Doctors accused of inserting catheter too forcefully

The patient was a 59-year-old man who had a history of high cholesterol and smoking.

He began to experience cramping in his left calf after walking a short distance and was referred to a vascular surgeon for an evaluation.

He was diagnosed with moderately severe vascular occlusive disease. After a trial of the medication Trental, he had an absent pulse in his left foot. Testing revealed a distal superficial femoral artery popliteal occlusion.

The physician performed a surgical bypass. The plaintiff had had no urinary problems prior to surgery. After the spinal tap was placed, the circulation nurse attempted to place a Foley catheter, without success. The surgeon made a second attempt at passing the Foley catheter and noted in his operative report that it went in without resistance, producing a drop of fluid in the catheter. The 5cc balloon was inflated without resistance and the surgery was performed.

After surgery, the patient did not have any urine output. He was markedly distended and there was blood at the meatus. His rectal exam identified a boggy prostatic area with approximately 30 grams of smooth, benign prostate.

A cystoscopy revealed an area of extreme trauma past the urethral sphincter. No tract was identifiable past the prostatic urethra into the bladder; instead, an unidentifiable tract, through which the cystoscope was negotiated, continued from the bulbar urethra to the rectum. The scope was able to be passed from the urethra out through the anus.

Multiple attempts were made at passing the cystoscope from the penile urethra into the bladder, without success. There was a complete urethral disruption. A transvesical realignment was performed and a connection from the urethra to the bladder neck was re-established.

The patient underwent a procedure to repair the area and was discharged with a colostomy, which was later reversed. He has scars on his leg and abdomen.

The patient alleged that the surgeon and nurse deviated from the accepted standard of care when they used excessive force to insert the Foley catheter.

Both defendants claimed that the catheter was confirmed to be in the bladder before it was inflated because of the feel during the insertion, the length of catheter inserted and the return of urine. They argued that the perforation was a risk of the procedure.

The case settled for $850,000.

Type of action: Medical malpractice

Injuries alleged: Failure to properly place catheter during surgery causing perforated bladder and

resulting urinary problems

Date: November 2009

Submitted by: Elizabeth N. Mulvey and Michael J. Harris, Crowe & Mulvey, Boston