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Doctor said it was cancer, it wasn't, but news came too late

Doctor said it was cancer, it wasn't, but news came too late

February 19th, 2018 in Missouri News

ST. LOUIS (AP) — Last April, Harald Boerstler went in for his annual checkup. Among the results: an elevated protein level in his blood that could signal prostate cancer. The doctor told Boerstler high readings do not always signify cancer and he could wait and have the test run again or have a biopsy, a process of going through the colon to make 12 needle injections into the prostate for samples. It would require taking antibiotics beforehand and local anesthesia during the procedure.

Boerstler, 52, wanted to rule out cancer as quickly as possible. He was starting a new job the next month. Peace of mind trumped any trepidation about an invasive procedure.

The St. Louis Post-Dispatch reported on May 1, his first day on the new job with an architecture firm, Boerstler's phone rang. It was the urologist to whom his doctor had referred him, and he had bad news: The biopsy revealed prostate cancer. It was invasive and aggressive. Lymph nodes near the prostate in addition to nerves connected to the gland would have to be removed to reduce the risk of spreading.

Thirty days later, Boerstler was in the operating room. The initial report immediately after surgery was hopeful. Doctors said the prostate had not ruptured and the cancer was likely contained within the removed gland. The following week, Boerstler returned to his doctor's office to have a catheter taken out and to get the results of a pathology report that would ultimately lead him on a path of follow-up treatment.

"Well, we're confused," the urologist said to Boerstler. "Either the labs got mixed up or you were miraculously healed."

It turns out Boerstler's removed prostate was healthy. The biopsy results that showed the fast-growing cancer belonged to another patient. There had been a mix-up.

It was hard for Boerstler to fathom such an error. He thought any chance of that happening had been negated when he, at the urologist's suggestion, had a DNA swab taken at the same time he had the biopsy. Matched against one another, it would be nearly impossible to mix up test results among patients.

But that's exactly what happened.

Boerstler said he's telling his story in hopes of helping others, but with caveats. As a condition of a financial settlement, he cannot publicly disclose the urologist's name, the lab where his biopsy and DNA sample were sent nor the hospital with which the physician is affiliated. He also cannot talk about the amount of money he received to keep the case from going to court. He received the check this month. Boerstler did allow a Post-Dispatch reporter to review his medical records to verify the facts of his story, and the Post-Dispatch is honoring the agreement he made with the doctor's insurance company.

"It was settled to everyone's satisfaction" is the official answer Boerstler's attorney has instructed him to give.

The DNA test that gave Boerstler assurance his biopsy would not get mixed up is not universally viewed by doctors as the panacea for laboratory errors.

Dr. John Pfeifer, vice chairman for clinical affairs in the pathology and immunology department at Washington University School of Medicine, has done extensive research on biopsy mix-up results and said such mishaps are rare, at less than 1 percent.

As a result, not all physicians see the point of taking a DNA swab, a test that can add $300-$400 to a patient's medical bill.

"There is the middle ground — the most rational place for a lot of this," said Pfeifer, who had no involvement in Boerstler's case. For example, if a woman comes in with a lump on her breast, "a (positive) biopsy result will be very much in line with what we anticipated. On the other hand, if it came back negative, then that would be an appropriate time to take a DNA swab to match against the biopsy."

A smaller group of physicians will recommend a DNA swab with every biopsy, determining "the liability that would come with that (error) would be so high it actually saves money to do (the DNA test) in every case." And then there is a third group of doctors who understand mistakes are ultimately going to happen and a DNA test is not necessarily going to prevent them.

Pfeifer said the more information a patient has, the better.

"Every good physician out there should welcome a conversation about (DNA) testing," he said.

At the kitchen table of his Southwest Garden home, Boerstler sat with an accordion file folder packed with medical documents, piecing together the health odyssey of the last 10 months.

Among the documents was a letter his attorney wrote to legal counsel for the insurance company.

"As a result of your client's negligent and reckless handling of his biopsy sample, Mr. Boerstler's world has been dedicated to handling one physical and emotional trauma after another," Boerstler's attorney wrote.

Boerstler's "unnecessary saga," as his lawyer wrote, included a swelling of his scrotum to the size of a grapefruit three days after his prostate was removed. At the emergency room, a series of tests were run. Ultimately, the swollen area was packed in ice.

The evening of June 7, just a few hours after his doctor told him of the mix-up, Boerstler was working his side job at Circus Flora, where he is house manager. He noticed his shirt was wet. Underneath, the surgical dressing was soaked, a yellowish red color. It was seepage from the incisions.

The doctor eventually decided to reinsert the catheter to relieve swelling he said was caused by fluid building up in Boerstler's bladder. Three of the six incisions from the surgery were leaking. Two weeks later, after the catheter was removed a second time, a bulge grew on the right side of Boerstler's abdomen and 850 milligrams of lymphatic fluid was drained. A week later, more fluid was drained.

Boerstler continues to deal with incontinence and impotence. He was given prescriptions for Cialis, then a high dosage of Viagra. Neither worked. Penile injections were offered as a remedy. Boerstler said he is not ready to try that.

"The personal enjoyment, satisfaction that comes with intimate relations, can never happen again," Boerstler's attorney wrote. "The profound impact on his psyche is beyond description."

As for the financial impact, Boerstler's out-of-pocket expenses stand at about $9,000, after insurance. That does not take into account the financial settlement.

Boerstler said one mistake is one too many, and all doctors should offer a DNA sample to go along with the biopsy. Even though there was a mix-up in his case, the DNA sample eventually was used to verify that an error had been made.

"It's $350 vs. $68,000. That is the difference between a more fail-safe test and the cost to do a surgery that was not needed," Boerstler said, referring to his case. He thinks the testing process should go even further, having the lab results examined by a third party.

"You never check your own work," said Boerstler, an architect, pointing to the construction business as an example.