dog I didn't like to that hospital. And The Advocate is a pretty reputable newspaper...so not sure how biased it would actually be. Other than that, I have nothing constructive to add to this debate. I don't know enough about bypasses or circumcision.

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Dana - posted on 04/10/2011

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Do you mean they can't be circumcised at all or not until it's corrected? For your particular family's issues.



Depending on the degree of hypospadias many children may need the foreskin for repair and they do end up circumcised.

I'm also talking better quality of life if one happens to have the foreskin be in the way of the urethra. Or removing it so it can be repaired and they don't grow up with a bent penis.



That to me falls under better quality of penis life. ;)

[deleted account]

Three of my seven brothers are hypospadic. Four of my nine nephews are hypospadic. This is a hereditary condition. They can not be circumcised. Circumcising them would hurt them. Not help them. Penis quality of life would go down.

Dana - posted on 04/10/2011

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I think Mary's explanation makes a lot of sense. He might have been sick enough that putting him under was going to be risky as it was, so to then wake him back up and do it all over again...

And if he did have hypospadias, it very well could be that having a circumcision would be a good move for him anyhow. Like Mary also stated, many men that age aren't circumcised, hell most of them are lucky to be born in a hospital. So, he might not have ever known of his condition (if it were to be something like hypospadias) and then therefore treatment for better "penis quality of life". ;)

[deleted account]

I still don't understand why the procedure wasn't just rescheduled...to give the patient time to come out of the anesthetic, make an educated decision and THEN continue forward. It does seem a bit communistic that the doctors decided all on their own they needed to circumcise...I would think they should have waited until they had further consent from their patient. But...we aren't sitting here with his entire medical record in front of us. He may well HAVE consented to the procedure...or maybe he consented to a generalized statement that gave the doctors permission to continue forward with the circumcision. If they hand you a paper at the hospital, do you read every wherewithto and hereforth? I don't...I get the gist of what they are asking me to sign...and then I sign it, or I don't. Could the man be confused about exactly how much permission he gave the doctors? Again, we will never know, we don't know the WHOLE story.

Dana - posted on 04/10/2011

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Ink, I thought the same thing actually since my son was born with hypospadias. I just find I don't have the heart to try and bring reason to a circ debate anymore. lol

[deleted account]

It may have been impossible to insert a catheter if the man were hypospadic.
http://www.ncbi.nlm.nih.gov/pubmedhealth...

It's a condition some men are born with. This article says 4 in 1,000. BAsically, what it means is their pee-hole isn't right on the 'end'. If it is tucked under the folds at the base of the foreskin...it may well HAVE been medically necessary to remove the foreskin to insert a catheter.

Isobel - posted on 04/08/2011

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I was thinking what Mary said...YAY ME...it's like getting the right answer on a test

or should I say the answer the prof agrees with ;)

Lesa - posted on 04/08/2011

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A close friend of mine used to work in palliative care and said that the majority of elderly gentlemen had uncut penises and that some were in constant pain due to infections and that is was almost impossible to retract it to clean it. Perhaps, this gentlemen had a serious infection that they did not know about prior to the surgery as they wouldn't be checking out his penis. Like Mary said, it sounds like pieces of the story are missing. I think the court would have awarded him something if the doctor just decided to do it without any medical reason. Just my opinion though.

Sneaky - posted on 04/08/2011

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What kind of incompetent doctor needs to circumcise someone to insert a catheter??????????? Yank the doctors license at LEAST.

Charlie - posted on 04/07/2011

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Oh shit ...well thats just gross how can they say it wasnt medical battery or malpractice ??



Not to mention it is a clear violtaion of his human rights they removed a functioning part of his anatomy without consent .......

Ez - posted on 04/07/2011

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Imagine being put under for a bypass and waking up minus a foreskin? It would be funny if it wasn't so awful. I do agree there seems to be more to this story, but it doesn't change the fact that the situation seems to have been handled badly.

Dana - posted on 04/07/2011

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Yeah, we've got one of those hospitals near me too. Though I don't think they'd be so stupid to circumcise a man for no reason! :|

[deleted account]

Dana, I understand wanting to double check. That's why I put my two cents in on this debate. I know about the reputations of the hospital and the newspaper...even though I can't add much else...lol.

Dana - posted on 04/07/2011

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Yes, Sara, it does seem like an reputable newspaper. I just wanted to double check because it seems lately that some of these articles about circumcision aren't always truthful.

Dana - posted on 04/07/2011

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Can we have a link to this article?



I tend to agree with Mary, there's a lot more going on here than is stated. I'd like to see if this article is written by someone who is biased, as it seems it may be.



