Hospital negligence news

 

Vaginal birth after caesarean section (VBAC) - risks of rupture and RCOG recommendations

The RCOG Each Baby Counts programme’s recent report into the anaesthetic care which contributed to the serious brain injury, neonatal death and stillbirths suffered by 49 babies in 2015 highlights some of the highest risk areas in maternity patient safety. Aside from the essential teamwork, communication and forward planning which is needed to handle the multiple, time-sensitive, emergencies which occur in maternity units, the report emphasised that trial of vaginal birth after a previous caesarean (VBAC), if incorrectly counselled, undertaken and managed can result in uterine rupture, severely brain damaging the fetus and threatening the life of mother and baby. 

Serious injury was caused to a baby when signs of uterine rupture (including maternal tachycardia, breakthrough pain between contractions and a worrying CTG trace) were missed during a trial of VBAC labour. Despite these warning signs, the mother was incorrectly given syntocinon, a uterine stimulant, increasing the stress on her uterine scar. The report reiterated that pain breaking through a previously effective epidural in a woman with a history of uterine surgery must always trigger an obstetric review for scar rupture.

What are the risks of VBAC compared with a planned repeat caesarean section (ERCS)?

Assuming that delivery takes place at or after 39 weeks gestation in circumstances suitable for VBAC:

  • Planned VBAC has a 1 in 200 (0.5%) risk of uterine rupture, compared with 2 in 10 000 (0.02%) in a previously unscarred uterus. The risk increases when VBAC delivery is induced or labour is augmented with syntocinon.
  • The success rate for planned VBAC is 72-75% but increases if the mother has had a previous vaginal or successful VBAC delivery. If VBAC delivery is successful, it has fewer complications than ERCS.
  • Unsuccessful VBAC resulting in emergency caesarean section carries the greatest risk of adverse outcome.
  • The risk of unsuccessful VBAC and caesarean section increases if VBAC labour is induced or augmented.

Who is suitable for VBAC?

The RCOG guidelines for VBAC list the circumstances most suited to VBAC:

  • Singleton pregnancy (i.e. expecting one baby)
  • Cephalic presentation (baby is head down)
  • Pregnancy at 37 weeks or more
  • Single previous LSCS (lower segment caesarean section - scar across the lower part of the abdomen)

A successful VBAC delivery is more likely where the mother is taller, younger than 40, and has a BMI below 30, and the labour starts spontaneously before 40 weeks, and the baby is in vertex presentation with a birthweight below 4kg.

The risk of uterine rupture during VBAC increases with the mother’s age and the baby’s gestation and size, and where the mother’s last delivery took place less than 12 months previously.

Who can’t have a planned VBAC delivery?

Planned VBAC is contraindicated where there is:

  • A history of uterine rupture
  • Previous classical caesarean scar (scar goes vertically up the middle of the mother’s abdomen)
  • Placenta praevia (i.e. the placenta’s position would obstruct a vaginal delivery)
  • The mother has a history of other uterine surgery

Who decides whether the delivery will be by VBAC or ERCS?

The choice of delivery mode must be agreed by the mother and a senior obstetrician, based on her personal risk factors, before the planned date of delivery and after she has been counselled about the risks and the circumstances in which a trial of VBAC would be abandoned and caesarean section needed. All antenatal counselling must be documented in the medical records. If ERCS is planned, an agreed contingency plan for early spontaneous labour must be written in the records.

What additional safety measures are in place during VBAC delivery?

Labour must take place in a delivery suite equipped for continuous intrapartum care and monitoring, with facilities for immediate caesarean delivery and advanced neonatal resuscitation. The fetal heart must be continuously monitored electronically from onset of regular contractions throughout the VBAC, to ensure early detection of maternal or fetal compromise, obstructed labour or uterine scar rupture. The mother’s condition and progress of labour must be regularly monitored by one-to-one care.

What are the clinical signs of uterine rupture in labour?

The three classic signs of uterine rupture are pain, vaginal bleeding and fetal heart-rate abnormalities, but in 48% of all cases the scar breaks down without any maternal symptoms and is diagnosed later during surgery.

Clinical signs associated with uterine rupture include:

  • Abnormal CTG (most common sign)
  • Severe abdominal pain, particularly if the pain persists between contractions
  • Sudden scar tenderness
  • Abnormal vaginal bleeding
  • Haematuria (blood in the urine)
  • Previously efficient contractions stop 
  • Maternal tachycardia (elevated heart rate), hypotension (low blood pressure), fainting or shock
  • There is a change in abdominal shape and fetal heart-rate not detected at the previous transducer site
  • The fetus is no longer presenting properly

Suspected rupture of the uterine scar is an emergency requiring urgent caesarean section and neonatal resuscitation as the unborn baby is deprived of oxygen, leading to permanent brain damage or death.

