Question

Scenario #1

Immediately after a laparoscopic bilateral hernia repair, the surgeon ordered an in-and-out urinary catheterization to drain urine from the bladder and to confirm that there was no blood in the patient’s urine, which would be indicative of a possible bladder injury during the surgical procedure. The surgeon then left the operating arena.

A registered nurse subsequently inserted a Foley catheter with an inflatable retention bulb rather than an in-and-out (straight) catheter. She then had a second nurse inflate the bulb while the catheter was still in the patient’s urethra. This inflation of the catheter bulb while in the patient’s urethra caused a tear in the urethra, requiring a second unsuccessful catheterization by the attending surgeon, and an eventual abdominal catheterization of the patient’s bladder by a urologist. The patient subsequently sued the two nurses, the attending surgeon, and the acute care setting for negligence.

Questions:

Was there negligence in this case and who should be liable for the negligence?

What type of damages should be assessed and how would you begin to determine the amount to assess?

Given that there were multiple individuals involved in this case as well as the institution that employed these individuals, how would you determine the percentage of liability for the multiple defendants, assuming that more than one defendant should be assessed with damages?

How would you decide this case?

Answer 1

1. Yes , there is negligence in this case . Negligence is the lack of proper care over something . Here in this ,the surgeon has ordered an in and out Foley's catheter but the nurses did two negligences :-

- firstly ,they were told to put an in and out Foley's catheter but they put inflatable retention bulb Foley's catheter without informing the surgeon.

- secondly , they haven't put the catheter or inserted the catheter completely into the bladder and inflated the bulb in the urethra itself which resulted in urethral tear.

The two nurses and the surgeon is liable for the negligence because the nurses must have informed the surgeon about the inflatable Foley's catheter and they must have carefully inserted it into the bladder before insflating the bulb. After the surgery ,the surgeon shouldn't have gone by justing telling the order ,he must have put the catheter or assisted in putting the catheter in a post operative patient.

2.Negligence caused patient related damages must be assessed . Patient is the priority of any health care system . So, the problems caused by the negligence to the patient must be assessed and taken care of . Physical and psychological damages has to be assessed and interventions should be taken against them . In this case ,due to improper catheterization urethral tear has developed and anxiety ,it's severity and damage must be assessed and subsequent care has to be provided . A thorough patient physical and mental assessment will be done to determine the amount of damage caused .

3. In this case ,multiple individuals are involved in the malpractice - two nurses, surgeon , institution that employed theses individuals . All of them are defendants . If I were there as the authority then everyone involved in this case have been punished and penalized in the same way , based on the ethical principles . The percentage of liability or legal responsibility will be same for each individual without any discrimination on the basis of bias and favour .