How a Nursing Expert Witness Report Uncovered Catheter Care Failures

When Standard Catheter Protocols Fail: A Medico-Legal Case Review

In this case review, we examine a real-world scenario where a nursing expert witness report identified significant lapses in catheter care within a rehabilitation unit. The patient, an elderly man recovering from surgery, developed a life-threatening infection. The findings shed light on how seemingly minor documentation and escalation failures can culminate in severe outcomes—and legal exposure.

Thorough written records—paired with clinical insight—form the backbone of defensible nursing care in medico-legal contexts.

Background of the Case

The report, compiled by an Apex nurse expert with over 25 years of clinical experience, assessed whether the standard of nursing care—specifically catheter care—met the expected level. The patient, initially recovering from a fractured neck of femur and COPD, was re-catheterised multiple times due to urinary retention. Over time, signs of sepsis emerged, including:

• Strong, offensive-smelling urine

• Abdominal and genital pain

• Late escalation to urology

• Delayed investigation of symptoms

What the Nursing Expert Witness Report Found

Meticulous clinical note-taking remains a cornerstone of both safe patient care and defensible medico-legal practice.

The nursing expert witness report identified several key failings:

• Incomplete catheter care plans

• No documented rationale for failed catheterisation attempts

• Delayed recognition of sepsis symptoms

• Lack of documentation on family-reported concerns

• Disrespectful language in nursing notes (e.g., dismissive of patient's distress)

  
  

Despite initial good practice during hospital admission, the report concluded that the care in the rehabilitation unit breached acceptable nursing standards.

“In my opinion, the general documentation and catheter care at the rehab centre was generally poor and falls below a reasonable standard.”— Apex Nurse Expert Report

Legal and Clinical Implications

The report applied the Bolam and Bolitho tests, concluding that the care would not be supported by a responsible body of nurses. However, causation was deferred to a medical expert, highlighting the collaborative nature of multidisciplinary evidence in clinical negligence cases.

This case exemplifies how nursing documentation, if insufficient, can directly lead to allegations of negligence.

Why a Nursing Expert Witness Report Matters in 2025

With the rise of digital records and litigation involving catheter-associated infections, solicitors, insurers, and Trusts must:

• Ensure compliance with RCN catheter care guidance

• Maintain clear escalation pathways

• Train nurses in medico-legal documentation best practices