Benjamin Houghton had fewer reasons than most to fear the surgery he'd scheduled at the West Los Angeles VA Medical Center to remove his potentially cancerous left testicle.
For one thing, the 47-year-old Air Force veteran and father of four already knew that he could function normally with a single, healthy testicle.
For another, he was getting his surgery in a system that has prided itself on its pioneering efforts to prevent medical errors. One top VA official said the VA's approach to safety is considered "a benchmark by healthcare organizations throughout the world."
But in Houghton's case, the hospital missed the mark. Last June 14, doctors mistakenly removed the right testicle instead of the left, according to medical records and a claim filed by Houghton and his wife Monica, 39.
Now the couple are seeking about $200,000 for future healthcare costs outside the Department of Veterans Affairs system and an undisclosed amount in damages. Their claim is pending.
Houghton was left deprived of the testosterone the healthy testicle produced, setting him up for potential health complications including sexual dysfunction, depression, fatigue, weight gain and osteoporosis. Within a healthcare system with nationally recognized patient safety innovations, he joined the ranks of hundreds of thousands of Americans each year who are victimized by medical errors.
"At first I thought it was a joke," said Houghton, who recalls being told of the mistake immediately afterward, while he was in recovery. "Then I was shocked. I told them, 'What do I do now?' "
Dr. Dean Norman, chief of staff for the Greater Los Angeles VA system, has formally apologized to Houghton and his wife.
"We are making every attempt that we can to care for Mr. Houghton, but it's in litigation, and that's all we can tell you," he said. Norman added that the hospital has made changes in its practices as a result of the case.
But Houghton, who has received care through the VA since his discharge in 1989, wants nothing more to do with a system that he believes failed him.
The surgery Houghton went in for that day was not urgent. He had first been diagnosed with metastatic testicular cancer in 1989. He declined surgery at that time and retired after chemotherapy at Andrews Air Force Base in Maryland.
There had been no sign of the cancer's recurrence, but his left testicle was atrophied and painful, and there was a chance that it could harbor cancer cells.
The VA surgeon, fifth-year UCLA medical resident John T. Leppert, was supposed to remove Houghton's left testicle and perform a vasectomy on his right side for birth control purposes, according to medical records that Houghton and his attorney gave The Times.
In medical parlance, what happened instead was a "wrong site surgery," a category that includes operating on or removing the wrong limb or organ, doing the wrong procedure or treating the wrong patient. It is a rare, if often devastating, occurrence.
Leppert could not be reached for comment.
The mistake resulted from a series of missteps along the way, a classic pattern long recognized by safety experts. Errors, they say, are seldom due to a single doctor's or nurse's incompetence or negligence.
By its own guidelines and those of national hospital regulators, the VA hospital was required to obtain informed consent from the patient for the surgery, mark the operation site and take a "timeout" in the operating room to double-check that doctors were targeting the correct site, doing the correct procedure and operating on the correct patient.
According to Houghton's medical records, something appears to have gone awry at all three of these steps.
The consent form, prepared the day of surgery, stated that the right testicle was to be removed and a left vasectomy performed, when it should have said the opposite. The records do not say who prepared the form.
Both Leppert and Houghton signed it, Houghton said. Houghton did not have his glasses so could not read it, his wife recalled.
The surgeon said, " 'This is what we talked about before. Just sign here and here,' " Houghton said. "I didn't actually read it."
Although Houghton's experience serves as an object lesson on reading consent forms carefully, even a thorough examination won't necessarily catch errors, said Fran Griffin, project director at the nonprofit Institute for Healthcare Improvement in Cambridge, Mass.
"You see what you expect, not what is actually there," she said. "That's why the consent, while it's an important step, by itself will never be sufficient."
The next step -- marking the site with a surgical pen -- is supposed to take place before sedation, so the patient can participate.
Houghton said he was asked to identify the surgical site and pointed to his left testicle, but both he and his wife said no one marked it. Houghton's records don't mention a mark.