As specialists in birth trauma claims, Boyes Turner’s medical negligence team are experienced in helping mothers and babies affected by uterine rupture during inappropriately counselled or managed VBAC deliveries.  

If you or your baby have suffered severe injury as a result of birth-related medical negligence contact one of our specialist solicitors by email mednegclaims@boyesturner.com.

What is kernicterus?

Kernicterus is a rare but dangerous complication of neonatal jaundice in which the baby’s brain is damaged from excessive levels of bilirubin.

Bilirubin is a yellow pigment that everybody has in their blood. It is released into the bloodstream during the body’s normal process of breaking down old red blood cells.  It is processed in the liver and stored in the bile duct and gallbladder. Its function is to help the body digest fats in the small intestine, where it is known as bile, and it is then excreted along with the rest of the body’s waste. 

What is the difference between kernicterus and jaundice?

When there are excessive amounts of bilirubin in the blood and the liver is unable to process it, the first signs that the baby has excess bilirubin may include:

  • yellow discolouration of the baby’s skin
  • yellow discolouration of the whites of their eyes
  • dark staining of the urine (visible on their nappy)
  • pale chalky stools

This condition is known as jaundice and affects 60% of full term babies and 80% of premature babies during the first few days of life. Breast fed babies are at greater risk of neonatal jaundice and may suffer the effects of the condition for as long as a month.

Neonatal jaundice usually lasts up to two weeks and is usually harmless but it must be diagnosed, monitored and treated if it doesn’t resolve early to avoid the development of more serious conditions.

In addition to its own risks, jaundice can be a sign of other conditions which may need treatment, such as:

  • Infection
  • Sepsis
  • Liver disease
  • Incompatibility between the mother’s and the baby’s blood groups
  • Bruising and metabolic disorders
  • Sickle cell anaemia
  • Enzyme deficiencies

How does untreated jaundice develop into kernicterus?

When the liver is unable to process the excess bilirubin in the blood, the baby will have hyperbilirubinaemia (too much bilirubin in their blood).

Where a baby has hyperbilirubinaemia  (jaundice), their bilirubin levels must be monitored and, if rising rapidly or exceeding the threshold bilirubin levels, the baby must be treated with phototherapy. They will sometimes also need an exchange blood transfusion.

If left untreated, the toxic, unconjugated (not metabolised by the liver) bilirubin can penetrate the blood-brain barrier where it damages the brain and spinal cord, causing neurological dysfunction. This is known as bilirubin encephalopathy and its features - the pattern of damage to the brain – are known as kernicterus.

The baby may show the initial signs of kernicterus brain damage by:

  • Poor feeding
  • Failing to respond to stimulus, such as clapping hands in front of them
  • Decreased muscle tone (floppiness)
  • Seizures or fits
  • Arching of the spine

Long term disabling effects of kernicterus brain damage vary in severity but include:

  • Cerebral palsy
  • Hearing loss
  • Learning disability
  • Impaired eye movements

My baby was brain damaged by delayed treatment for jaundice – how can I find out if I can claim?

At Boyes Turner we are experts in helping children affected by severe brain damage in the birth and neonatal period. If your child has suffered brain damage from kernicterus, our specialists will be happy to advise you about whether your child has a claim arising from negligent care after your baby’s birth, or the treatment they received for jaundice either in hospital or from the community midwives in charge of their care after they were discharged home.

Legal Aid may be available if the child suffered severe neurological injury owing to negligence before or during birth or during the first eight weeks of life.

If you are caring for a child with severe neurological disability which was caused by negligent medical care of jaundice contact the team by email at mednegclaims@boyesturner.com.

Meningitis and brain injury - what can you expect?

Boyes Turner are supporting Meningitis Now’s #MayMayhem campaign in which the focus is on putting the fun into workplace fundraising to support the charity’s important work. 

Message behind the #maymayhem

Meanwhile, the message behind the mayhem is that meningitis kills. It also maims, leaving its survivors permanently disabled by limb loss and damage to the brain.

Whilst many of the physical effects of an acquired brain injury give rise to obvious disability, other consequences of the damage to the child’s developing brain can be more subtle, appearing and changing over time, making them harder to understand.

Emotional and behavioural after-effects of brain injury are often misinterpreted, particularly in a growing child or teenager. It is important for the child’s parents, wider family and school to recognise that the child may not be able to control or understand their own emotions and challenging behaviour, and to seek appropriate specialist help to support the child.

What emotional and behavioural changes can I expect following my child’s meningitis brain injury?

