Significant damages achieved for patient who lost sight during routine cataract surgery

We have obtained significant compensation for our client in her clinical negligence claim against Frimley Health NHS Foundation Trust.

Our client’s claim related to negligence before, during and after surgery to remove a cataract from her left eye.

In 2018, our client noticed a slight worsening in her left sided vision. She had previously undergone cataract surgery for her right eye and recognised that the deterioration in her left vision might be because of a cataract. She discussed her concerns with a consultant ophthalmic surgeon at the defendant trust. He confirmed that she had a cataract in her left eye and recommended surgery. Our client agreed to surgery, but on the condition that the consultant would personally perform the procedure. He agreed, although advised that our client would need to wait longer for surgery. She agreed to wait for as long as was needed.

Our client’s cataract surgery was listed the following year on 14 February 2019. At her pre-operative assessment, she asked the nurse to confirm that the consultant would be performing her surgery, as agreed. She was told that he would be.

On 14 February, our client attended Frimley Park Hospital for her cataract surgery. She was taken to theatre where the consultant was present, and exchanged pleasantries with him. She was taken to a side room by a junior clinician for some eye tests. He did not introduce himself or speak with our client about her surgery.

Our client was then assisted onto the operating table in theatre, at which point her right eye was covered, and her left eye was draped and held open with instrumentation. She was advised to remain very still. She could not see in detail the surgeon who began operating on her eye. Part way through the procedure, the surgeon called out to say that there had been a complication. Our client at that point recognised that the surgeon was not the consultant and realised that the consultant who had agreed  to perform her surgery, had not, in fact, done so. After the surgery our client was informed that there had been a minor complication, but one which would have no bearing on her outcome.

The day after surgery, our client noticed that her left eye was painful, and her vision was becoming gradually less clear. On the second day after her surgery she attended the emergency eye unit at Frimley Park Hospital because of her painful left eye. She was seen by a junior doctor who found that the pressure in her left eye was very high. She was given eye drops, which worked to an extent, but when she was sent home the pressure in her left eye was still much higher than normal safe limits.

Two days later, our client attended hospital again. The pressure in her left eye had risen. She saw the same junior doctor who, again, prescribed eye drops and sent her home. Two further days later, our client noticed that she could not see anything at all from her left eye. She eventually saw her consultant, and after tests and investigations, was told that she had suffered injury to the optic nerve, which had caused irrecoverable and permanent injury to the sight from her left eye.

Our client complained to the trust, which stated that her surgery was uncomplicated and that she had suffered an unfortunate but recognised complication of surgery. She then approached Penningtons Manches Cooper to investigate a potential clinical negligence claim on her behalf.

After obtaining and reviewing our client’s medical records, we felt that there were issues in the way in which she was consented to treatment, and that there may have been failures in her post-operative management. Instructions were sent to an independent expert ophthalmic surgeon. He identified criticisms of the defendant trust, as follows:

• there was a failure to obtain our client’s consent to treatment. If it was found to be correct that she had, in fact, agreed with the surgeon that he would personally perform her surgery, he should have performed the procedure himself or explained that her surgery would be performed by a junior surgeon under his supervision and given her the choice to proceed or not;
• there was a failure to remove viscoelastic from her left eye at the end of surgery. Viscoelastic is a viscous substance used during cataract surgery to protect the eye from being damaged by the instrumentation used to remove the eye’s natural lens. It is important that, at the end of surgery, the surgeon removes the viscoelastic, because failing to do so will prevent aqueous drainage and can cause pressure within the eye to build to dangerous levels. In the expert’s opinion this is exactly what happened in our client’s case; it was the only plausible explanation for the very high pressure in our client’s left eye post-operatively;
• there was a failure by the junior doctor post-operatively to consider the cause of the dangerously high pressure in our client’s left eye, to suspect that viscoelastic had been retained, and to arrange an anterior washout of our client’s left eye;
• it was the expert’s opinion that, had the viscoelastic been removed at the end of surgery or had the junior doctor suspected retained viscoelastic, then our client would have had a normal outcome and retained normal vision. In the expert’s opinion, the identified failures had caused our client to suffer a significant injury to the sight from her left eye.

Following receipt of expert evidence, allegations of negligence were presented to the defendant in a letter of claim. The defendant trust, in its response, denied all of the allegations that were made. The defendant argued that the complication of raised pressure following cataract surgery is recognised, and had not been caused by any negligent failure of the defendant’s clinicians.

We discussed the defendant’s arguments with the expert, who remained adamant that the level of pressure in our client’s eye following surgery could only have been caused by retention of viscoelastic, and the failure to remove it was negligent. Accordingly, court proceedings were issued and served on the defendant.

Within three months of serving the claim, we received correspondence from the solicitor for the defendant stating that a defence would not be filed and that the defendant would admit that there had been negligence in our client’s care. Specifically, it was admitted that the junior doctor was negligent for not suspecting that our client’s dangerously high pressure was caused by retained viscoelastic. The defendant admitted that, had it not been for that failure, our client would have retained normal vision and would have avoided the total loss of sight from her left eye.

By this point we had investigated the impact of the injury on our client. The loss of sight from her left eye permeated all aspects of her life. She was less able to drive and couldn’t drive to see her children and grandchildren, who lived far away, because she was too afraid of driving on busy motorways. She couldn’t walk her dog as and when she wanted. She couldn’t read books or watch television comfortably. Meal preparation and cooking, and maintaining her house were all made difficult because of the injury to her sight.

A care expert was instructed to assess our client at home and set out recommendations as to her care and equipment needs. On the basis of these recommendations, we prepared a schedule setting out the financial losses that our client had incurred and was likely to incur in the future. These included items of equipment for use at home, additional household lighting, and funds to pay for a domestic cleaner, an ironing service and a support worker.

The parties agreed to enter into negotiations to discuss settlement of the claim and ultimately came to an agreement to resolve the claim in excess of £200,000. This level of compensation was sufficient for our client to put in place the items of equipment and services that she needed to ensure she has support for her sight loss for the rest of her life.

Our client was concerned not only to obtain compensation for her injuries but to try to effect change in the NHS so that other patients do not experience the same failures as she did. The trust has confirmed in correspondence to our client that changes have been made to the way in which patients are consented. In particular, the trust has confirmed that patients should be told when surgery may be performed by a junior doctor, and that they should be given the option to decline this.

This case also demonstrates the importance of clinicians not just treating the patient’s symptoms, but recognising, understanding and treating the underlying cause. Had the clinician two days post-operatively considered and recognised the probable cause of our client’s dangerously high intra-ocular pressure, she would have received appropriate treatment and her outcome would have been very different. She would not have suffered the permanent loss of sight from her left eye which will affect her for the rest of her life.

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