Surgery negligence news

 

Amputation: What are the 3 most common causes we see?

Amputations are more common than you might think. The recent GIRFT report on vascular surgery puts the current number of lower limb amputations performed on the NHS each year at around 8,000, with an associated mortality rate of 7.5%. The good news is that with awareness, self-care and proper medical care, many amputations are preventable. For those whose avoidable amputations were caused by medical, employer or other road user negligence, financial help may be available through a legal claim.

Boyes Turner’s experienced amputation lawyers regularly help amputees restore their mobility and independence by securing funding to pay for rehabilitation, essential prosthetics, home adaptations and essential care and domestic assistance. Where the amputee is unable to return to their former employment, we can help alleviate the financial hardship that arises from their loss of earnings.

We asked our amputation specialist lawyers to tell us the most common causes of avoidable amputations which can give rise to a compensation claim:

Traumatic injury

Trauma, such as farm or factory accidents, where the injury arose as a result of unsafe working conditions or in an unsafe environment for visitors or children, are common causes of amputation claims against the employer or owner of the premises.

Road traffic accidents give rise to claims where a pedestrian, a cyclist, passenger in a car or taxi, pillion passenger on a motorbike or a bicycle, or another driver has been injured as a result of someone else’s negligent driving.

Complications of diabetes

With Type 2 diabetes on the increase, diabetes-related amputations are now performed at an alarming rate of 20 each day in England. Four out of five diabetes-related amputations are preventable, arising from minor foot conditions such as cuts, blisters, foot ulcers or sprains which develop into more serious infections or deformities such as Charcot foot.

Diabetes can lead to reduced blood circulation and loss of sensation in the sufferer’s feet, which means that they might not feel a blister or small cut until it has become infected or formed an ulcer. They might continue to walk on a sprained ankle until it develops signs of Charcot foot.

Diabetics and their health carers can reduce their risk of lower limb amputation by carrying out regular visual checks of their feet, promptly treating any signs of injury – cuts, blisters, discharge or oozing, redness, warmth or swelling – with rest, antibiotics if needed, and referral to foot care specialists.

Peripheral ischaemia

Peripheral ischaemia – a serious condition in which narrowing or blockage of the arteries restricts blood flow to a limb – was listed in a recent report on rising litigation costs by the Medical Protection Society (MPS) as one of the top five areas of substantial claims in GP practice.

If peripheral ischaemia is unrecognised or left untreated it can lead to ulcers, gangrene and amputation. Diabetics, smokers and sufferers of coronary artery disease are at increased risk, regardless of age, but 20% of adults over the age of 60 are believed to have some degree of peripheral artery disease.

Ischaemia to a limb can also be caused by surgical errors, such as mismanaged peri-operative anti-coagulation where the patient is known to be at risk of thrombosis or surgical injury to the popliteal artery.

If you have suffered an amputation or a serious injury with future risk of amputation as a result of someone else’s negligence, contact us on mednegclaims@boyesturner.com.

Delays in cranial neurosurgery highlighted by latest GIRFT report

The latest report to be published by Getting It Right First Time (GIRFT) reveals the deficiencies and opportunities for improvement in the way cranial neurosurgery services are provided by the NHS. In contrast to previous GIRFT reports which have focussed on learning from variation in practises between NHS Trusts, GIRFT’s cranial neurosurgery report highlights that patient pathway inefficiencies and delays are being experienced in all of the 24 NHS hospitals which perform cranial neurosurgery, to the detriment of patient care and the frustration of the neurosurgeons.

The report specifically states that it is not a call for additional financial investment. Many of its recommendations can be implemented by NHS Trusts with minimal effort yet deliver an immediate impact on surgical capacity and throughput, resulting in more procedures taking place and patients who need urgent surgery receiving it faster. Implementation of its recommendations will optimise the use of existing resources to avoid delays and cancellations, free up hospital beds, deliver a better and faster service to patients whilst saving the NHS up to £16.4 million each year. NHS Improvement’s deadline for implementation of GIRFT’s cranial neurosurgery recommendations is June 2019.

What is cranial neurosurgery?

Cranial neurosurgery is a sub-specialty of neurosurgery which covers a range of surgical procedures performed on the brain or on the nerves in the skull. It includes the care and treatment of serious conditions and emergencies, such as traumatic brain injuries, intracranial bleeding and brain tumours, where timely surgery can save lives.  

Cranial neurosurgeons also carry out elective (non-emergency) surgery, such as relieving pain caused by nerve damage, and have a key role in monitoring patients with head injury.

In England, cranial neurosurgery is carried out in only 24 NHS hospitals which, together, admit 75,000 neurosurgery patients each year. In many of these cases, the patients were admitted for investigation, such as an MRI or CT scan or for monitoring after a head injury but did not have surgery. 40% of cranial neurosurgery admissions were for emergency treatment, most commonly for cranial trauma (head injury).