Meningitis Now lists some of the common difficulties that children may experience after a brain injury:

  • Tiredness leads to frustration and irritability when the child finds it difficult to return quickly to former activities or struggles to cope at school.
  • Mood swings, such as crying or laughing more quickly, temper tantrums, bedwetting and nightmares are common in the recovery period. Tiredness only makes them worse.
  • Anxiety, depression and loss of confidence come from realising that the illness has changed their life, worry about becoming ill again and coping with the long-term effects of their injury.
  • Apathy, lethargy, despondency and poor motivation can be misinterpreted as laziness, whereas they can arise from damage to the areas of the brain which affect arousal and initiation of activity. Without support, the child can slip beneath the radar at school, thereby failing to achieve their potential, and may become socially isolated.
  • Anger and aggression come from impairment of the brain’s ability to control behaviour and from frustration or struggling to cope emotionally with their injury.
  • Obsessive behaviour and lack of flexibility impede a child’s ability to adapt to different situations, including socially.
  • Disinhibition and sexually inappropriate behaviour in which the older child has no insight into the consequences of their behaviour. This exposes them to added risk of harm, causing friction with parents and teachers, and isolates them from friends who find them embarrassing.

These behaviours can arise from neurological damage to the brain impeding the child’s ability to regulate their own behaviour but also from the child’s psychological reaction to their illness and its impact on their life, their former activities, friendships and independence. Cognitive impairment makes it difficult for the child to communicate their frustration and everything is made worse by fatigue, anxiety and confusion. The child’s pre-injury personality and the dynamics and stresses within the family will also affect the child’s behaviour. Medication, such as anti-convulsants, also affect the child’s tiredness, behaviour and learning capability.

At Boyes Turner we understand that following meningitis or a brain injury the damage may go far beyond the physical. We work with educational, clinical and neuropsychologists, and child psychiatrists to assess the full effect of the injury and to secure the funding necessary to provide rehabilitation, therapy and ongoing support.

Our clinical negligence lawyers also work closely with our Special Educational Needs team to ensure that the child receives appropriate SEN assistance, whether that is in a mainstream or specialist school. By ensuring that we fully understand the child’s needs we are able to secure for them higher levels of compensation.

If you are caring for a child who has suffered a brain injury as a result of negligent medical care please contact by email on mednegclaims@boyesturner.com.

#MayMayhem 2018 - Support Meningitis Now this May

Here at Boyes Turner, #MayMayhem is underway as our brain injury lawyers ‘unleash the mayhem’ in support of leading meningitis charity, Meningitis Now.

Whilst our office antics will raise a smile, along with funds for Meningitis Now’s valuable work in the prevention and alleviation of suffering from meningitis, we’re deadly serious about this devastating disease.

What damage can meningitis cause?

Meningitis can kill within hours. Its survivors can be left with severe disability, including amputation and the serious after-effects of acquired brain injury. These will vary depending on which area of the brain has been affected by the disease.

Where incorrectly treated or late diagnosed meningitis has led to permanent brain damage in a child, it is important that the nature of the injury and the full extent of its impact is understood to ensure that the child is properly compensated for the lifelong pain, suffering and financial loss that they will incur. Different types of injury give rise to different problems in different areas of a child’s life, so we work hard to ensure that the child’s needs, now and continuing into adulthood, are properly assessed and recovered as part of their claim.

What physical symptoms can I expect my child to suffer after an acquired brain injury from meningitis?

Meningitis Now’s fact sheet on the physical effects of acquired brain injury refers to some of the physical problems faced by children after brain injury from meningitis:

  • Impaired movement and coordination

    Where meningitis injures the child’s brain in the neonatal period around or shortly after the time of birth, this can lead to cerebral palsy.

    Brain injury at any age can cause difficulty with movement and coordination, affecting posture, control over gross motor skills such as walking and running, or fine motor skills such as writing or manipulating objects with the hands.

    Muscle tone might be too tight or too loose, affecting the ability to hold the body in certain positions or sit upright, and can cause dizziness, problems with balance and coordinated movements.
  • Seizures (fits) and epilepsy

    Seizures are both a sign of meningitis and an after effect of brain injury.
  • Headaches and fatigue

    Headaches and extreme tiredness are common effects of acquired brain injury, but can also be caused by anti-epileptic medication. They can also affect the child’s behaviour and ability to function at home and at school.
  • Hydrocephalus

    Hydrocephalus is a build-up of cerebro-spinal fluid on the brain when the normal flow of fluid around the brain and spinal cord is restricted. The additional pressure on the brain is sometimes alleviated by  surgical insertion of a shunt to help the fluid drain into another part of the body, such as the abdomen.
  • Incontinence

    Impaired control of bowel and bladder function can follow severe brain injury.

The physical disability arising from a brain injury affects every aspect of the life of the sufferer who may need lifelong assistance with mobility and independence, personal care, education, accessibility and adapted accommodation and will suffer financial losses from their inability (or reduced ability) to work.

Boyes Turner’s specialist brain injury solicitors work with experts in a wide range of disciplines including neurology and paediatrics, occupational therapy and physiotherapy, disabled housing and nursing care to assess our clients’ needs. Our expertise enables us to recover top level damages awards to meet their lifelong needs for therapies, equipment, accommodation, education and care.

