Several men treated for impotence at the Parnell Medical Group, an Edina clinic that opened last year, wound up in the emergency room with painful and embarrassing complications that, local urologists say, were the result of inappropriate and irresponsible care.

Doctors called in by one hospital say the patients had been provided with excessive doses of medications, which they injected at home, resulting in erections that lasted for several hours. No one at Parnell had the expertise to take care of them, the doctors say.

As a result, one urology clinic filed a complaint in September with the state Board of Medical Practice charging that Parnell does not meet the community "standard of care."

Parnell's clinic director, Brian Ahern, said in an interview that the clinic changed hands last October, and that no problems have occurred since then. The clinic has just hired a urologist who will become medical director, Ahern said. But that physician has himself been recently disciplined for alcoholism by the medical board, according to public documents.

Still, the physicians say that their complaint remains unresolved and that the clinic remains unequipped to handle medical complications if they arise. Meanwhile, they say, Parnell is taking advantage of a vulnerable group of patients who are unlikely to complain if something goes wrong -- men with impotence.

"They chose an area of medicine where they can play upon the fears of men," said Dr. Mark Fallen, a doctor with Urologic Physicians.

The doctors say their concern is patient care, not competition for patients. "I think there is plenty of that business to go around," said Dr. Todd Fleming of Urology Associates, who filed the complaint.

They say they are puzzled that men would go to Parnell rather than talking to their own doctors or going to a urology clinic, where insurance would probably cover their costs. Instead, they pay hundreds of dollars to Parnell.

But it doesn't surprise Eli Coleman, a psychologist and sexual health expert at the University of Minnesota. "Men are very insecure about their sexuality," he said. It's hard for them to talk to anyone, even their doctors, about sexual problems. For many, he said, it's easier to grab onto "a magical solution."

Viagra started it all

Parnell is a new player in the enormous impotence-treatment market that has developed since the introduction of Viagra and similar medications. An estimated 10 million to 30 million men suffer from erectile dysfunction (ED), a rate that is rising along with the conditions linked to it -- diabetes, high blood pressure and prostate cancer.

There are dozens of similar clinics in other states, though a physician with the American Urological Association said his organization has not heard of widespread problems.

Local urologists say Parnell is the first local clinic they know of that treats impotence without also treating the full range of urological conditions and their complications.

Ahern said Parnell is a "wellness" clinic for men. It was started last year by Texans who saw an untapped market for male sexual treatment in the Upper Midwest. Ahern, who said he is a former stock trader and investment manager, bought the clinic with a business partner in October.

Parnell now has a part-time general practitioner who administers the injectable drugs, he said. A urologist, Dr. Bhupinder Singh, will become medical director later this month. Singh, whose license was suspended in 2007 for alcoholism, was allowed to resume practice in January. According to documents from the Board of Medical Practice, Singh is now required to work in a group practice setting and meet regularly with a physician.

Ahern said that Singh was not available to comment, but that the board had approved his new position at Parnell. Rob Leach, the board's executive director, said he could not confirm that because such information is confidential.

Leach said state law also prevents him from saying whether the board is investigating a complaint against Parnell. The board makes its findings public only if disciplinary action results.

Parnell sells a variety of treatments, including oral medications such as Viagra, nutritional supplements, testosterone creams and injectable medications, Ahern said. The clinic has treated more than 1,000 customers, and is focused on improving its customers' romantic relationships.

"It's not just about sex," said Ahern, who wore surgical scrubs during an interview in his Edina office. He said Parnell charges $200 for an office visit and testing, plus $125 to $250 for the injectable medications. It does not take insurance.

Parnell has spent "hundreds of thousands of dollars" advertising in local media, Ahern said, including the Sports section of the Star Tribune. Its ads promise "Real doctors. Real medicine. Real results."

Urologists say Parnell does use real medicine -- the same kind they use in the 40 percent of cases in which ED pills don't work. The results are real as well. They cited at least four Parnell patients who went to the emergency room with erections that lasted for many hours and caused considerable pain -- a complication that should happen rarely, if at all.

Ahern said he knows of only three such cases.

In the ER

Dr. Roland Ugarte, a doctor with Urology Associates, said that in late October he was called into the emergency room at Fairview Southdale Hospital in Edina to treat a 33-year-old man who had used injections provided by Parnell.

"An injection is the last thing we use," Ugarte said. "I've been in practice for 20 years, and I've never had one of my patients go to the ER with an erection."

The patient declined a request to be interviewed for this story because, Ugarte said, he had signed an agreement with Parnell after it paid his medical expenses. Ahern confirmed there was an agreement but declined to say what it was.

Dr. Mark Fallen said he was called to the Fairview Southdale ER in September to treat a 55-year-old man with diabetes and high blood pressure who had an erection that lasted eight hours after he injected himself with drugs he got from Parnell. Fallen said he was able to treat the problem by removing blood from the man's penis with a large-bore needle.

Permanent damage

Dr. Tony Makhlouf, a University of Minnesota urologist who specializes in impotence, said urgency is critical in such cases because, after three to four hours, an erection can cause permanent erectile dysfunction.

Ahern said Parnell provides patients detailed instructions and monitors the first dose of the medications, just like urology clinics. He said the doctors who treated the patients who ended up in the emergency room were working under contract to Parnell and are no longer with the clinic.

Ahern also said two of the patients showed up at Parnell when their erections would not go away. When a physicians assistant, no longer with Parnell, was unable to help, they were sent to the ER. That's still what would happen if a Parnell patient develops a prolonged erection, he said, because the clinic does not have the expertise or the facilities to handle the minor surgical procedures to treat them.

"If it becomes more complex ... we're not equipped for that," he said.

Josephine Marcotty • 612-673-7394