Cranial neurosurgery patients often need a lengthy stay in hospital owing to the severity of their condition and the longer recovery period from highly invasive surgery. For many, their care takes place in a critical care unit followed by extended monitoring on a ward, before moving on to rehabilitation. The average length of stay for patients following non-elective cranial neurosurgery was 19.4 days. 14% of patients stayed longer than 28 days.

Areas of concern arising from the report

GIRFT found that, without exception, all 24 NHS Trusts experience patient throughput delays which the frustrated neurosurgical teams believe are preventing them from seeing more patients and treating them sooner. After their treatment, patients are staying under the care of cranial neurosurgery longer than is clinically necessary, delaying the admission and treatment of new patients and resulting in high cancellation rates of those already admitted for elective surgery. 

Two-thirds of trusts fail to meet national 18-week referral-to-treatment targets for admitted neurosurgical patients, with eight trusts treating fewer than 60% of patients within the 18 week deadline. One in ten patients with subarachnoid haemorrhage or SAH (bleeding between the membranes surrounding the brain) do not receive surgery within the target time of 48 hours from diagnosis. This is a serious failing because any delay in treating SAH exposes the patient to the risk of severe brain damage or death.  

Even where cranial neurosurgery is not urgent, unnecessary stays in hospital cost the NHS more money, take up beds that delay treatment for other people and increase distress and infection risk to the patient.

The bottlenecks are experienced at every stage in the patient’s pathway. Patients have to wait for critical care beds to become available and these may be occupied by post-surgical patients awaiting discharge because the cranial neurosurgical centre has difficulty moving the patient on to other hospitals, rehabilitation centres or discharging them to a home setting with adequate rehabilitation support. The problem is compounded for tertiary (specialist treatment) hospitals because they are contractually obliged to accept referred patients requiring a specialist cranial neurosurgical procedure, whereas district general hospitals are not, and with their own stretched bed capacity and lack of rehabilitation resources, they can be unwilling or unable to take their post-surgical patient back.

Recommendations

The GIRFT cranial neurosurgery report recommends several ways in which hospitals can improve patient pathways to reduce delays and cancellations, speed up access to vital treatment, start post-operative rehabilitation sooner and improve patient experience:

  • Admitting patients on the day of surgery rather than in advance, particularly for minimally invasive procedures which don’t need anaesthetic and surgery for some brain tumours, to free up clinical care beds for more patients.
  • Reorganising the way operating theatres are used by designating one (existing, not new) theatre for acute procedures with open slots to cater for emergency admissions. This will  avoid disruption, cancellations or delays to patients already booked for elective procedures who are currently having to make way for emergency patients with higher clinical priority.
  • Speeding up discharge from cranial neurosurgery by making commissioning changes to compel referring hospitals to take their patients back once the patient is clinically ready. The success of this depends on better integration with community services to provide adequate and timely physiotherapy, OT and other rehabilitation support.
  • Avoiding thousands of neurosurgery admissions for non-surgical procedures, such as scans and post-operative checks, and consultant time spent in communicating scan results, which could be carried out by other multidisciplinary team members in outpatients or the patient’s home by phone or video-link.
  • Combining multiple consent and pre-admission clinic appointments to reduce the number of appointments that the patient needs to attend.
  • Avoiding delays by electronic information-sharing of patients’ scans and records between district general hospitals and the cranial neurosurgery centre, to avoid patients having to undergo repeated scans or long waits to be seen by a consultant because their information is not readily available.  

The GIRFT team envisaged that freeing up consultants from many of their 20,000 appointments each year will improve the use of resources, speed up discharge, reduce admissions and increase critical care bed capacity for when it is clinically required.

Freeing up just one extra bed per NHS trust per day would allow thousands more patients to receive the care of cranial neurosurgeons each year with no additional increase in resource – a goal that GIRFT believe is possible for each of the 24 NHS Trusts to achieve.

GIRFT estimate that implementation of their cranial neurosurgery recommendations will result in improved patient experience and outcomes whilst saving the NHS £16.4 million per year.

If you or a family member have suffered serious injury as a result of medical negligence during cranial neurosurgery call our specialist medical negligence solicitors by email 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.

Compensation claim settled for £150,000 after hysterectomy causes bowel damage

An individual has received £150,000 to compensate her for the injuries she sustained following an unnecessary sub-total hysterectomy. The surgery was performed after an ovarian cyst was suspected to be malignant.  However, it was later discovered that the cyst was in fact benign and if the doctor had taken the appropriate steps in the circumstances, including a full review of the various ultrasound images, it would have been clear that the risk of the cyst being malignant was less than five per cent.