If you are caring for a child with serious disability arising from negligent medical care of meningitis please contact us by email at mednegclaims@boyesturner.com.

Meningitis in babies - new warnings from latest research

A new research study into the characteristics of bacterial meningitis in babies below the age of three months has identified potentially dangerous flaws in the way meningitis is currently diagnosed.  

The Meningitis Research Foundation, which funded the St George’s Hospital research team study, Clinical Characteristics and Risk Factors for Poor Outcome in Infants Less Than 90 Days of Age with Bacterial Meningitis in the United Kingdom and Ireland, has warned that doctors relying on the classic sign of fever to trigger further medical investigation may be missing the opportunity to diagnose meningitis in this exceptionally high risk age group.

Whilst babies under the age of three months are 70 times more likely to contract bacterial meningitis than adults, the study found that only 54% of the 263 meningitis babies studied were reported to have a temperature above 38°C. Fever was more commonly reported in older babies, whereas, in the  younger age group, the common but less specific symptoms, such as poor feeding, lethargy and irritability could more commonly be mistaken for mild illness.

Fever is not the only sign of meningitis but is regarded as a key feature. The NICE Guideline: Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management (at paragraph 1.1.1) warns that fever is ‘not always present, particularly in neonates’. Newborn babies (also known as neonates) are the highest risk age group for meningitis.

The study found that other specific features of meningitis, such as bulging fontanelle (the area on top of the head where the baby’s skull bones have not yet fused), seizures, coma and neck stiffness were far less common in infants under three months. Seizures were reported in 28%, bulging fontanelle in 22%, coma in 6%, and neck stiffness in only 3%.

The incidence of bacterial meningitis in babies hasn’t changed since the 1980s. Early diagnosis and rapid treatment remain the key to avoiding the devastating consequences of this deadly disease.

Fever can no longer be relied upon as a reliable main symptom of meningitis in babies under three months old. To assist in recognition and diagnosis, The Meningitis Research Foundation have now updated their symptoms information for parents. The charity has also created a teaching package for clinicians, reflecting the findings of the recent research.

As specialists in clinical negligence claims of the utmost severity, Boyes Turner’s meningitis experts have acted for many children and adults who have suffered permanent brain damage, severe disability and amputation arising from delayed diagnosis and treatment of meningitis.

We support the efforts of charities such as the Meningitis Research Foundation and Meningitis Now and the breakthroughs in awareness and positive change that arise from studies such as this. We now look forward to seeing this awareness reflected in changes to guidelines and clinical practice in the hope that fewer lives will be affected by this devastating disease.

If you are caring for a child with serious disability arising from negligent medical care of meningitis please contact us on 0118 952 7201 or email us on mednegclaims@boyesturner.com.

 

GIRFT Cardiothoracic surgery

Getting It Right First Time (GIRFT) has published its latest report into NHS adult cardiothoracic surgery in England. The GIRFT programme aims to help improve the NHS by identifying variations in practice and procurement, sharing and supporting the implementation of proven best practice with health professionals and hospital managers across the country, thereby improving patient care and saving costs. It does so with funding and support from the Department of Health and is jointly overseen by NHS Improvement and the Royal National Orthopaedic Hospital NHS Trust.

In keeping with previous reports, Cardiothoracic Surgery GIRFT Programme National Specialty Report, makes 20 recommendations which, if implemented could save the NHS up to £52 million a year. The report contains a statement of support from The Society for Cardiothoracic Surgery (SCTS) which also produced a joint response with the Royal College of Surgeons urging the NHS to act upon the recommendations.

The term cardiothoracic surgery relates to surgical treatment of disease in the heart, lungs and major blood vessels in the chest. 7 million people in England have cardiovascular disease which accounts for 27% of all deaths. 28,250 cardiac surgery operations and 69,000 thoracic surgery operations are performed each year. 

Only 31 units in England perform this major, technically demanding surgery in which success depends on highly skilled, multidisciplinary teamwork. Although low-volume compared to many other areas of surgery, cardiothoracic surgery is high cost and often high risk with a measurable mortality rate. Patients needing these sorts of operations have life-threatening diseases and are amongst the most ill that the NHS faces. Since survival rates and clinical outcomes in adult cardiac surgery have been published, they have improved such that the UK’s survival rate for cardiothoracic surgery is currently ranked as one of the best in the world.

