The potentially fatal consequences when patients are lost to the follow-up process

Posted: 22/12/2021

There are many conditions that require ongoing medical monitoring and review. An example of such a condition is an abdominal aortic aneurysm (AAA).

An AAA is a balloon-like swelling of the aorta, the main blood vessel that runs from the heart down through the chest and tummy. An AAA can enlarge over time and rupture, causing life-threatening internal bleeding.

Most aneurysms are small to medium, from 3 to 5.4 cm across, and won’t require treatment. However, because they can grow, regular ultrasound scans are recommended on a yearly or quarterly basis depending on its size. These are carried out to check if the AAA is getting bigger. If it grows to 5.5 cm or more, a referral will usually be made to a surgical specialist so that treatment options can be discussed to prevent it from getting bigger or rupturing.  

There are two main treatments available for an AAA:

• Endovascular repair (EVAR) is a type of keyhole surgery which involves placing a small metal tube covered with mesh inside the damaged section of the aorta through a small cut in the groin.
• Surgical repair involves replacing the affected part of the aorta with a plastic tube.

AAAs can be very dangerous therefore it is crucial that patients have regular follow-ups, which include ultrasound scans, to monitor the  size of the AAA and so that they can be promptly referred to a surgical specialist to discuss treatment options as soon as the aneurysm has enlarged to 5.5 cm or more.

The consequences of a patient with an AAA being ‘lost’ to the follow-up process can be fatal. This is demonstrated in a claim that the clinical negligence team at Penningtons Manches Cooper is currently dealing with. The team is acting on behalf of a bereaved husband who sadly lost his wife from an AAA. She was diagnosed with an aneurysm in 2012 and referred to the vascular surgery team at Basildon University Hospital, part of the Mid and South Essex NHS Foundation Trust. As our client’s wife’s AAA was below 5.5 cm, it was decided that she would have ongoing surveillance, by way of regular ultrasound scans, to keep a check on its size.

In December 2014, it was noted that our client’s wife’s AAA had enlarged to 5.9 cm; however, she was only informed of this in April 2015. At this point, she was told by a vascular surgeon that her case would be discussed in the vascular multidisciplinary team’s meeting, and they would be in touch with her regarding further management in due course. However, our client’s wife did not hear anything further from the vascular surgery team at the hospital. She did not receive any follow-up or onward referrals, and no further investigations took place, despite her contacting the hospital on at least two occasions to find out what was happening. In 2017, our client’s wife died abruptly when the aneurysm ruptured.

A claim was submitted to the trust alleging that had her care been appropriately followed up on in December 2014 once it had been established her aneurysm was bigger than 5.5 cm, and had she been referred to an appropriate vascular centre for advice and management, surgery to repair her AAA would have been recommended in 2015 and, on balance, this would have been successful and her death prevented. The trust has since admitted liability in full. It has admitted that she should have been followed-up and referred for surgery in 2015, and that it is likely surgery would have been successful and her death avoided. The trust also admitted that she was deprived of the chance of life-prolonging treatment for her AAA.

Furthermore, the claim submitted to the trust prompted it to undertake a separate internal investigation. As part of this investigation, the trust reviewed all patients with AAA’s and, in doing so, alarmingly identified that there were a further six patients that had been lost to the follow-up process.

Varisha Gorasia, an associate in the clinical negligence team at Penningtons Manches Cooper, comments: “It is frightening to think how many patients are lost to the follow-up process every year. This can quite often be down to simple administrative errors, but the consequences can be catastrophic. In this case, the investigation into our client’s wife’s death triggered the review of all patients with AAA’s between 2012 and 2017. Therefore, by investigating this, our client has potentially saved the lives of others.”

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