Operations are carried out across a wide variety of medical disciplines and all surgery carries some risk of additional harm being caused to the patient.
When considering a claim for clinical negligence it is important to note that the fact that a patient has ended up in a worse condition following surgery does not necessarily mean the surgery was carried out negligently.
The reasons for the unexpectedly poor outcome following surgery need to be investigated and the skilled specialist clinical negligence lawyers at Geldards can assist with this.
A consent form should be provided to every patient before surgery and the risks of the procedure should be fully discussed and explained. Signing a consent form is not always possible when the need for surgery is urgent. However, if there is time to explain the risks of a procedure, failure to do so will represent a negligent breach of duty. Injuries caused by negligence can result from inappropriate use of equipment. This can cause severed nerves, damage to vital organs (such as perforated bowel or bladder), or a nicking of blood vessels causing internal bleeding.
A case handed down in 2015 has expanded this area of negligence. We would be happy to advise you on the merits of your claim; a patient’s choices as to treatment must be respected. Indeed, a doctor has a specific duty to warn a patient of the material risk inherent in any proposed treatment.
The term general surgery refers to surgery performed on many digestive organs, including; bowel, liver, colon, pancreas and gall bladder.
Many of these organs can be operated on using keyhole techniques and this type of operation is referred to as a laparoscopic procedure. This is generally preferred over open techniques, called laparotomies, as the patient is left with a smaller scar and the procedure is generally less risky and invasive. However, a failure to use the camera scope with adequate skill and care can cause injuries and claims may also arise when a keyhole procedure reverts to an open procedure because unexpected damage is caused during surgery.
If you believe you may have a claim for clinical negligence following an operation, you should contact a member of the Clinical Negligence Team at Geldards for a free initial consultation.
RELEVANT SURGICAL NEGLIGENCE CASES
RH v CARDIFF AND VALE UNIVERSITY HEALTH BOARD
In June 2011 the Claimant was admitted to Llandough Hospital in Cardiff to undergo surgery to reconstruct and re-secure his right hip. Prior to the surgery the Claimant received a spinal epidural injection to administer anaesthetic.
Following surgery the Claimant became aware of and complained of numbness and a loss of feeling in the perineal and saddle area. Whilst the epidural catheter remained in place the Claimant was administered Clopidogrel. Despite the Claimant continuing to complain of numbness and reduced sensation in the saddle area, the Defendant did not investigate the causes of the same until an MRI scan was undertaken the following month. The scan revealed an epidural haematoma had formed at the L1/2 level. By that date it was not possible to treat or ameliorate the effect of the haematoma. The haematoma caused the Claimant to suffer Cauda Equina Syndrome.
The Claimant (a retired medic) alleged that the Defendant was negligent in that the Trust caused or permitted the Claimant to be administered Clopidrogel whilst the epidural catheter remained in situ only a day after the surgical procedure. As a result of the incident the Claimant developed Cauda Equina Syndrome. The nerves supplying the perineal and saddle area are irreversibly damaged. The Claimant has marked compromise in his bladder and bowel functions. His lifestyle is grossly restricted as a result of the negligence.
The Defendant made a Part 36 Offer in the sum of £120,000 on the 25 March 2014. The Claimant made a counter offer on the 7 April 2014 in the sum of £180,000 which was accepted by the Defendant.
JP v POWYS LOCAL HEALTH BOARD
By Order of the High Court of Justice on 15 November 1990, it was ordered that the Defendant pay the Claimant damages for injury arising from negligence in her management under the Defendant’s care on 18 June 1984, when she underwent surgery for cholecystectomy and suffered injury to her right hepatic duct and transection of the common hepatic duct. She required surgery for biliary reconstruction. The damages awarded to the Claimant by the Court were awarded on the basis that the Claimant would not in future develop complications of her
injury, including a stricture of any of her biliary ducts; serious deterioration of the neurosis from which she then suffered; and other complications. An order for provisional damages was made.
The Claimant did go on to develop -
- A complex biliary stricture, involving the origin of both the anterior and posterior branches of the right hepatic duct, and for which she required treatment including surgery on 14 November 2011 for right hemi-hepatectomy;
- Neuropathic wound pain;
- A serious deterioration of neurosis, with recurrence of depressive disorder.
She underwent ERCP (Endoscopic Retrograde Cholangiopancreatography) under intravenous sedation on 2 February 2010. A PTC (Percutaneous Transhepatic Cholangiogram) was performed under local anaesthetic on 22 February 2010. Attempted balloon dilatation of the anastomosis was undertaken but had to be abandoned and a percutaneous drain was placed. Images from this investigation showed a stricture affecting the origins of the left and right hepatic ducts at the confluence of the two bile ducts and the site of the Hepaticojejunostomy anastomosis. A repeat PTC was performed on 23 February 2010 under general anaesthesia with balloon trawl for gallstones in the right anterior sectoral hepatic duct. The Claimant was discharged home on 26 February 2010.
The Claimant remained under the review at the Hammersmith Hospital. She developed recurrent right upper abdominal pain. Antibiotics were given and she underwent pain clinic review.
On 14 November 2011 the Claimant underwent surgery for right hemi-hepatectomy. The previous incision was opened, with left subcostal and cephalad midline extensions. Right hemi-hepatectomy was performed. It appeared that the hepatico-jejunostomy into the left hepatic duct was patent and did not require revision. The Claimant was discharged home on 2 December 2011 with an abdominal drain in place.