The GIRFT cardiothoracic surgery report recommends changes which will improve experience and outcomes for patients which go beyond mortality or survival rates. Delays (which increase risk), cancellations and unnecessarily long stays in hospital will be reduced by a series of measures including:

  • Routine day-of-surgery admission
  • Ring-fencing of ward and ITU beds for elective cardiothoracic surgery
  • Pooling of non-elective cases so that patients are operated on in the next available theatre session with the next available appropriate surgeon
  • Ensuring that every patient is seen by a consultant both pre and post-operatively, seven days a week (to avoid delays in waiting for discharge if no consultant can review at the weekend)

Patients’ risk and outcomes (including risk of stroke and deep sternal wound infection) will be improved by measures including:

  • Ensuring that conditions needing highly specialised treatment, such as aortovascular surgery and mitral valve surgery, are only operated on by surgeons with specialist skills in that condition.
  • Specialist surgeons will operate on higher numbers of cases, as variations in practice,  outcomes and mortality strongly suggest that higher volume is associated with better outcome.
  • Minimum activity requirements for surgeons. 
  • Major trauma centres to have rotas to cover both thoracic and cardiac trauma surgery rather than relying on cardiac surgeons to provide emergency thoracic surgery cover. (There are only 27 cardiothoracic surgeons in England, with 182 cardiac-dedicated surgeons and 92 purely dedicated to thoracic surgery).
  • Centralised and reduced numbers of lung cancer multidisciplinary teams with a thoracic surgeon present on every team.

During their visits the GIRFT team found that because clinicians and providers knew very little about the litigation claims that were being made against them, very few lessons had been learned from claims. The Department of Health has stated its goal to turn the NHS into a learning organisation but unless clinical staff are given information about litigation claims and proper analysis of claims is carried out at local and national levels, opportunities are being missed to improve patient care. GIRFT recommended implementation of their five point plan to reduce litigation costs - including detailed analysis and review of all claims as serious untoward incidents (SUI)  -  to ensure that lessons are learned to save costs and improve patient care.

If you or a family member have suffered serious injury as a result of medical negligence during cardiothoracic surgery call our specialist medical negligence solicitors on 0118 952 7219 or email mednegclaims@boyesturner.com.

How to end a deputyship

A deputyship can be brought to an end automatically or through choice. There are several ways in which a deputyship can end and these are:

  1. If a person dies then the deputyship comes to an immediate end and the Death Certificate must be sent to the Office of the Public Guardian. At that point, the Executors of the Will or the Administrators if a person died intestate (without a Will), will take over the administration of the person’s assets.                     
  2. The Court of Protection can make an Order terminating the deputyship if the deputy retires or resigns. An application will need to be sent to the Court of Protection with details of the proposed new deputy and confirmation as to the retirement or resignation of the current deputy.
  3. A person may recover mental capacity so that they are able to make to their own financial decisions, in which case evidence of recovery such as a doctor’s letter will need to be sent to the Court of Protection together with a COP9.

Please note that apart from in the case of when a person dies, you cannot stop being a deputy until you have received the relevant Court Order discharging you as a deputy. However, the security bond will remain in force for seven years after the death of the person you are deputy for unless there is a Court Order cancelling it. A security bond is an insurance provision which would have been put in place to protect the finances of the person concerned.

We would be happy to assist you in an application to the Court of Protection should you wish to retire and arrange for another person to take over as deputy. We can prepare applications for lay deputies (a family member or friend) or for a professional deputy such as ourselves.

We are also able to prepare the applications to the Court should a person recover capacity and either then manage their finances themselves or wish to place money into a personal injury trust. This may be useful for added protection if a person regains capacity but remains vulnerable and needs additional support and protection.

Ruth Meyer leads our Court of Protection team and has over 20 years specialist experience. Ruth acts as a professional deputy in respect to finances for children and adults who have received an award for compensation for medical negligence or who have an acquired brain injury. However, she is also able to act for people with dementia as well as any other age related illness that affect mental capacity. Please feel free to call any of the team members for a free initial discussion.

If you would like to discuss your current deputyship arrangement or to talk about how to end one up please email our specialist team on cop@boyesturner.com.

60 seconds with... Sita Soni shares her experience in running cervical cancer clinical negligence cases

Following on from Cervical Cancer Awareness Week we asked Sita Soni, an associate solicitor in the clinical negligence team, about her experience of successfully investigating cervical cancer medical negligence cases.

What key information do you need from an individual who has concerns about their cervical cancer medical care?

I always listen to the client’s recollection and their concerns about the care they received first. It’s really important to understand exactly what has happened and how the client feels about it. To understand whether there an investigation should take place, I usually ask the client to let me know:

  • What, if any, symptoms they experienced
  • Their history of smear testing
  • Any relevant attendances at the GP or hospital and advice they were given
  • What diagnosis they have been given
  • What treatment has been advised/given
  • The impact of the diagnosis and/or treatment

Can you investigate a case even if the individual is still having treatment?

Yes. The fact that a medical negligence case is ongoing should make no difference to the medical care the patient receives. It is best to investigate a claim as soon as possible, as the client’s recollection of events will be clearer. 

There are also legal time limits for bringing a claim for medical negligence, so it is better to investigate concerns as soon as possible after the patient suspects that errors have occurred.

