By Debby Woodin

Globe Staff Writer

A Jasper County jury will decide whether two doctors and a hospital were vigilant enough in their care of a diabetic who became infected with flesh-eating bacteria after a biopsy and had to undergo a colostomy.

Testimony opened Tuesday in Jasper County Circuit Court in Joplin in the malpractice trial of Dr. G. Scott Brehm and Joplin Urology Associates, and Dr. Paula Hartzell and Freeman Health System.

James Welsh, 73, of Neosho, is an Eagle-Picher Industries retiree who reported enjoying a healthy and active lifestyle until three years ago, when he underwent a biopsy done by Brehm to test a lump found in Welsh's prostate, one of his attorneys, Patrick Martucci of the Hershewe Firm in Joplin, told jurors in opening statements.

Martucci argued that the biopsy and a poor diagnosis led to the infection. Attorneys for Brehm, Hartzell and Freeman contend that Welsh's infection was so rare that the doctors had no reason to suspect that flesh-eating bacteria were the cause.

Shortly after the biopsy, Welsh reported pain that he thought was caused by the procedure, but within a few days he was also afflicted by stomach discomfort and severe diarrhea. He went to Freeman Hospital West's emergency room, where Hartzell diagnosed a kidney or urinary-tract infection.

She ordered an intravenous antibiotic and sent Welsh home with oral antibiotics.

A week after the biopsy and a day after he had been to the emergency room, Welsh was to have an appointment with Brehm to learn the results of the biopsy, which showed a malignant cancer.

But, on the day of the appointment, Welsh's wife called Brehm and told him that Welsh was too sick to go to the doctor's office. She told the doctor that Welsh had been to the emergency room, and had been diagnosed with a kidney or urinary infection. Two days later, Welsh was rushed to the emergency room when his diarrhea had worsened and his wife noticed a white discharge.

An abscess was found in the area of the prostate where the biopsy had been done, and flesh-eating bacteria had spread around his buttocks and prostate area, killing tissue and muscle.

He underwent emergency surgery to remove the infected area and eventually had to have a colostomy because of the damage caused by the infection, the jury was told.

He was in the hospital for five weeks and underwent two surgeries, along with the installation of a permanent colostomy bag. The bag prevents Welsh from returning to his former active lifestyle, Martucci told jurors.

Welsh alleges that Hartzell and Freeman Health System failed to provide adequate care by not performing an examination of the biopsy site the day Welsh went to the emergency room. He also alleges that Brehm failed to provide adequate care by not informing Welsh of the risk of infection before or after the biopsy, and by not calling Welsh in for an examination when Brehm learned Welsh had been to the emergency room with symptoms of an infection.

If the infection had been caught days earlier, it might have been contained and eradicated before it caused so much damage, Martucci argued.

Brehm's attorney, Bruce Hunt of Springfield, told jurors that Welsh suffered "an incredibly unique infection" that spread rapidly between Welsh's first emergency-room visit and his second one, three days later.

Welsh's case is so rare that none of the doctors Welsh will call as experts during the trial to testify against Brehm and Hartzell "have ever seen a flesh-eating infection caused by a biopsy," Hunt told jurors.

Brehm relied on the diagnosis in the emergency room and the Welshes' wishes not to keep the appointment and go to his office the day after Welsh had been to the emergency room, Hunt said.

Brehm told Welsh's wife that day to take him to the office the next day if he was not better. The Welshes did not do that, instead waiting two more days before they sought any other medical treatment, jurors were told.

The trial is expected to last through Friday.

This Week's Circulars