Boyes Turner’s medical negligence solicitors secured a £162,500 settlement in a surgical negligence claim for the family of an elderly man who died after his external iliac artery was cut during a hernia repair operation at a private hospital in Reading. Surgical injury to external iliac artery causes major haemorrhage The deceased had been referred by his GP to the defendant surgeon for private surgical repair of an inguinal hernia. The operation was performed by the surgeon at a private hospital. During the procedure, the deceased’s external iliac artery was injured, causing a major and rapid haemorrhage (bleeding), which the surgeon could only control with digital pressure (pressing on the artery with his fingers). The surgeon sought help from a vascular surgeon who came to assist in the operating theatre and noted that the external iliac artery was transected and had probably been cut by a deep suture (stitch). There was a long delay before the vascular surgeon could perform the iliofemoral bypass procedure which was necessary to restore vascularity to the leg, because the private hospital did not have a suitable graft, and a taxi was sent to collect the graft from the John Radcliffe Hospital, the regional vascular centre, in Oxford. The external iliac artery is a major blood vessel within the pelvis that continues down the body from the common iliac artery and ultimately becomes the femoral artery. It is critical for the supply of oxygenated blood to the leg. The injury to the artery led to severe blood loss and shock and the deceased suffered a cardiac arrest. CPR was performed and adrenaline administered but it was many hours before the surgery was completed owing to further complications with missing equipment and problems arising from blood clotting. Transfer to an NHS hospital for intensive care The deceased was eventually transferred by ambulance to the intensive care unit (ICU) at Royal Berkshire Hospital, with vascular advice provided remotely by vascular surgeons from the John Radcliffe Hospital, Oxford, which, despite the deceased’s poor perfusion (blood flow) to his leg, had refused to accept his transfer to the more specialist hospital. The vascular graft was found to have failed and, without proper blood supply, the deceased’s leg became necrotic. After a further two day delay, an above knee amputation was performed in an attempt to save his life, but he died two days later from a series of pulmonary emboli (blood clots). Support for the family with the inquest and surgical negligence claim We were instructed by the deceased’s daughter and personal representative on behalf of his estate and his dependent widow, to represent the family at a three-day inquest and then seek compensation via a surgical negligence fatal injury claim. After the inquest, we pursued a claim against the private surgeon on the basis that the deceased’s fatal injury had been caused by the surgeon negligently damaging the external iliac artery by cutting it with a suture (stitching) needle during the operation, causing the major haemorrhage. If the hernia repair surgery had taken place correctly, avoiding injury to the artery, the deceased would have made an uneventful recovery and lived a near normal expectancy for a man of his age. Defendant surgeon maintains denial of liability The defendant surgeon failed to respond to our formal letter of claim and offer to settle. We issued court proceedings and the defendant surgeon responded by denying liability on the basis that the injury was caused by a recognised operative complication. We disputed this on the basis that the damaged blood vessel was a major artery which was some distance from the surgery which was taking place. It should have been easy to identify and avoid with correct surgical technique. We rejected the defendant surgeon’s additional suggestion that the artery was diseased and had disintegrated when pressure was applied to control the bleeding elsewhere. Our stance was supported by the vascular surgeon’s noted findings at the operation and the defendant surgeon’s own description of the injury in later conversations with Oxford. We maintained that surgical injury with a misplaced suture was the more likely cause of injury, as the surgeon had also accepted when questioned at the inquest. We responded by serving on the defendant a formal request for his confirmation as to whether or not he had put the suture needle into the artery. Settlement eases financial hardship for the deceased’s widow We then received a settlement offer of £125,000 from the defendant and, after further negotiations, achieved a settlement of £162,500. Given the deceased’s age and history of ischaemic heart disease with a previous quadruple coronary bypass artery graft, this provided a near full value settlement for our clients, despite the defendant’s denial of liability. The majority of the settlement related to the deceased’s widow’s loss of dependency on his pension income and services. Whilst financial compensation can never make up for the loss of her husband and the life they enjoyed together, the settlement will help provide for her comfortable retirement. Recognising the risks and benefits of private hospital care Given the long waits for non-urgent NHS treatment, many patients are opting for the speed, ease and personal, consultant-led service offered by private medical and surgical care. This case highlights some of the other considerations that patients should recognise when deciding to have surgery in a private hospital, which include risk factors that may be outside their chosen surgeon’s control. These include the lack of easily accessible intensive care or multidisciplinary expertise and facilities, as well as whether arrangements are in place for handling unexpected complications, mistakes in surgical procedures or medical emergencies. In this case, the surgical injury caused the patient to suffer a major haemorrhage, which ultimately led to his death. However, the surgeon’s ability to respond to the injury was hampered by the fact that the operation was taking place in a private hospital without the necessary blood supplies, specialist equipment, on-site expertise and protocols for dealing with emergency situations. The private hospital made changes after receiving criticism from the coroner at the inquest into the deceased’s death. The John Radcliffe Hospital at Oxford was issued with a Regulation 28 Notice (Prevention of Future Deaths Report) following their unhelpful response to the surgeon’s request for transfer of his patient. If you or a family member have suffered severe injury as a result of medical negligence or have been contacted by HSSIB/MNSI or NHS Resolution you can talk to a solicitor, free and confidentially, for advice about how to respond or make a claim by contacting us.