How will a cervical cancer medical negligence case be funded?

Usually the case will be funded by a Conditional Fee Agreement (also called a “no win no fee agreement”) with After The Event insurance. This means that the client doesn’t have to pay any legal costs at the start of the claim and will not be liable for any costs if the case is unsuccessful. In a successful claim the majority of the claimant’s legal fees are paid by the defendant. I take great care in explaining the funding arrangement in detail to my clients to make sure they are entirely comfortable with the agreement. Where a claim, even if successful on its merits, is unlikely to be financially viable for the claimant, I let them know at the outset as we would never advise a client to pursue a disproportionately expensive claim.

How do you investigate whether the hospital/GP has acted negligently?

All cases are different and there is no one-size-fits-all approach to investigating a case. I will, however, always need the claimant’s medical records from their GP surgery and hospital, so in every case I  request these and consider them carefully. I take a detailed statement from my client to record clearly their recollection of what happened. 

Medical negligence claims must be supported by expert evidence. When investigating cervical cancer claims, a gynaecological oncologist is usually instructed to comment on whether the treatment was negligent and if so, to advise on what should have happened instead. The gynaecological oncologist will also comment on the impact, if any, of the negligent treatment, for example, whether intensive treatment like radiotherapy could have been avoided with correct medical care.

Other medical experts may also be required. We select our experts carefully according to the needs of the individual case.

How do you calculate the level of compensation in a cervical cancer case?

The valuation is tailored to the individual client. No two cases are the same because no two clients are the same. I discuss with each client the physical and psychological impact of the negligence, and the extent of their financial loss. We take into account the side effects of any avoidable treatment (i.e. fatigue, pain, bowel and bladder impairment), whether they been able to go back to work or are now on reduced hours and so experiencing a loss of earnings, whether they need extra help at home with cleaning and other chores. The aim is to help my clients rebuild their lives after a cancer diagnosis.

Some of the difficulties are permanent and may require medical treatment or therapy to alleviate, so I look at my clients’ needs for help not only now but also for the rest of their lives. I include the costs of any treatment or therapy required in the claim. I usually instruct experts to help assess the client’s current difficulties and their future outlook. This might involve evidence from a colorectal expert, a pain expert, a care expert and a psychiatrist. 

Why do you think it’s important for cervical cancer negligence cases to be investigated?

Each of my clients have their own reasons for pursuing a medical negligence claim. Some say closure is the most important reason for them. They want to know if things went wrong in their medical care and what could have been avoided. Understanding what has happened allows them to move on. Some clients are seeking help and support to put their lives back on track with private medical treatment and therapy specific to their needs.  Others are concerned about the financial implications for their family if they can no longer work to their full capacity after cancer treatment and want the help that a successful claim can provide by alleviating the financial hardship which often follows cancer negligence. 

My experience in working closely with our clients and volunteering for Jo’s Trust, the UK’s only cervical cancer charity, has equipped me to support my clients during and after the process, to understand their concerns, and fully answer their questions about the next steps.

Sita has recently achieved a £575,000 compensation settlement following a delay in diagnosis of cervical cancer. For more information about this case, have a look at our website here.

Vascular Surgery - the latest report from Getting It Right First Time (GIRFT)

The latest report from the GIRFT programme has been published, revealing its findings and recommendations for improving the way vascular surgery is delivered by the NHS in England. Funded by the Department of Health and overseen by NHS Improvement and the Royal National Orthopaedic Hospital NHS Trust, GIRFT is proving successful in helping the NHS to learn and improve its practises by identifying variations in NHS care, sharing best practice with clinicians and hospital managers across the country whilst supporting necessary changes, thereby saving costs.

The latest report sets out 17 recommendations for improvement based on information gathered from NHS data and visits to each of the 70 NHS Trusts which provide vascular surgery services. In addition to raising concerns about quality and discrepancies in the available NHS data, the report highlights fundamental weaknesses in the way that vascular surgery is delivered. Patients are routinely experiencing unacceptable and potentially dangerous waiting times for surgery. These delays increase their risk of experiencing major strokes, life threatening rupture of abdominal aortic aneurysms and amputation, depending on their condition. The report emphasises that by its very nature, even where the need for vascular surgery is not classed as an emergency, it must always be regarded as urgent.

Currently, 43,000 vascular surgery procedures are performed in England each year by 450 consultant vascular surgeons, often working with vascular interventional radiologists, in 70 NHS Trusts. In order to ensure that NHS patients needing vascular surgery can be treated urgently in accordance with NICE guidelines and in a way that minimises their risk, GIRFT recommends that this important and often life-saving surgery must be provided through a reduced number of properly staffed and equipped specialist centres, via an advanced yet proven ‘hub and spoke’ network model that has worked effectively elsewhere within the NHS.

