Perforated bladder results in sepsis and subsequent lawsuit

A 74-year-old man presented to a urologist for a nonsurgical insertion of a Foley catheter on November 28, 2017. He was sent back to his nursing care facility, where he was living before the procedure. One week later, on December 4, 2017, the patient was septic and was taken to the hospital by ambulance. He was admitted and received a computed tomography (CT) scan. About an hour later, he underwent an exploratory laparotomy. The surgeon performing the procedure found a 10-cm hole in the bladder during the surgery. He also noted urine in the abdominal cavity. As a result of this procedure, the surgeon made a diagnosis of peritonitis and performed resection surgery on the small bowel and colon. The patient received a colostomy bag and was sent back to his nursing care facility shortly thereafter. The surgeon suggested to the patient that the perforation likely occurred when the urologist inserted the catheter on November 28.

The patient was hospitalized again because of a colostomy malfunction. He was treated and released. He returned to his nursing care facility and ultimately was released to go home and stay with his wife. During this time, the patient’s wife was primarily taking care of him, cleaning out his colostomy bag and aiding in household tasks.

The patient filed suit against the urologist and nursing home, alleging negligence and seeking recovery of past medical expenses and damages for the plaintiff’s past pain and suffering. All defendants denied negligence and further denied that any claimed negligence proximately caused any injury to the plaintiff. Following initial discovery, the plaintiff dismissed the nursing home from the case. The claims against the urologist proceeded.

As against the urologist, the plaintiff claimed the urologist perforated the patient’s bladder, which led to sepsis and hospitalization. As alleged, the plaintiff claimed that the urologist was negligent in inserting the catheter, which caused the bladder perforation, which required additional surgery, hospitalization, and the colostomy bag.

The plaintiff died of unrelated causes before trial, on October 20, 2020, and his estate was substituted in as the proper party. The case proceeded to trial.

At trial, the plaintiff’s expert urologist testified that the defendant urologist negligently inserted the catheter guide during the catheterization procedure, and that this negligence caused the bladder perforation. In response, the defendant urologist denied perforating the bladder and denied causing the sepsis infection. The defendant’s expert testified that the urologist met the standard of care and pulled back the catheter guide before it could hit or perforate the wall of the bladder. The defendant’s expert also noted that, after the plaintiff went to the hospital following his sepsis infection and treatment, he underwent a CT scan that indicated no signs of perforation. The expert further indicated that if the catheterization on November 28 had caused the bladder perforation, urine would have immediately leaked into the abdominal cavity, and there were no signs that that occurred. The expert then gave his opinion that the sepsis would have resulted much sooner, near December 1, if the urologist had in fact been negligent. Defense counsel utilized the records from the nursing care facility that indicated that the plaintiff had not shown signs of sepsis until December 4, so the perforation had to have taken place after the catheterization. Defense counsel further noted the laparoscopy showed weakened and dead bladder tissue, which could have been spontaneously perforated. In the alternative, the defense argued that the surgeon who performed the laparoscopy somehow punctured the plaintiff’s bladder during the procedure.

After 4 days of trial, the jury deliberated for 45 hours and returned a defense verdict and finding of no negligence.

LEGAL PERSPECTIVE: Often, the underlying facts of the suit and the facts of the plaintiff’s preexisting conditions and medical history are relevant to medical malpractice suits. Regardless, perhaps even more important are the expert witnesses. An expert witness specializing in the same medical practice area is crucial to determine whether the alleged conduct of a physician deviated from the requisite standard of care. Here, the defense counsel’s expert witness pointed out key facts that determined that, if the urologist had indeed been negligent in inserting the catheter, the signs of sepsis would have occurred much earlier than they did in the plaintiff in this case. As a result, the jury found that the urologist could not have perforated the plaintiff’s bladder.