Surgery negligence news

 

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.

Claim after patient develops sepsis post-bariatric surgery

I recently read of a case of a woman who underwent gastric bypass surgery but unfortunately she developed a leak from one of the join sites that led to her developing sepsis, respiratory failure and the need for emergency surgery. 

After the surgery and because of the sepsis, the lady developed a fistula and had to undergo further surgery.  She also developed abdominal adhesions and suffered with bowel problems.

The lady sought legal advice and her legal representatives were able to prove that although leaks are recognised complications of the surgery, the surgeon did not adequately check for leaks during the surgery.

The case settled for £570,000.

£350,000 compensation after wrong weight loss surgery procedure performed

I was shocked to read of a case where the wrong weight loss procedure was performed on an individual.  The individual, a woman, brought a legal claim for this and recovered £350,000 in compensation.

It was reported that a Roux-en-Y procedure had been requested, but a biliopancreatic diversion was actually performed. The incorrect surgery caused her to suffer Dumping Syndrome and malnutrition. She required care and was no longer able to work.

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