If implemented, the recommended changes could improve surgical outcomes for seriously ill patients whilst also achieving costs savings by reducing length of hospital stays, reducing the number of readmissions and making better use of surgical resources. Other recommendations include opportunities to save money which is currently wasted through variations in the procurement of equipment and other products.

What is vascular surgery?

Vascular surgery saves lives through a variety of important procedures such as reconstructing, unblocking or bypassing arteries that are blocked by atherosclerosis. This hardening or furring of the arteries reduces blood flow to vital organs and, if untreated, can lead to sudden death, strokes and amputation. Another life-saving procedure deals with aortic aneurysms before they rupture, often causing death.

Where surgery is delayed there is always a risk to life or limb. Patients needing vascular surgery are, by definition, very frail and their condition is often compounded by additional complications (or co-morbidities) such as hypertension, diabetes, chronic lung disease or ischaemic heart disease. This puts them at greater risk from surgery, increases their need for intensive post-operative care, raises the likelihood that they will need to be readmitted to hospital and increases their mortality rate when compared to other types of surgery.

The GIRFT report highlights some key procedures in which delays are increasing those risks:

  • Abdominal aortic aneurysm (AAA)
    An abdominal aortic aneurysm is a bulge or swelling in the aorta. If it ruptures it causes internal bleeding and sudden loss of blood pressure and is usually fatal without emergency surgery. Most procedures are, therefore, carried out before rupture, with the aim of preventing rupture. Once a patient is identified as being at risk of rupture, surgery should take place urgently. However, GIRFT found that patients whose AAA surgery was classed as ‘elective’ (i.e not yet ruptured) rather than ‘emergency’ (already ruptured) were often having to wait several weeks for surgery.

  • Carotid endarterectomy (CEA)
    Carotid endarterectomy removes atherosclerotic build-up in the carotid arteries which carry blood to the brain. This procedure is usually performed on patients who have suffered a minor stroke or transient ischaemic attack (TIA) to prevent the life threatening and disabling major stroke which often follows a minor stroke. NICE guidelines mandate that CEA should be carried out within two weeks of diagnosis of a minor stroke or TIA. However, GIRFT found wide variation between NHS Trusts in the waiting time from diagnosis to CEA surgery, with some patients having to wait for 28 days or more.  

  • Lower limb revascularisation
    Lower limb revascularisation treats peripheral vascular disease (caused by blocked arteries) by improving blood flow through the arteries in the legs. Timely revascularisation by angioplasty (using a ‘balloon’ to widen the artery or a stent to keep it open) or bypass can prevent the need to amputate. Around 8,000 lower limb amputations are performed on the NHS each year. Major amputation currently has a 16.5% high emergency re-admission rate and a 7.5% mortality rate. GIRFT found that earlier identification of risk and reduced waiting times for revascularisation could reduce the numbers of amputations.

Dealing with delay

The GIRFT report found that lack of available facilities and lack of integration with other departments were often a cause of delay. However, the key finding of concern was that vascular surgery tends to be carried out only in ‘normal’ working hours, which limits the number of procedures that are carried out each week. Only six NHS hospitals in England currently offer elective (non-emergency) vascular surgery at weekends, even though they all must have on call teams available at weekends to deal with emergencies.

The key recommendation of the report was that vascular surgery should be delivered seven days a week, centralising resources and expertise through specialist hubs. In doing so, patients will be given greater choice from a range of available procedures, surgery will be performed more quickly by more experienced surgeons using better facilities and specialist equipment in an environment where there is appropriate multi-disciplinary support. Recommendations were also made in relation to pre-habilitation and planning for perioperative care thereby reducing avoidable post-operative readmissions.

At Boyes Turner we specialise in helping brain injured and amputee clients rehabilitate and rebuild their lives following severe injury caused by unacceptable treatment delays. We understand the physical and psychological damage that is caused by these injuries and we work hard to obtain compensation which can pay for prosthetic limbs, specialist equipment, adapted vehicles and homes, along with meeting the costs of necessary care and replacing lost earnings.

Whilst the findings of the GIRFT report into vascular surgery highlight the number of patients who are potentially suffering amputations and other serious injury unnecessarily, GIRFT’s previous reports and successful implementation of its recommendations provides hope for improvement.

Boyes Turner welcome the courageous and valuable work that is being carried out by GIRFT’s clinical leads and their teams to identify areas where unnecessary suffering can be avoided and champion best practice to bring about change.  

If you or a family member have suffered serious injury as a result of hospital negligence during vascular surgery call our specialist medical negligence solicitors on 0118 952 7219 or email mednegclaims@boyesturner.com.

 

60 seconds with a medical negligence lawyer - Julie Marsh

Over the following year we will be sharing a series of question and answer articles about our day-to-day lives in the medical negligence team. Following on from World TB Day, we asked Julie Marsh, a senior associate solicitor in the clinical negligence group, about her experience of running medical negligence claims in relation to the delayed diagnosis and management of TB.