The Claimant was admitted overnight to the University Hospital of Wales, Cardiff, on 13 December 2011 with blood and pus in her drain. She was discharged for further follow up and management at the Hammersmith Hospital.
The Claimant had three or four checks on her drain and re-suturing of the drain at Hammersmith Hospital to ensure that it stayed in place. She was finally reviewed at the Hammersmith Hospital on 9 January 2012 when it was noted that she was feeling well and had no issues. The drainage was minimal over 48 hours and the drain was removed in the clinic.
During February 2012 the Claimant spent four days in the Royal Gwent Hospital with fluid on her lungs. This did not require drainage and she was treated with antibiotics.
Following the operation on the 14 November 2011 the Claimant had suffered pain by the lateral end of her right sided abdominal wound. The pain was being treated by the Pain Clinic at the Royal Gwent Hospital and the Claimant underwent paravertebral blocks on 18 July 2012 and 21 November 2012. This pain is neuropathic and is related to nerve damage from the intercostal nerves supplying the right lateral end of the abdominal wound which was extended to perform the liver surgery.
On the 14 November 2011 the right lateral end of the incision was extended by 9cm. The vertical wound was extended upwards by 6cm. There is a 6cm area of very weal abdominal wall with a cough impulse and there is an increased risk of development of an incisional hernia.
The Claimant suffered recurrence of depressive disorder. Her sense of well-being and quality of life is reduced and the depressive disorder contributes to her overall distress, the level of which has risen since the changes to her physical health that led to the operation to remove part of the liver.
The prognosis for the Claimant’s recurrent depressive disorder is guarded as it will be dependent upon the extent to which the chronic pain will continue.
Pleadings were served on the 3 December 2012. A Case Management Conference took place on the 24 April 2013.
A Joint Settlement Meeting was held on the 28 January 2014 at which the Claimant accepted the sum of £360,000 plus her reasonable costs of the action.
DP v NEWCASTLE UPON TYNE HOSPITAL NHS TRUST
The Claimant underwent right knee Anterior Cruciate Ligament reconstruction on 8th February 2010. The Claimant reported numbness after the surgery which remained present at the time of discharge from hospital. The Claimant remained dissatisfied with his knee, and on 31st July 2012, was seen for a second opinion. The Defendant agreed in January 2013 to extend the limitation period. The Defendant agreed to a further extension in May 2013.
Medico-legal opinion suggested that there was a technical problem in drilling the femoral tunnel and it was possible that the lower end of the graft was not adequately tethered. Revision surgery was carried out where it was possible to drill a new femoral tunnel without having to remove the interference screw in the old tunnel and a new hamstring graft was harvested from the left knee.
It was alleged there was faulty siting of the femoral tunnel in the primary surgery, which resulted in the ligament reconstruction being placed too anterior and thus impinging on the inter – condylar notch, restricting extension of the knee and placing the ligament in a position where it was likely to rupture.
The Claimant served a Letter of Claim on 19th June 2013 alleging that the Defendant had negligently drilled two femora tunnels in the first procedure, suggesting intra-operative difficulty in drilling the femora tunnel satisfactorily, but the operation note was not documented to that effect.
The Claimant alleged that the graft in the primary surgery was placed too anteriorly, and impinged on the inter-condylar notch – causing restriction of the full extension of the knee, and the graft was placed in a
position where it was likely to rupture.
The Claimant also alleged that if the ligament had been accurately positioned, properly tensioned and stabilized within the bony tunnels, then by three months the Claimant would have recovered from the procedure with an appropriate course of rehabilitation, and by six months would have returned to his normal sporting activities.
On 13th November 2013, the Defendant finally responded to the Letter of Claim with a Part 36 offer in the sum of £15,000.00.
The Claimant rejected this on 29th November 2013 and made a counter offer in the sum of £25,000.00.
On 11th December 2013, the Defendant increased its offer to £17,500.00 which the Claimant accepted on 18th December 2013.
CLAIMANT v SALISBURY NHS FOUNDATION TRUST
The Claimant suffered extensive and severe burning to her vagina in what ought to have been a routine endometrial ablation procedure in 2008.
As a consequence she required a total hysterectomy and numerous operations and skin grafting. The Claimant suffered physical and psychological injury with interference in her social and domestic activities and can no longer enjoy normal marital relations. Proceedings were issued March 2011, with the Defendant then admitting breach of duty and causation.
Claim settled 7th Nov 2012 at £300,000 plus payment of her costs.
CLAIMANT v HWYEL DDA LOCAL HEALTH BOARD
In August 2008 the Claimant underwent a Total Abdominal Hysterectomy with conservation of the ovaries at the Defendant Hospital.
Prior to the procedure, the Defendant failed to administer prophylactic antibiotics such that the Claimant suffered a surgical site infection due to Staphylococcus Aureus, in combination with an anaerobic bacteria. Subsequently the Claimant developed a further infection as a result of the infection of the devitalised tissue. The Defendant confirmed that there were no records to suggest that antibiotics had been given, but that it was “their normal practice”. The Defendant was repeatedly invited to admit breach of duty, but no admission was forthcoming for several months and its position on causation was reserved.
Subsequently causation was admitted, and the claim settling with the Claimant securing damages in the sum of £25,000 plus payment of her costs, after Court proceedings were issued and served.