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Nurse botches catheterization causing severe urethal stricture: case on point: Tucker v. Community Medical Center, 833 A.2d 217 -PA (2003).

ISSUE: In this unusual case, the Pennsylvania courts were confronted with the issue of whether or not a nurse, in the course of inserting a urethral catheter into a patient, caused a stricture. The case had several interesting components, including the fact that a nurse who was employed by the defendant hospital was a member of the jury panel. The trial court refused the plaintiffs' request to strike the nurse from the panel. The failure of the plaintiffs to make timely objections in this and other regards was construed to be a waiver of their rights.

CASE FACTS: On November 1, 1995, William Tucker was admitted to Community Medical Center (CMC) to undergo an exploratory laparotomy. The laparotomy was performed due to persistent low abdominal pain. Once the patient had been anesthetized, the CMC scrub nurse, Erica Schuback, provided a #16 French Foley catheter to the circulating nurse, Dorothy Gaughn, to catheterize the patient. Nurse Gaughn applied 10 ccs of lubricant to the flexible latex catheter and proceeded to insert it into the urethra through he patient's urethral opening. When the catheter was almost halfway inserted, Nurse Gaughn felt "some resistance." She withdrew the catheter slightly and simultaneously rotated it in an effort to determine whether the pliable catheter had "kinked" during insertion. As she did this, she noted the presence of red-tinged fluid in the catheter tubing and immediately withdrew the catheter from the patient's urethra. She notified Dr. Saadeddine Hijazi, who was scrubbing for the surgery in an adjacent room. In their effort to investigate the etiology of the resistance, Dr. Hijazi used a smaller catheter as a "dipstick" by inserting it approximately 1" to 11/2" into the tip of the patient's urethra to ascertain whether the dark fluid was blood or urine. Upon withdrawing the smaller catheter, Dr. Hijazi likewise observed a red-tinged fluid and contacted a urologist, Dr. Milan Smolko, who performed a cytoscopy and visualized a urethral "stricture," which he proceeded to dilate with surgical instruments so that a larger #18 French Foley catheter could be inserted into the patient's bladder to catheterize him. Dr. Smolko diagnosed the patient's condition at that time as "severe urethral stricture disease." Dr. Smolko performed a diagnostic laparoscopy, lysed the symptomatic adhesions, which were present on the bowel wall and the lateral wall of the pelvic cavity, and removed the patient's appendix. The patient and his wife brought suit for medical malpractice against CMC and Dr. Hijazi alleging that Nurse Gaughn used "excessive force" in attempting to insert the catheter and perforated the lining of the patient's urethra, thereby causing him to develop "strictures" and "false passages" that resulted in urologic complications and sexual dysfunction. The plaintiffs offered the testimony of a urologist, Dr. Michael Goodman, in support of their allegations. CMC and Dr. Hijazi maintained that unbeknownst to any of the healthcare providers the patient had a preexisting, asymptomatic stricture that constricted his urethral channels and compromised the ability to catheterize him. After trial, judgment for the defendants was rendered by the Court of Common Pleas of Lackawanna County. The plaintiffs appealed.

COURT'S OPINION: The Superior Court of Pennsylvania affirmed the judgment based on the verdict rendered in the lower court. The court held, inter alia, that the jury, as finder of fact, had rendered a verdict predicated on the testimony and evidence presented to it. This was within the parameters of what a reasonably prudent jury could find.

LEGAL COMMENTARY: Counsel for the plaintiffs failed to preserve their rights by failing to timely file post trial motions. Issues, which were not preserved for consideration in post trial motions were waived. Whether or not this could have had a substantial impact on the ultimate outcome of the case remains unanswered. Despite the fact that there were allegations by the plaintiffs of "triple-level hearsay," the court found that the admission of testimony is a matter left to the discretion of the trial judge. The court found no abuse of discretion in this case. Editor's Note: Pamela Ruth Barton, a nurse-employee of CMC, was on the jury panel. The trial court refused to strike her from the jury panel for cause despite the efforts of the plaintiffs to do so. The court held that the decision to grant or deny a challenge for cause for a juror in a close relationship with either of the parties in the case is a question of law and a subject to ordinary review.

Meet the Editor & Publisher: A. David Tammelleo, JD, is a nationally recognized authority on health care law. Practicing law for over 40 years, he concentrates in health care law with the Providence, R.I., firm of A. David Tammelleo & Associates. He has presented seminars on medical, nursing and hospital law throughout the United States. In addition to his writings as Editor of Medical Law's. Nursing Law's & Hospital Law's Reagan Reports, his legal articles have been published in the most prestigious health law journals. A prolific writer, his thousands of articles, as well as his achievements as an attorney and lecturer, have won him recognition in Martindale-Hubbell's Bar Register of Preeminent Lawyers, Marquis Who's Who in American Law, and Who's Who in America.
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Title Annotation:Nursing Law Case of the Month
Author:Tammelleo, A. David
Publication:Nursing Law's Regan Report
Date:Feb 1, 2004
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