Our database search yielded a total of 26 cases, of which 10 met the inclusion criteria. Table 1 summarizes each of the 10 cases. The cases occurred between the years 1931 and 2022, with 60% (6/10) having happened since 2013. 60% (6/10) of the cases involved an inmate as the plaintiff. The most common alleged breach of duty was violation of the 8th Amendment (50%, 5/10), which, among other measures, protects against cruel and unusual punishment. All those cases involved inmates. The other alleged breaches included negligence or indifference to the patient’s medical condition (40%, 4/10) and disability discrimination (10%, 1/10). Regarding the overall nature of the breach of duty, half of the cases cited an alleged lack of treatment or inappropriate treatment (e.g., prescribing medication when surgery should have occurred) while the other half cited consequences of surgery (e.g., failure to correct the varicocele, failure to perform operation according to medical standards, infection resulting from the operation).

The most common alleged damages included pain or suffering (80%, 8/10), infertility (30%, 3/10), and loss of testicle (30%, 3/10). The other alleged damages included loss of earnings/income due to incapacitation (10%, 1/10), infection (10%, 1/10), and loss of potential offspring due to infertility caused by unsuccessful varicocele treatment (10%, 1/10).

A urologist was included among the defendants in 6 of the 10 cases. Other defendants included prison wardens, healthcare institutions, prison complexes, other non-urologist physicians (e.g., radiologists, internists, primary care physicians), nurses (RNs and NPs), and pharmacists). The defense in 8 of the 10 cases included multiple defendants, with some involving up to 18 (Diaz v. Spencer).

The verdict in 90% (9/10) of these cases favored the defendant. The lone case which favored the plaintiff occurred in 1951, included a urologist in the defense, and involved a retained drain inside the scrotum which led to infection and ultimately orchiectomy. 100% (6/6) of the cases involving inmates favored the defendant. The justifications for the rulings in favor of the defense oftentimes cited the lack of definitive evidence of deliberate misconduct by the defendant, medical records that contradict the allegations, and/or testimony given by outside physicians in support of the defendant’s actions and reasonings. To give an example, in Canales v. Abramson, the court ruled in favor of the defense; part of their justification reasoned that a difference in opinion over his varicocele treatment between the medical professional and the patient which resulted in a suboptimal outcome for the patient did not constitute deliberate negligence that could be considered malpractice. Furthermore, although the patient suffered from prolonged pain related to his varicocele, there was no evidence that the defense purposely withheld treatment or denied care. In cases such as this, the onus to provide evidence is placed upon the plaintiff, not on the defense.

Looking more specifically at the cases which involved urologists as the defendant, we found that of the 6 cases, 3 involved an inmate as the plaintiff, and 3 involved non-inmates. The cases occurred in 1931, 1951, 1999, 2009, 2013, and 2014. All the non-inmate cases claimed malpractice as the primary breach of duty, as opposed to the breach of the 8th Amendment in the cases involving inmates. Furthermore, only one urologist had undergone fellowship training.