A 28-year-old woman requested sterilisation on medical grounds because she was a carrier for haemophilia A. Her young son was severely affected by the disease and her daughter was a probable carrier. The patient was duly referred to a consultant obstetrician and gynaecologist who arranged for her admission for laparoscopic tubal ligation.
The patient had no history of bleeding during previous elective surgery (appendicectomy, tonsillectomy and removal of a breast lump). She had also had two uneventful pregnancies/vaginal deliveries. As a result, no coagulation tests were performed before the operation. The surgeon used the laparoscopic technique initially, but the clip being attached to the left Fallopian tube was not applied satisfactorily. As there were no other clips available, supplies having failed to arrive, he proceeded to formal laparotomy with open sterilisation.
Some hours later the patient became shocked and had to have a second laparotomy when bleeding in the lower end of the wound was discovered. The bleeding points were diathermised and the wound closed. The following day, however, a further laparotomy had to be performed because of continuing bleeding - this again appeared to be in the layers of the abdominal wall retroperitoneally. The surgeon carried out ligation of the rectus muscle and right inferior epigastric artery. It was at this stage that it was realised that the patient had a coagulation disorder and she was given Factor VIII. The patient was transferred to a regional hospital for further management where more complications developed requiring a transverse loop colostomy under Factor VIII cover. Six weeks later the colostomy was closed under cover of Factor VIII. The operation was uneventful. Several weeks later the patient was re-admitted with presumed small bowel obstruction, which settled on conservative treatment. A sixth operation to repair an incisional hernia was carried out under cover of Factor VIII eight months later, when there was no untoward bleeding.
The patient alleged negligence on the part of the Health Board and the surgeon. There were many allegations against the surgeon, including failure to carry out any, or adequate blood tests before surgery to ascertain her Factor VIII level, and failure to stop excessive internal bleeding. This in turn, it was said, had led to various complications that had required additional operations and had resulted in severe internal damage, permanent scarring to the abdomen, and psychological problems.
Experts instructed on the member's behalf felt that, given the patient's previous history of having had surgery without bleeding, the surgeon's decision to operate without preoperative coagulation tests was not negligent, though it would have been sensible to have done them. They felt, however, that:
"…the management of her haemorrhage thereafter was not satisfactory, knowing that she was a carrier for haemophilia A…"
It was noted that it was a common mistake to believe that female relatives of haemophiliacs could not be affected by the disease.
The case was settled out of court for £100,000.
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