Settlement Secured Following Delayed Diagnosis and Treatment

Mr T was an elderly, vulnerable individual with a number of pre-existing medical conditions. He was admitted to hospital with neurological symptoms and was treated as a transient ischaemic attack. During that admission, he developed urinary retention requiring insertion of an indwelling urinary catheter. He was subsequently discharged with a catheter in situ and a plan for ongoing catheter management in the community, whilst at a care home.

District Nurses provided catheter care, blood glucose monitoring and insulin administration over the coming days where his blood glucose was recorded as elevated and insulin was administered. An emergency visit was needed as Mr T removed his urinary catheter, with the balloon still inflated, causing trauma and bleeding. However, District Nurses did not reinsert the catheter.

The Registered Nurse advised care staff to monitor urine output and to observe for abdominal pain, distension and reduced urine output. However, the hospital discharge summary, which recorded urinary retention, was not available to the attending nurse at that time. Mr Ts GP was informed of the catheter removal. Despite the above, no urgent review, reassessment of urinary retention or assessment of infection was undertaken.

Over the coming days the nurses continued to monitor Mr T and his blood glucose levels progressively increased and it was recorded that Mr T was at high risk of falls. The elevated readings were not escalated. At this point it was noted that his testicles were enlarged and a swab was required. Despite this, no swab was arranged at the next nurse attendance and there was no escalation to the GP.

The following day Mr T was reviewed where it was noted that there was a strong odour, consistent with an infection and a swab was taken but no further action requested until the swab results were back.

Unfortunately, the following day Mr T was found unresponsive and pronounced deceased by emergency services. The cause of death was recorded as pyelonephritis of the kidney.

Upon instruction, Myriam sought medical evidence from a care expert and microbiologist this was supportive in highlighting that Mr Ts pre-existing medical conditions placed him at a higher risk of infection and that there was a failure to investigate any signs of infection following his traumatic removal of his catheter. His raised blood glucose levels represented a clinically significant change of stress and potential infection.

There was also a failure to obtain a swab despite the signs of the infection and there was no documented clinical justification for the omission.  The experts confirmed that it would have been appropriate to arrange urgent medical review or hospital admission and to commence intravenous antibiotics.

The Trust representing the District Nurses admitted liability and the claim was settled for £10,000.