Lawsuit alleges urethral damage following ED go to
On February 26, a 56-year-old man introduced to the emergency division (ED) with a chief criticism of fever, chills, and physique aches for two days. His prior medical historical past was optimistic for a urethral stricture, for which he started receiving remedy when he was aged 24 years. Previous to this ED go to, the affected person underwent a number of procedures to dilate his urethra and had been seen within the ED on quite a few events for urinary tract infections. A number of makes an attempt had been made within the ED by the nursing workers to catheterize the affected person, with out success. The affected person was given intravenous fluid and voided; nonetheless, he started to show tachycardia and hypotension.
The affected person was admitted to the hospital as a result of a suspected urinary tract an infection. Urine and blood cultures had been ordered, and the affected person was began on ceftriaxone (Rocephin) for doable sepsis. His admitting diagnoses included dehydration, urinary tract an infection, hypotension, and rule-out sepsis.
The affected person was seen by the attending doctor. After testing and 5 days of hospitalization, the affected person was discharged from the hospital by the attending and given directions to proceed antibiotics and follow-up together with his main care doctor.
5 days later, the affected person was seen by a urologist, with complaints of hematuria and issue voiding. He reported a current damage to his urethra from the ED go to on February 26. The urologist tried to carry out a cystoscopy in hopes of inspecting and dilating the urethra. Nevertheless, he was unable to efficiently go the scope past the stricture as a result of presence of a number of false passages.
The urologist opted to take the affected person to the working room and insert a suprapubic catheter to be saved in place so long as vital to permit for decreased swelling and therapeutic of the urethra, which was 7 months.
The affected person sued the ED doctor, the attending doctor, and the hospital, claiming malpractice and urethral damage. The ED doctor and hospital had been dismissed beneath confidential phrases previous to trial. The case proceeded to trial in opposition to the attending doctor solely.
In accordance with the affected person, the attending doctor negligently didn’t request a seek the advice of with a urologist throughout his hospital keep and didn’t refer him for an emergent urology seek the advice of on discharge. Had he completed so, the affected person claimed he wouldn’t have wanted the suprapubic catheter that stayed in place for 7 months.
The affected person’s knowledgeable internist opined that the attending doctor fell under the usual of care as a result of his failure to concentrate on the character and extent of the urethral damage suffered on the time the affected person was admitted to the hospital. The knowledgeable testified that the attending doctor negligently didn’t carry out a genitourinary examination of the affected person at any time throughout his keep, negligently didn’t request a seek the advice of with a urologist whereas the affected person was on the hospital, and didn’t refer the affected person to a urologist at discharge. The affected person’s knowledgeable additional testified that had a urologist been consulted, further makes an attempt at putting a Foley catheter utilizing a information wire would have been made in effort to alleviate urinary retention and keep away from the necessity for the suprapubic catheter.
Protection counsel for the attending doctor argued that his consumer met the usual of care and that nothing he did or didn’t do triggered the affected person’s damage. The protection knowledgeable testified that previous to the affected person’s discharge, the attending doctor ordered a renal ultrasound and one other set of blood and urine cultures. The renal ultrasound revealed a distended bladder with an irregular posterior bladder wall. Along with the orders for laboratory research, the attending doctor adjusted antibiotic remedy. In the course of the subsequent 3 days, the affected person responded nicely to the antibiotic remedy, and his white blood cell depend regularly returned to regular. The protection knowledgeable additional testified that the attending doctor complied with the usual of care. He testified that the first motive for hospital admission was a life-threatening urinary tract an infection that was adequately handled and that the usual of care didn’t require a urology seek the advice of beneath the circumstances as a result of any additional makes an attempt at catheterization would have been contraindicative as a result of affected person’s critical an infection.
The protection’s urologist opined that the affected person had a persistent downside with a urethral stricture and famous that the pure historical past of persistent strictures includes recurrent procedures designed to dilate the stricture and, at occasions, require placement of a suprapubic catheter to permit irritation across the stricture to resolve.
After a 7-day trial and jury deliberations of almost 2 days, the jury returned a verdict 10-2 for the plaintiff on negligence and 12-0 for the protection on causation.
LEGAL PERSPECTIVE: In a malpractice case, a plaintiff should show each negligence and causation. Right here, the jury discovered the plaintiff proved his negligence case however didn’t show that the negligence triggered the plaintiff’s damage. Finally, this case resulted in a win for the protection.