What key information do you need from an individual who has concerns about their medical care and whether there has been a delay in diagnosis of tuberculosis?

It is important to have an accurate chronology of events in a case like this. I need to understand why the client thinks there has been a delay in diagnosis and treatment of tuberculosis and how long that delay might have been.

I take a detailed statement from the client and any family members about when they first noticed symptoms indicative of tuberculosis, when they first sought medical help and their condition and reported symptoms at that time. 

It is also important to understand any treatment that has been given over time, and the effect that this has had on the individual.   

Can you investigate a case even if the individual is still having treatment?

Yes.

It is important to investigate a medical negligence claim as quickly as possible. There are time limits associated with bringing claims of this nature which need to be considered. It is also important to start the investigation as soon after the events as possible, so that the client’s recollection of the facts is as fresh as it can be. 

Treatment for tuberculosis can go on for six months or more. Sadly, tuberculosis can have long-lasting effects which need ongoing treatment and management of symptoms, but a client shouldn't wait until the conclusion of their treatment to consider a claim. The sooner we can establish liability, the sooner we can obtain interim payments to help ease any financial hardship from loss of earnings and other costs, often long before the case is finally concluded.

How would a case like this be funded?

Usually a claim is funded by way of a Conditional Fee Agreement (sometimes called a “No Win, No Fee Agreement”) backed by after-the-event insurance. This means that there are no upfront costs to the client to get the investigation underway and that the client will not be liable for any legal costs if the investigation is unsuccessful. In a successful claim, the Defendant pays the majority of the legal costs.  

It is very important to discuss the funding arrangements for bringing a claim with a client at the outset, so that they understand the terms of the agreement and are entirely comfortable with them before a claim is underway. 

Where a claim, even if successful on its merits, will not be financially viable for the claimant, I let them know at the outset as we never encourage a client to pursue a disproportionately expensive claim.    

How do you investigate whether the hospital/GP has acted negligently?

To investigate a claim for medical negligence, it is necessary to assess the standard of care that the patient received from their health practitioner, whether that was their GP, or the doctors at a hospital.   

Once I have a statement from the client, I obtain a copy of their medical records and analyse treatment that was given to the client. It is very important to have the client’s input at this stage as there can be factual inaccuracies in medical records and there might be a factual dispute which is critical to the case.  

A claim for medical negligence must be supported by medical expert evidence. In tuberculosis cases a respiratory physician will usually be required to comment on the extent of the injury that the client has sustained as a result of any delay in diagnosis, and will also be asked to give an opinion on the client’s condition and prognosis. 

The standard of care must be assessed by an expert from the same discipline as the health practitioner whose care gave rise to the claim. So, for example, a GP expert would be needed to assess care from a GP.

How do you calculate the level of compensation in a delay in diagnosis of tuberculosis case?

The valuation of any claim is entirely tailored to the individual client, the impact of their injury and their circumstances. 

The client’s injury and its impact on their life must be considered very carefully. Where there has been a degree of respiratory disability as a result of a delay in diagnosis of tuberculosis, this can have far-reaching effects on the individual, their family and all aspects of their life. I make sure that I understand fully how the claimant’s life has been affected by the additional injury that has been caused by the delay.  

It may be necessary to include a claim for new accommodation. In a case I have recently worked on, the client lived in a very old building where it was difficult to maintain a constant air temperature or to have standard central heating. As a result of the bronchiectasis caused by the tuberculosis and the damage to her lungs from the delay in treatment, any change in room temperature caused extreme coughing fits. My client will need to move to a modern and well insulated and centrally heated house in the future so that these coughing fits can be avoided. In this scenario, we include a claim for the additional costs associated with moving to suitable accommodation from the defendant.   

It is also important to consider the future in cases of this nature. Unfortunately, damage to the lungs can result in reduced immunity to chest and other infections. If a condition called Aspergillosis is contracted then the consequences for the client can be severe, sometimes requiring the removal of a lung, which can be life-threatening and extremely debilitating.  

Why do you think it’s important for tuberculosis negligence cases to be investigated?

Unfortunately, there is currently surprisingly little awareness of tuberculosis and its dangers.  However, the signs and symptoms are relatively easy to identify, and timely treatment for inactive tuberculosis is straightforward with minimal  long term effects. However, the consequences of any delay in treatment can be devastating to the individual and their  family, and the impact on their finances and way of life can be considerable. 

Boyes Turner’s clinical negligence team are currently acting in several cases of serious disability and devastating injury arising from delayed diagnosis and treatment of TB.​ If you or a member of your family having suffered severe injury as a result of delayed treatment for tuberculosis or other infectious disease, contact us on 01118 952 7219 or email claimsadvice@boyesturner.com.

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