No scalpel vasectomy

A patient suffered a scrotal haematoma following no-scalpel vasectomy

A 48-year old man was referred for a vasectomy to a GP, an MDU member, who was experienced in performing no-scalpel vasectomies. At the initial consultation, and with the aid of diagrams, the GP explained how he would perform the procedure, and talked through the possible complications including the risk of bleeding which, if severe, might require hospital admission. The MDU member also gave the patient an information leaflet that listed the possible complications of a vasectomy.

Two weeks later, the patient attended for the procedure, which seemed to be uncomplicated, and the patient went home, having been given advice regarding post-operative care, and an information leaflet with post-operative instructions.

Two days after the procedure, the patient was admitted to hospital with a scrotal haematoma that required drainage.

The patient made a complaint to the primary care trust, who carried out a root cause analysis, with which the GP cooperated fully. The analysis raised some concerns about the standard of the doctor's note keeping and audit, but none about his operative technique.

Eighteen months later, the GP received a letter of claim from solicitors instructed by the patient, alleging that the patient had not been properly advised about the procedure and complications. It was also alleged that the performance of the vasectomy was below an acceptable standard and that as a result the claimant had suffered a scrotal haematoma.

The GP was unable to recall the operation itself, but on the basis of his usual practice he was able to describe in detail the consent process that he would have undertaken, and how he would have carried out the vasectomy. He was also able to provide copies of the leaflets which the claimant had been given, both before the vasectomy and on discharge. Although the consent form itself did not list haematoma as a possible complication, it referred to the leaflet, which did clearly state that this was a potential complication.

The MDU obtained independent advice from a GP expert with experience in performing no-scalpel vasectomies. The expert was entirely supportive of the care afforded to the claimant and felt that he had been provided with adequate information peri-operatively. The technique used by the GP is well-recognised, and there was nothing to suggest that the vasectomy had been performed in a substandard way. Unfortunately, the claimant had suffered a recognised complication of the operation, about which he had been warned.

The letter of claim raised concerns about the doctor's record keeping, as had the PCT investigation, but this was of no causative consequence, since it had not contributed to the occurrence of the haematoma.

The MDU served a detailed letter of response, setting out the doctor's standard practice in relation to the consent process and the operation itself, providing copies of the leaflets, and responding to the allegations made on the basis of the independent expert advice. It was also emphasised that the doctor had cooperated fully with the root cause analysis, and had taken steps to address the issues raised by this.

The fact that a root cause analysis had taken place did not indicate that the procedure had been performed in a substandard way. Liability was denied, and the claim was subsequently discontinued.

This case emphasises the need to keep accurate and contemporaneous records. Doctors should clearly explain the potential complications of a procedure, document these on the consent form, and if possible provide the patient with a leaflet, giving them sufficient time to read and consider this before the operation takes place.

It is also important to cooperate with investigations into complications that arise, and take steps to address issues that may be identified. This is part of efforts to improve clinical care for patients, and reflective practice, and is not necessarily indicative that care has fallen below an acceptable standard.

Dr Claire Wratten
Senior medical claims handler

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