The individual had a previous medical history of endometriosis and ovarian cysts. Following concerns that a cyst on her ovary was malignant, she was advised by the doctor to undergo a sub-total hysterectomy, even though there was a high risk that she could develop bowel damage and had previously been told to avoid surgery.

It was alleged that the doctor had failed to review the individual’s various ultrasound images, failed to consider the CA125 tumour marker and failed to refer the matter to the multidisciplinary team before advising the individual to undergo surgery.

Following the advice of the doctor, the individual felt re-assured and underwent surgery. Unfortunately, during the surgery her lateral femoral cutaneous nerve and bowel were damaged. As a result, she suffered from peritonitis (an infection of the abdomen lining) and required emergency surgery to repair the bowel and treat the peritonitis. She sadly became infertile after experiencing early menopause and suffered from many other symptoms, including bowel obstruction, severe abdominal pain, poor mobility and a tingling sensation in her legs.

All of her symptoms were considered to be permanent and had a dramatic effect on her daily life. Her husband had to help her to get in and out of bed and help her with personal hygiene. As household chores became impossible, her husband had to resume the role, including cooking, cleaning, laundry and food shopping.

The hospital admitted liability and a settlement was reached in the sum of £150,000. £60,000 was attributable to the individuals pain and suffering which was considered extensive and permanent. £90,000 was attributable to past and future care costs.

Emily Hartland, a solicitor at Boyes Turner comments:

“This is a sad case involving permanent injuries which could have been avoided. Whilst the compensation will never reverse the damage caused, the money will help the individual and her husband to pay for any future care needs. ”

New recommendations - obese patients with diabetes to be offered weight loss surgery

Recommendations have recently been published for patients who are obese (with a BMI of 35 and over) with recent onset of type 2 diabetes to be offered an assessment for weight loss surgery.  The recommendations highlight the need to identify and manage the obesity as well as the diabetes. 

Additionally, those patients who have a BMI of between 30 and 34.9 with recent onset type 2 diabetes should potentially also be offered an assessment for weight loss surgery.

The aim is that these patients will have more control over their diabetes, which may help reduce the medication they require.  It must be recognised that weight loss surgery requires long term management in terms of diet and exercise in order to manage diabetes.

If the diabetes is managed successfully, it is reported that patients will be less likely to have diabetes-related illnesses such as heart disease, stroke, nerve damage, eye damage and kidney disease.  Despite the potential benefits of weight loss surgery, it also carries serious risk of complications and should be carefully considered.

The outcome of the consultation is awaited.

The current criteria for weight loss surgery is set out here

Sita Soni of the medical negligence team at Boyes Turner comments:

“that with the increasing availability of weight loss surgery and more operations being performed, medical negligence claims in relation to this type of surgery have also seen a rise, as previously reported by the Medical Defence Union. Unfortunately each type of weight loss surgery carries a high risk of complications. Some complications are recognised and cannot be avoided, but other errors would be considered negligent and which can result in a weight loss surgery compensation claim.”

Six figure settlement after skin reduction surgery complications

Nicola Woolley, a 45 year old lady, who underwent a successful gastric bypass operation in 2007, has been left with permanent skin disfigurement and lifelong pain after an alleged negligent procedure to remove excess skin. It is reported that the surgeons removed too much skin causing various problems.

Ms Woolley who was 26 stone before the gastric bypass and lost 11 stone after the surgery, underwent a tummy tuck to remove excess folds around her waist and stomach in 2009, but subsequently developed serious blistering and significant pain.  She was diagnosed with epidermolysis (a skin disorder causing the skin to become fragile and can result in serious blistering).

Ms Woolley underwent 12 further procedures including skin grafts and fluid drainage in attempts to improve matters but doctors then told her there was nothing further they could do.

Ms Woolley instructed legal advisers to investigate a medical negligence claim into the care she received from the hospital.  The hospital did not admit the care was inappropriate in any way but settled the case for an undisclosed six figure sum.

Ms Woolley is now left in permanent pain in her lower back and buttocks, whether sitting down or standing as well as scarring.  It is reported by the legal advisers that the compensation will help Ms Woolley adapt her house, bring in professional carers to assist with her daily routine, fund pain management therapy as well as emotional support. It is also said that it is unlikely she will be able to work again.

Sita Soni, solicitor with the Boyes Turner medical negligence team, comments:

“It is devastating for this lady and her family that she underwent the weight loss procedure (also known as bariatric surgery) for better quality of life, but that surgical complications of the excess skin removal has meant that she is now dependent on others and will experience lifelong pain and discomfort.  Hopefully the compensation will go some way in overcoming some of the difficulties she faces”.

