In November 1999, 67-year-old Herschel “Hurshell” Ralls travelled to a hospital in Wichita Falls, Texas, for bladder cancer surgery. He expected removal of his bladder, possibly part of his prostate—but when he awoke from anesthesia, he discovered doctors had also amputated his penis and testicles. This medical error stirred outrage, a lawsuit, and enduring questions about surgical consent and oversight.
Ralls underwent what he believed would be a standard cystectomy to treat bladder cancer. According to his account, surgeons did not inform him or his wife that removal of his penis or testicles might be necessary.
During the procedure, doctors determined they believed cancer had spread into his penile tissue and elected to excise those organs as well.
Ralls later filed suit against the Clinics of North Texas and the surgical team, claiming violation of informed consent and medical standards.
Ralls’ surgeon later stated that he believed the cancer had spread to the penis during the bladder removal, prompting him to perform the additional surgery. However, tissue samples were not sent for laboratory testing until after the operation.
Subsequent examination by a Dallas-based physician confirmed that Ralls did not have penile cancer.
The case was scheduled for trial in late August 2003, but the parties reached an out-of-court settlement during that August trial. The precise settlement date is unclear, though press reports indicated the settlement was announced around August 27, 2003.
The hospital and surgeons did not admit wrongdoing in the settlement, and the terms were kept confidential.
Penile cancer remains rare yet devastating, often delayed in diagnosis because early lesions cause little pain. Risk factors include phimosis, poor hygiene, being uncircumcised, smoking, and human papillomavirus infection. Most cases involve squamous cell carcinoma, while premalignant lesions fall under penile intraepithelial neoplasia (PIN).
Early-stage disease typically responds well to surgical excision or organ-sparing approaches.
In more advanced cases, removal of lymph nodes may be necessary, though such surgery carries significant morbidity.
Careful staging and multidisciplinary management are essential for improving outcomes and preserving quality of life. 1
Ralls’ wife, Esther, recalled that neither she nor her husband were ever told that his genitals might be removed during the procedure. Speaking after the surgery, she said they felt blindsided by the outcome. Recounting the moment, she explained that they had gone in expecting treatment for his bladder, but “woke up to something they could never have imagined.”
According to later news interviews, Ralls said his wife had to “hold his hand in bed” when she first realized what had been done, and that the two struggled with anger, confusion, and deep emotional distress in the months that followed. The family later expressed the hope that “nothing like this happens to anyone else”.
The central legal claim hinged on lack of informed consent—that the medical team failed to warn Ralls of the possibility of penile and testicular removal. His wife testified that they were shocked by the extent of the organ loss. The case drew national attention as an extreme instance of surgical error.
Ethically, this incident underscores the importance of transparency and patient autonomy in high-risk operations. The possibility of radical outcomes, however rare, must be clearly communicated before surgery.
In the United States, the law says doctors must clearly explain the important risks of a treatment before a patient agrees to it. This idea comes from a major court case in 1972 (Canterbury v. Spence), which set the standard that patients should be told what a “reasonable person” would want to know before making a decision.
But just because a patient signs a consent form doesn’t mean the doctor is automatically protected. If the surgery is done carelessly, or if the doctor goes beyond what the patient agreed to, the physician can still be held responsible.
In fact, when a doctor performs a procedure without permission, the courts may treat it as battery—similar to non-consensual physical contact. An early example was the 1905 case Mohr v. Williams, where a surgeon operated on a patient’s ear without consent.
Over time, medical ethics have moved away from treating consent as just a signed piece of paper. Instead, it’s meant to be a real conversation: the doctor explains the risks, the benefits, and the alternatives, and makes sure the patient truly understands before moving forward.
References:
1. Pagano, Christopher J., and Dana M. Hayden. “Penile Cancer and Penile Intraepithelial Neoplasia.” StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing, January 2023. Accessed October 3, 2025. https://www.ncbi.nlm.nih.gov/books/NBK499930/.
2. MyPlainview. 2003. “Man Settles Lawsuit with Doctors over Penile Amputation.” MyPlainview, August 27, 2003. https://www.myplainview.com/news/article/Man-settles-lawsuit-with-doctors-over-penile-9024334.php.
3. ABC News (Australia). 2003. “Settlement Reached after Patient Gets the Chop.” ABC News, August 29, 2003. https://www.abc.net.au/news/2003-08-29/settlement-reached-after-patient-gets-the-chop/1471194.
4. ABC News. 2003. “Man’s Penis Removal Was Surgical Mistake.” ABC News, August 10, 2003. https://abcnews.go.com/GMA/story?id=124631&page=1.
5. O’Neill, O., and A. Faden. 2007. “Surgeons’ Silence: A History of Informed Consent in Surgery.” Journal of the Royal Society of Medicine (via PubMed Central). Accessed October 3, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC2150649/.
6. CAP Physicians. 2023. “Informed Consent Is No Shield to Negligent Surgical Advice.” CAP Physicians. Accessed October 3, 2025. https://www.capphysicians.com/articles/informed-consent-no-shield-negligent-surgical-advice.
(Rh/Eth/ARC/MSM)