The risks of the procedure, including the possibility of ureteric damage, were explained and the abdominal hysterectomy was carried out without complications.
The scene
A week later, the patient complained of being unwell with right renal angle pain. An ultrasound showed right hydronephrosis and an IVU indicated obstruction of the distal ureter. The patient underwent another operation, by a consultant urologist, in which the right ureter was re-implanted. A post-operative cystogram showed complete drainage of the contrast with no evidence of leaks. A J stent was left in place for six weeks.
Six weeks later the patient was admitted with acute abdominal pain. The stent was removed and the pain improved, but she required four further corrective procedures.
The patient brought a claim alleging that the consultant gynaecologist had carried out the initial surgery negligently and, as a result of the negligence, her ureter was damaged. She also alleged that she suffered severe permanent psychological and urological sequelae.
Expert opinion
An independent gynaecologist considered the case and was critical of the patient’s management. It was the expert’s view that, in the presence of second degree prolapse, a vaginal hysterectomy was indicated. He also expressed the opinion that ureteric damage should not occur in this type of case.
The MDU gynaecologist accepted the expert’s view and agreed with the contention that the hysterectomy was uncomplicated and straightforward, there were no visibility issues due to bleeding or difficulty of access and therefore the damage should not have occurred. Examining the patient, the expert observed that she had made a full recovery from the surgery and there was nothing to suggest that she had ongoing problems from the ureteric injury. The patient had complained of urinary urgency and stress incontinence and the expert advised that these were related to the birth of her six children and not to the surgery or the ureteric damage.
Outcome
The claim was settled for a moderate sum in respect of the further procedures the patient had to undergo, along with an award for pain and suffering.
In cases where liability is established, condition and prognosis also need investigation to ensure that the level of damages being sought is appropriate. In this case, the patient alleged that she had severe permanent sequelae. The expert evidence did not substantiate this and therefore the compensation awarded was less than originally claimed.
This page was correct at publication on 29/11/2012. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.