Plastic tubing left inside patient after weight loss surgery

The patient underwent gastric band surgery in 2007 which was later converted to a gastric bypass.   Unfortunately an abscess formed and had to be drained. In January 2010, the patient had abdominoplasty surgery (“tummy tuck”) to remove excess skin and fat, but the wound became infected and broke down.

By March 2010, the patient developed a lump in her abdominal wall.  The lump did not resolve so the patient was sent for a scan in 2011. The scan showed that one inch of plastic tubing had been left inside her abdomen from the previous surgery.

The patient developed infections as a result of the retained plastic tubing and required further surgery to remove it and repair the damage caused. The patient was unhappy with the care that she received and sought legal advice for her claim to be investigated. After medical negligence solicitors were instructed, the NHS Trust admitted that the plastic tubing had been left in the patient’s abdominal wall. After negotiation between the legal advisers, the claim was settled for an undisclosed sum of money.

Sita Soni, solicitor with Boyes Turner’s medical negligence team comments:

“Cases such as this one are considered ‘never events’ because these mistakes should never occur.  There should be strict systems in place to prevent this kind of situation arising. It is unknown how much this case settled for but the valuation should have compensated the individual for any pain experienced as a result of the retained tubing, additional and otherwise unnecessary surgery to remove the tubing as well as any long term problems arising out of the mistake”.

Alder Hey admits its operating theatres are not safe

Alder Hey Children’s NHS Foundation Trust has produced a damning internal review, warning that operating theatres at the Hospital are unsafe.

The review suggests that junior nurses and technical staff are carrying out complex tasks beyond their capabilities. The report also suggests that staff are failing to report their mistakes or near misses.

The hospital treats approximately 270,000 a year. It is now being investigated by the Care Quality Commission after whistle blowers warned that the theatres were unsafe.

The Director of Nursing at Alder Hey Hospital has also carried out a separate report, and warns that members of staff are frequently asked to carry out tasks which put patients at risk.

In 2013, the Daily Mail revealed concerns after a surgeon who had previously worked at the hospital had stated that two babies had died needlessly due to mistakes by overworked staff.

In the 1990s, the Hospital was at the centre of an organ scandal, after it emerged that staff had removed the body parts of 850 children without their parents consent.

The Care Quality Commission carried out an unannounced inspection of the Hospital in December, and is currently compiling a report of its findings which is likely to be published in the next few weeks.

A spokesman for the Hospital told the Daily Mail that they “acknowledge there have been difficulties within the theatre team at Alder Hey for some time.”  He went on to say that “over the past year the Hospital has undertaken a range of measures to address the concerns, and make changes within the department”.

Julie Marsh, specialist medical negligence solicitor comments:

“It is very concerning yet again that Alder Hey Hospital is at the centre of a controversial report, this time relating to failures in operating theatres putting patients’ lives at risk.  Patients are often worried enough about any form of surgery, and should not have to worry about the competency of the theatre staff as well. This failing is fundamental to service that the hospital provides, and goes to the heart of the issue of the duty of care the hospital owes to its patients. It is hoped that the Care Quality Commission report will identify the failings so that they can be addressed as a matter of urgency by the Trust and their staff”.

£35,000 compensation awarded to woman after failed gastric band surgery

It was reported in the Grimsby Telegraph that a woman received £35,000 in compensation after errors were made during a gastric band procedure.

The lady had experienced difficulties losing weight due to other health problems and was subsequently referred for gastric band surgery.

The procedure was performed via keyhole surgery and apparently without complication.  After the procedure, the lady started to experience significant pain and was admitted to intensive care and later induced into a coma.

It was reported that the lady suffered numerous complications, include acute peritonitis, because the surgeon did not close up one of the incisions used during surgery.

The lady was in hospital for a total of five weeks, during which she underwent further operations.

The lady sought legal advice and recovered £35,000 in compensation for the consequences of the surgical error.

Patients seeking compensation for weight loss surgery on the increase

I recently read an article which reported that there has seen an increase in the number of patients seeking compensation after weight loss surgery in the last two years.

The Medical Defence Union (MDU), which is an organisation who insure doctors, reported an increase in medical negligence cases against private surgeries since 2003 (35 cases) but noted that 21 of those claims began in the last two years.

It was reported that the MDU believes that claims will continue to increase as demand for procedures grow.   BMI Healthcare have apparently seen a 20% year-on-year increase in requests for weight loss surgery.  It is not surprising then to read that nearly 9,000 weight loss procedures were reportedly performed last year alone.

It was stated that the MDU reports that most of the weight loss surgery claims are ongoing, with the estimated value of each one ranging from £2,500 and £500,000 but that not all of the cases will result in settlements.

Complications which often result in legal claims include slipping gastric bands and delays in diagnosing problems such as infections.

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