A 56-year-old male retired truck driver presented to the ER with a chief complaint of fever, chills, and body aches for 2 days. His prior medical history was positive for a urethral stricture for which he began receiving treatment when he was 24.
Prior to his urethral injury, the patient underwent several procedures to dilate his urethra and had been seen in the ER on numerous occasions for urinary tract infections. On presentation to the hospital, he reported to the ER physician that he had had trouble catheterizing himself at home. The ER nursing staff made several attempts to catheterize the patient, but to no avail. A urologist was consulted, who recommended that if the patient was able to void, there was no need to place a catheter in the ER.
The patient was subsequently given IV fluid and was able to void; however, he began to demonstrate tachycardia and hypotension. An internal medicine doctor then admitted the patient for a suspected UTI and to rule out sepsis. Urine and blood cultures were ordered and the patient was started on antibiotics for possible sepsis.
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The man was seen for the first time by the internal medicine doctor the day after his admission. After testing, the patient was discharged 4 days later with instructions to continue on his antibiotic therapy for 7 days and follow up with his primary care physician. Later that day, the patient presented to the ER again with a chief complaint of hematuria and difficulty voiding. He was advised to make an appointment with a urologist.
Soon after, the patient was seen by a urologist. The urologist attempted to perform a cystoscopy, but he was unable to pass the scope beyond the stricture due to the presence of multiple false passages. The urologist opted to place a suprapubic catheter under general anesthesia. The plan was to leave the suprapubic catheter in place as long as necessary to allow for decreased swelling and healing of the urethra.
The patient later sued the hospital, the internal medicine physician, and nursing staff. The case proceeded to trial against the internal medicine doctor only.