Claim settled against gynaecology team for failure to advise on hysterectomy options and incomplete oophorectomy

The Penningtons Manches clinical negligence team settled of a claim against the gynaecology team of a South West hospital for alleged consecutive failings in our client’s management over a three year period.

For many years, our client was under the care of the gynaecology team at her local hospital for problems with lower abdominal pain and menorrhagia (heavy menstrual bleeding). In late 2007, our client was seen by a junior gynaecologist who informed her that she would be an ideal candidate for a total abdominal hysterectomy. As our client was only in her early 40s at the time, she thought this was a very drastic option but she was assured by the doctor that a hysterectomy would completely resolve her problems, particularly with the heavy menstrual bleeding. On this understanding, our client agreed to undergo a total abdominal hysterectomy with conservation of both ovaries and she was listed for the surgery in early 2008. 

However, in the interim, our client learned that an alternative to a hysterectomy was a sub-total hysterectomy which retained the cervix. She had not been given this option by the hospital and had no information about the relative risks  and benefits but preferred to have a less extensive procedure. Prior to the surgery, our client informed her surgeon that she wanted to retain her cervix and the surgeon agreed to this with no questions. No discussion took place about the reason for her request, nor was she advised of the risks and implications of retaining her cervix rather than having it removed as part of the hysterectomy as had been planned. Crucially, and unbeknown to our client at the time, there is a risk of continued bleeding if the cervix is retained but this was never explained to her. 

Unfortunately, following her sub-total hysterectomy, our client  continued to suffer with menorrhagia and pelvic pain. She continued to attend  the gynaecology  clinic and frequently reported her continuing symptoms but was never given an explanation why she continued to suffer with her symptoms, despite undergoing the hysterectomy.  

Sadly, our client developed further problems with very severe left sided abdominal pain in late 2009  for which she had to be hospitalised on many occasions. Following investigation, our client was diagnosed with cysts on the left ovary and, in early January 2011, our client underwent further surgery to remove both ovaries (known as a bilateral salpingo-oophrectomy). Due to the potential complexity of the surgery (partially due to the number of her previous surgeries), our client was assured that her consultant would perform the operation himself. This assurance provides our client with some comfort, particularly as her consultant knew of her complex past history in the event that there were any problems during surgery. 

However, despite having received assurance that her consultant would be performing the operation, our client was informed on the day that her surgery would be carried out by a locum surgeon to whom she was introduced just a few minutes before being taken into theatre. Understandably, our client was apprehensive about proceeding with a potentially difficult operation with a surgeon with whom she had not consulted previously and who may not appreciate the complexity of the operation. 

She felt that she had no other option but to proceed with the surgery, as she was concerned that any delay in surgery could have a detrimental impact on her health and she had already made home and work arrangements. The locum doctor subsequently carried out the bilateral salpingo-oophrectomy and, despite being informed post-operatively that the surgeon had managed to remove both ovaries and fallopian tubes successfully and without complication, our client experienced a very torrid recovery. 

Several months after her surgery, our client underwent an MRI scan and was informed that the surgeon had, in fact, failed to remove both ovaries as he had previously stated and that the left ovary was still in situ and there was also a remnant of the right ovary. 

Our client subsequently learnt that this issue had been highlighted by the hospital’s laboratory some months previously but she was not informed and no action was ever taken to resolve these issues. Our client was naturally very distressed to learn of these findings, which caused her to lose faith in the doctors at the hospital. Consequently, she felt that she had no other option but to transfer her care to another hospital where she had to undergo repeat surgery to remove both ovaries, which was thankfully, performed successfully.  

As a result of the failings during the first operation to remove both ovaries, our client instructed Penningtons Manches LLP to pursue a claim against the gynaecology team. During the course of the claim, medical evidence was obtained from an expert gynaecologist who was very critical of the standard of care received by our client for both her hysterectomy and the oophorectomy.  

We obtained independent expert evidence from a consultant obstetrician/ gynaecologist who was critical that there was a failure to appropriately explain the options of a total and sub-total hysterectomy together with the pros and cons of each of the procedures during the initial consultation and, subsequently, when our client requested that her cervix be retained. Our expert was very critical of the failure to inform our client of the risk of continued bleeding if she retained her cervix, particularly as the whole purpose in proceeding with the surgery was to achieve resolution of these symptoms. Furthermore, it was apparent that there was a failure to inform our client of other associated problems with a retained cervix, including the need for regular cervical smears particularly given her family history of cervical cancer. Our expert was of the opinion that such a discussion must take place in order to obtain informed consent from any patient. 

Our expert was also very critical of the preparation and performance of the bilateral salpingo-oophorectomy. Pre-operative investigations should have been carried out to assess the complexity of any operation and there was a clear failure to remove both ovaries during the course of the procedure. Our expert was of the opinion that our client’s case should never have been delegated to a locum doctor and the number of errors that transpired throughout the course of our client’s care arose because of the lack of any consultant led-care, as our client was predominantly seen by relatively junior doctors throughout. 

A letter of claim was subsequently submitted to the defendant’s representatives setting out the allegations of negligence in our client's care. Liability was contested in full and the defendants were difficult about producing the requested information. Given their refusal to admit any errors, we issued and served court proceedings and started proceeding through the court timetable, having made offers to settle which were rejected. The defendants  finally entered into negotiations, resulting in a settlement for our client.

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