On Sept. 9, 2013, plaintiff Mariano Cruz Vera, 64, a retailer’s custodian, underwent cryoablation of his prostate. The procedure was performed by Dr. Garo Tertzakian, a urologist, at the La Veta Surgical Center, in Orange. Vera had been diagnosed with prostate cancer in June 2013, and his prostate biopsy revealed the cancer to be a Gleason score 7 (3+4) with perineural invasion. Vera and his family had two office visits with Tertzakian to discuss the diagnosis and the treatment options, which included active surveillance; radical prostatectomy and radiation therapy, both of which were not performed by Tertzakian; and cryoablation, which was performed exclusively by Tertzakian. After the procedure, Vera was seen in Tertzakian’s office for his post-operative visit on Sept. 17, 2013. At that time, Vera’s Foley catheter was removed. He returned to the office the following day with a report of being unable to urinate. A new catheter was placed by a medical assistant. On Sept. 26, 2013, Tertzakian removed the new catheter. Shortly thereafter, Tertzakian left the country for an extended period of time and was unavailable to see Vera. However, almost immediately after the new catheter was removed, Vera began experiencing what he believed to be diarrhea. He sought treatment for that complaint from his primary care physician, as Tertzakian was out of the country. On Oct. 23, 2013, Vera’s complaint of diarrhea was communicated to Tertzakian. Since Vera’s primary care physician was already working up the cause of the persistent diarrhea with Vera, Tertzakian deferred to that physician. Six days later, on Oct. 29, 2013, Vera was determined to be was passing urine through his rectum as a result of a fistula that had formed, which allowed urine to pass from the urethra to the rectum and fecal matter to pass from the rectum to the urethra. As a result of his condition, Vera’s right testicle became severely infected and had to be surgically removed. Vera sued Tertzakian and the operators of the surgical center, La Veta Surgical Center and Surgicare of La Veta, Ltd. Vera alleged that the defendants’ actions constituted negligent treatment, a failure to detect, a failure to monitor and a failure to diagnose. The La Veta entities were dismissed from the case, and the matter only continued against Tertzakian. Vera and his family claimed that Tertzakian recommended cryoablation to them and steered them toward that choice. Vera also claimed that he awoke from the cryoablation procedure in excruciating pain and with profuse rectal bleeding but was discharged to home. Plaintiff’s counsel contended that the standard of care required that active surveillance be offered as the preferred option and that Vera never should have undergone cryoablation, as Vera remained sexually active and the surgical treatment virtually guaranteed erectile dysfunction and urinary incontinence. Vera’s urology expert opined that the complication of a fistula meant that something had gone wrong during the cryoablation to damage the tissue between the prostate gland and the rectum, allowing a fistula to form. The expert also opined that Tertzakian had breached the standard of care by failing to recognize the presence of a fistula, as evidenced by urine passing through the rectum, and that the delay in diagnosis allowed the infection to advance into the right testicle, thereby necessitating the loss of that right testicle. Similarly, the expert testified that the use of medical assistants to place catheters in the patient was against the law and that it was especially below the standard of care in a patient with a vulnerable urethra following cryoablation. Judge John Gastelum prohibited any witness from testifying that it was within the standard of care to allow a medical assistant to place a catheter, as medical assistants are not allowed to place catheters by law in California. Defense counsel contended that the standard of care did not require a recommendation in favor of active surveillance. Counsel also contended that a formation of a fistula is a known potential complication of the cryoablation procedure, even when performed well, and that there was no evidence that Tertzakian performed the procedure in a manner that was below the standard of care. Although the defense was forced to concede that it was below the standard of care to allow medical assistants to place catheters, counsel argued that there was no compelling evidence that any of the catheter placements were performed poorly or were the actual cause of any injury to Vera. The defense’s urology expert testified that the overwhelming majority of urologists would favor radical prostatectomy, radiation therapy or cryoablation over active surveillance in a patient with a Gleason score of 7 (3+4). The expert also testified that diarrhea is a very common post-operative complaint, especially given the antibiotics used, while a fistula is a very rare complication. Accordingly, the expert urologist opined that the standard of care did not require Tertzakian to suspect the presence of a fistula until Vera was patently passing urine through his rectum and fecal matter through his penis, by which time it was too late to save the right testicle., Vera claimed that as a result of the cryoablation, he was rendered incontinent of urine and suffered erectile dysfunction. He acknowledged that the procedure cured his prostate cancer, but he claimed that he developed a fistula, which allowed urine to pass from the urethra to the rectum and fecal matter to pass from the rectum to the urethra. He also claimed that as a result of his treatment and complications, his right testicle became severely infected and had to be surgically removed. Vera underwent a series of failed surgeries to repair the fistula over the next five years. During that time, a colostomy and a Foley catheter had to be in place, which were repeatedly changed by medical assistants in Tertzakian’s office until a definitive surgery at a University of Southern California hospital in 2018 resolved the fistula and reversed the colostomy. Vera’s urology expert opined that the attempts to repair the fistula once it was diagnosed were poorly conceived and doomed to failure, representing another breach of the standard of care. Vera claimed that he was left with permanent erectile dysfunction and urine incontinence. He also claimed that he was never able to return to work at his job as a custodian, costing him some 11 years of earnings. Vera sought recovery of $99,656 in future lost earnings, $106,800 in future care needs, $173,872 in past loss of earnings, and $250,000 in noneconomic damages, per statute, for his past and future pain and suffering. The defense’s urology expert opined that the subsequent repair surgeries were well-intentioned and designed to attempt to resolve Vera’s complaints, short of the definitive surgery that was ultimately performed at the University of California.