LA VA Medical Centre vs Houghton – with commentary by Dr David B. Samadi

Impending surgery is always nerve racking. Whether the surgery was something that an individual has had time to prepare for, or it was entirely unexpected, the reality of having to go under the knife makes people nervous. It is perfectly natural – a stranger standing over you, meddling through your insides as you lay unconscious on a table does not sound natural. Therefore, naturally, it makes us anxious to think about it. Some of us feel the nerves going into surgery, no matter how little or big said surgery is going to be. others feel entirely confident going in, without a care in the world. For 47-year-old Air Force veteran Benjamin Houghton, his impending surgery seemed to be quite straight forward. It was a seemingly simple removal of his left testicle, believed to harbour cancerous cells. Houghton had waited years after his diagnosis to have this surgery, but he was now ready. Despite his calm demeanour and the years of preparation leading up to the (perhaps inevitable) surgery, a mistake was made – or rather, a series of small errors led to a damaging mistake that would change Houghton’s life forever. Board-certified and top-tier Urologist Dr David B. Samadi knows the value of both patient and medical team learning about impending surgery, saying “learn everything about the surgery…strengthen your body, learn what to expect after surgery”. Despite this valuable advice from an esteemed professional in the field, all the preparation in the world could not prepare Houghton for the reality that awaited him when he woke up post-operation.

Diagnosed with metastatic testicular cancer in 1989, Benjamin Houghton was then in the Air Force. At the time of diagnosis, he declined to undergo surgery and instead underwent chemotherapy at Andrews Air Force Base in Maryland. The chemotherapy worked, and Houghton retired after his chemotherapy concluded. In 2006, he went to his doctor and had a check-up, as his left testicle was painful and atrophied. While there was no sign of the cancer having come back, the symptoms did lead the doctor to believe that there was a considerable chance that Houghton’s left testicle held cancerous cells. The decision was made to operate and remove the testicle and, hopefully along with it, the risk of the cancer returning with a vengeance.

In June of 2006, Houghton was going in for surgery to remove his left testicle, which was believed to have cancerous cells that may have returned after the previous years of chemotherapy. Fifth-year UCLA medical resident John T. Leppert was the surgeon assigned to Houghton’s procedure. Leppert was supposed to remove Houghton’s left testicle and perform a vasectomy on his right testicle (for birth control purposes). Dr Samadi stresses the importance of communication at vital points between patient and surgeon, staying “it is all about the doctor’s ability to be sensitive to the impact that things such as diagnosis can have on the patient, while staying truthful”. This is not always easy, as the operating team that performed Houghton’s surgery learned the difficult way. When Houghton woke up, the surgeon told him that there had been a mistake during the surgery – he had removed the healthy right testicle instead of the suspect left testicle, and had performed the vasectomy on the testicle.

This crucial error effectively robbed Houghton’s body of testosterone, as well as causing a ripple effect of other consequences, including emotional stability, fatigue, weight gain, and osteoporosis. Dr Samadi wisely states the importance of obtaining perspective from multiple professionals, saying “asking for a second opinion from a doctor can be intimidating…the reasons you should proceed when asking for a second opinion from a doctor, especially in the case of a life-threatening or serious disease, are much more compelling”. While the primary referencing point stems from diagnosis itself, it also holds true for surgical teams leading up to, during, and after medical procedures – with a team of experts in the room, all of them should weigh in and ensure that every single aspect of the surgery has been gone over, again and again.

Houghton and his wife, Monica, sued the VA Medical Centre for $200,000 in damages, and safety experts weighed in, stating that the multiple errors in the procedure were thought to be seldom due to the surgeon alone, but instead the practice and the methods that were used at the time of the procedure. In 2013 the Houghtons won their case against Los Angeles VA Medical Centre and the surgeons that were involved in the botched procedure. The hospital has since changed their practices in response to the case.

The publicity surrounding the case has ignited conversation among the medical community about what is to be considered acceptable standards of obtaining a patient’s consent for surgery (among other things). Of course, it is entirely comprehensible that surgeons make mistakes on rare occasions – after all, they are only human. Houghton is lucky, despite what some might say. While his botched surgery has been life changing, at the very least he has not lost his life during or as a direct consequence of said surgery. As of 2016, medical error is the third biggest cause of death in the USA alone. Lawsuits – not unlike Houghton’s case against the VA Medical Centre – do shed light on problems in the system, and give them the rightful chance to overcome and improve barriers and flaws in the system that is designed to protect.

Medical professions like Dr David B. Samadi pride themselves on their inherent ability to provide people with the medical care they need. The importance of putting one’s health as a top priority cannot be overstated, and yet unfortunately so many people either put their health in the backseat, or are provided with the wrong information or care. Both medical patients and professions in the industry must make changes to ensure that cases like Air Force veteran Benjamin Houghton’s do not happen again. What may seem like a minor inconvenience to one person can be life-altering to another – and the loss of Houghton’s testosterone is absolutely a life-altering consequence of a surgery gone wrong. While it is positive to see the medical practice responsible taking measures to change their practices, it remains a concern that even with so many checks and boxes to be ticked before, during, and after surgery, errors this damaging can still happen. Yes, surgeons are only human, but with so many involved in surgeries like Houghton’s, it is frankly appalling that such a mistake was not picked up before it caused irreversible damage. As Dr Samadi says, “learn everything about the surgery”.