Another death caused by a ‘Heilpraktiker’, non-medically trained alternative practitioner?

A German paper reported the following horrific story about a Heilpraktiker, an alternative practitioner without a medical degree:

Starting July 7, Torben K. (46) from Solingen will have to answer to the Wuppertal Regional Court. The Heilpraktiker is said to have injected silicone oil into the penis and testicles of a man († 32) at his request. Shortly thereafter, the patient developed health problems and later died.

The prosecution accuses the Heilpraktiker from Solingen of bodily injury resulting in death and violation of the Heilpraktikergesetz.

According to the report, the victim had traveled to Solingen in June 2019, where the defendant had given him the injection in his apartment.

Back home, the 32-year-old patient suddenly developed shortness of breath, had to be hospitalized, then transferred to the university hospital in Giessen. Seven months after the injection, he is dead. According to the indictment, the patient suffered multiple organ failure as a result of blood poisoning.

Three days of trial are scheduled. The defendant faces up to 15 years in prison.

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I had never heard of intra-testicular injections. So, I did a Medline search and found just two papers of the procedure in human patients:

No 1

Blunt trauma is the most common mechanism of injury to the scrotum and testicle. Surgical exploration with primary repair, hematoma evacuation, and de-torsion are common surgical interventions. A 20-year-old male with no previous medical history presented after a high-speed motor vehicle collision. Ultrasonography demonstrated heterogeneous changes of the tunica albuginea and decreased arterial flow to bilateral testicles. He was subsequently taken to the operating room for surgical exploration, which revealed bilateral mottled testes with questionable viability. Papaverine was injected into each testicle, which resulted in visibly increased perfusion and subsequent preservation of the testicles. Conclusion: Current evidence on the use of papaverine is isolated to testicular torsion. Additional research should be conducted on the use of papaverine in blunt testicular trauma. Papaverine injection may be a valuable treatment option when inadequate perfusion is observed intra-operatively.

No 2:

Purpose: We describe a simple technique to deliver local anaesthetic for percutaneous testis biopsies.

Materials and methods: With the testis held firmly, a 25 gage needle is used to inject lidocaine, without epinephrine, into the skin and dartos superficial to the testis, then the needle is advanced through the tunica albuginea and 0.5 mL to 1.0 mL of lidocaine is injected directly into the testis. The testis becomes slightly more turgid with the injection. A percutaneous biopsy is then immediately performed.

Results: Intra-testicular lidocaine, (without the need of a cord block or any sedation) was used on a total of 45 consecutive patients having percutaneous testicular biopsies. Procedure time was short (averages less than 5 minutes) and anaesthesia was profound. There was no change in the number of seminiferous tubules for evaluation compared to biopsies on men using a cord block. Only 1/45 men had a post-procedure testicular hematoma (this resolved in 4 weeks).

Conclusions: Intra-testicular lidocaine appears to be a simple, rapid and safe method to provide anaesthesia for a percutaneous testis biopsy.

All the other papers on intra-testicular injections were about animal experiments, mostly for exploring means of castration. This renders the above case even more unusual. The Heilpraktiker’s defense might stress that the patient wanted the treatment. That may be so but is it a valid excuse? No, of course not. In my view – and I am just a medic, not a lawyer – the Heilpraktiker is responsible for the treatment regardless of how much the patient insisted on it.