Edited to add. Forget it I found it.

Merry - posted on 04/07/2011

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Wow, what's with the mid 90s? Isn't that also when drs were telling moms that formula was healthier then breastmilk? It sounds like a very medically structured time to parent. My great grandparents all bf, my grandparents ff, my parents bf..... I wonder if circ also took a jump in those years and is now finally not so common.
Very interesting!

Merry - posted on 04/07/2011

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It was in 1995, foreskins in America were next to unheard of in that time. I don't doubt it wasn't a simple matter of ridiculous mis information about the intact penis. In the 90s I believe it was like 95% of American males were circumcised. It's possible these drs and nurses had literally never operated on an intact male.

Lady Heather - posted on 04/07/2011

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I might also add that I wouldn't call someone foolish because they are not experts in my field of work. I'm guessing you don't know how to run an archaeological excavation, but if you made less informed comments on such matters I certainly wouldn't call you ignorant and foolish. There are ways to explain nicely why something is necessary without making other people who are not medical professionals feel stupid.

Lady Heather - posted on 04/07/2011

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I'm assuming then that he would have been made aware of this possibility prior to the surgery? I think if there's even the slightest chance of that happening, they should mention it. Maybe he was, but of he wasn't they are at fault somehow. Seems to me that it's kind of a big deal to just do it without his knowledge.

I don't think medical providers are all idiots and obviously my post was in jest, but it is rather serious if possible complications aren't discussed with patients ahead of time. Either this guy is lying and they did mention it or they didn't think it was important enough to mention. Someone is a douche either way.

Becky - posted on 04/07/2011

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Wow, that's insane! If you had to remove the foreskin to insert a catheter, I'm pretty sure our doctor would've told us that when we were discussing the pros and cons of circumcision. "Oh yeah, if they ever need a catheter, they'll have to have an emergency circumcision first!"
If they did this without informing him first that it might have to happen and without getting consent from anyone, then I think he should definitely have grounds to win a lawsuit! Sheesh, that'd be like them removing one of my fallopian tubes when they took out my gallbladder! "Meh, it was in the way and you really only need one, so we took it out!" *eye roll*

Merry - posted on 04/07/2011

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Read the last phrase, it was ruled neither medical battery nor medical malpractice........does that mean be received nothing?!?!?! It was in 1995, but I'd hope he would get some sort of compensation, this is ridiculous!

Merry - posted on 04/07/2011

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I'd be scared to go under again too! You might wake up without your left foot or smomething! "Oh yeah, we had to amputate that foot, there was a wort on it, sorry!" sheesh, you need a witness to accompany you into surgery to advocate for you or something!

Lady Heather - posted on 04/07/2011

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Had they never seen an uncut penis before or something? I can just imagine it - "Omg what is that?"
"I don't know. Chlamydia?"
'Well we'd better get it off of there."
"Yeah, I know I wouldn't want one on my penis."

Seriously. Wtf? And then he doesn't even get his actual problem corrected?

Minnie - posted on 04/07/2011

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They shouldn't even have to retract the foreskin to place a catheter. They should be skilled enough to do it without retracting. ESPECIALLY with a non-retractible child.

Merry - posted on 04/07/2011

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My cousin was an intact infant when he needed a catheter, the idiot dr pulled s foreskin back to place it! My cousin had a lot of scar tissue and it was very firm and un moveable for years! Finally when he was about 6 it began loosening up and now he has normal function as an intact boy, but for years my aunt worried they would need to circumcise him if the scar tissue didn't soften.

*this is one misguided reason we chose to circumcise since we knew Eric had minor hydronephrosis and would be needing some teasing requiring catheters. Now I've found out you can place one without pulling back the foreskin, you just have to 'poke around' a bit to find the urethra.
Oh and you have to actually KNOW how to place a cath on an intact baby!

Minnie - posted on 04/07/2011

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Yes, that is a complete lie, that he had to be circumcised to be catheterized.

When one goes in for surgery there is extensive pre-op discussion on what will happen during the surgery. Did they not think to cover that they would be removing an organ from his body?

Outrageous.

Sara - posted on 04/07/2011

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My sister is a surgical nurse, and she has to insert catheters all the time, and she's told me that she's done it on uncircumcised men, you just pull back the foreskin.

This poor guy. Can you imagine waking up from surgery to find that had happened to you? I'd feel so violated.

Jenni - posted on 04/07/2011

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Now I'm not a doctor or anything but since when do you need a circumcision to have a catheter put in?
My husband under went major adominal surgery and had to have one, they had no issue placing one. :/
and ummm wouldn't they have consulted him first about it? Or the family member in charge of medical decisions if he is unable to make them?

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