How One Patient Was Forced To Have A Treatment Without Her Consent

pain(Author: Jill H. Osborne MA, President, IC Network)

There is no excuse for what happened to a female IC patient THIS YEAR. Her primary care provider suspected that she had interstitial cystitis and referred her to a urologist in her community. She made an appointment and met, initially, with the urologists nurse practitioner who asked the patient if she could obtain a “clean catch” urine sample using a catheter. What happened next is the closest example I’ve encountered to the rape to an IC patient by a medical care provider.

Without informing the patient, the nurse took the urine sample and then filled the patients bladder with silver nitrate, an old, outdated therapy that is NOT recommended for interstitial cystitis in the AUA Guidelines. The pain of the solution in her bladder had the patient screaming at the nurse, asking her what she did and then begging that it be drained immediately from her bladder. The nurse REFUSED and kept it in her bladder for five minutes.

Silver Nitrate and Clorpactin were last used for interstitial cystitis more than a decade ago. They harken from the days when caustic bladder wall “stripping” treatments were used to destroy any potential bacteria and encourage the growth of a new bladder lining. No longer in use, neither silver nitrate or clorpactin are mentioned in the 2011 AUA Guidelines as a treatment for IC/BPS and, in our experience, are only used by clinics with providers who are older and not familiar with the new approaches to treating IC.

“The concern about using these medications is their tendency to cause scarring and even stimulate the growth of more nerves at a later date. These medications are therefore not generally used..” – Robert Moldwin MD

The downsides of this “old school” treatment are numerous. Agonizingly painful, they usually required anesthesia to administer. In the IC Survival Guide (2000), Robert Moldwin MD wrote “they cause(s) a great deal of damage to the bladder surface… and destroy the nerves of the bladder.” He shared “The concern about using these medications is their tendency to cause scarring and even stimulate the growth of more nerves at a later date. These medications are therefore not generally used as a first-line therapy.” In 2014, first-line or step one therapies are designed to be calming and soothing to the bladder and pelvic floor, by using diet modification, pelvic floor muscle relaxation and so forth.

Silver nitrate is so caustic that, as Dr. Moldwin explained, “a test called a cystogram (CMG) must be performed prior to the instillation… to ensure that no fluid can move up the ureters and then up to the kidneys. Silver nitrate can damage and potentially block the ureter with scar tissue thus ureters which allow reflux must be blocked prior to treatment.” Neither anesthesia nor a CMG were offered to this patient.

When she asked the nurse why she placed silver nitrate in her bladder, the nurse said “That’s what we do for all patients who come into our office with with your symptoms… it usually doesn’t cause the pain that you experienced.”

I find this shocking and absolutely unacceptable. Silver nitrate treatment is notorious for causing severe pain. Why it would be administered during a first appointment, when the patient was just looking for diagnostic information and had yet to even speak with the urologist, is a question worth asking. Why, as well, is this clinic not following the AUA diagnostic protocol which talks, specifically, about reducing both physical (adverse events) and emotional trauma to the patient.

I call this bladder rape for a reason. This patient, and perhaps countless others in that practice, was given this painful, damaging therapy without her knowledge or consent. This patient then asked that the treatment be drained from her bladder. The NP refused and the patient was “forced” to keep it inside her for five minutes. This patient endured agonizing pain for weeks afterward. She is now afraid of receiving a urologists care. Absolutely inexcusable in 2014.

I encouraged her to deliver a copy of the AUA Guidelines to the office and to ask for explanation as to why she was given a therapy without her consent. IMHO, a complaint to the state medical board and/or the nursing board is justified. There is simply no excuse for administering a therapy as damaging as this without consent, nor for following the American Urological Association diagnostic and treatment guidelines. Worse, I have to wonder if this would qualify as criminal assault.

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