A Remedy For An Operation Gone Wrong… written by Marina Nkondi, Paralegal, Clinical Negligence

A Remedy For An Operation Gone Wrong…

When undergoing an operation, the expectation is that you have been placed in the hands of professionals and there is an implied expectation that the operation will be performed successfully. Where that expectation is not met, there may be a legal remedy to help you deal with the consequences of an operation which may have been performed negligently as in the below case.

The Claimant had been complaining of pain in the left leg for the previous two days having sustained lacerations. On 27th September 2012 she attended the Defendant hospital due to a possible collapse, rash and left lower limb injury. Following examination, an orthopaedic review and an x-ray, the suspected diagnosis was a slipped upper femoral epiphysis ('SUFE').

The Claimant was admitted unable to fully weight bear and with mild pyrexia. The Claimant was consented for surgery to insert cannulated screws into the left hip for a SUFE. After the surgery the Claimant attended follow up appointments and could fully weight bear by January 2013.

By March 2013 the Claimant was experiencing increasing pain on walking and x-ray revealed avascular necrosis around the tip of the screw. Further surgery took place on 29th March 2013 to back up the screw however the screw extractor tip broke off inside the screw and in order to retrieve it the surgery was converted from keyhole to open via an anterior hip incision and the head of the screw removed to be replaced by a cannulated screw and washer.

By May 2013 the Claimant's avascular necrosis was causing concern, with a degree of collapse of the femoral head. However, this did not deteriorate further and by the end of 2013 the Claimant was encouraged to put a little weight through the left lower limb. By January 2014, the Claimant was experiencing pain in the right groin and, following investigations, the Claimant was admitted to Birmingham Children's Hospital on 8th January 2014 for an in situ fixation of right Grade I SUFE.

Whilst both hips were checked, by April 2014 the Claimant had developed pain in the left ankle and right groin along with the left knee by September 2014. In October 2014 the Claimant was again admitted to Birmingham Children's Hospital and discharged after 5 days.

The Claimant was reviewed in November 2014 when she was partially weight bearing with crutches and by January 2015 the plan was for full weight bearing to commence with physiotherapy and ongoing review.

Against this background instructions were obtained to represent the Claimant for a claim for damages. Initial investigations were undertaken, the Claimant's medical records were sought for review and a Breach of Duty and Causation Report was prepared by a Consultant Orthopaedic Surgeon. The report concluded that the screw was too long and resulted in the Claimant requiring a more complicated operation to shorten the screw.

In November 2015 the Letter of Claim was sent to the Defendant. A Letter of Response was sent on behalf of the Defendant in March 2016 admitting certain elements of breach of duty and that the failure to act upon or discuss the substandard positioning of the screw resulted in the Claimant developing avascular necrosis. However, they denied breach with respect to the length of the screw, the use of unnecessary force in the use of the reverse threaded tool and/or whether the tool was fit for purpose and that the approach to remove the screw was substandard.

The Defendant also denied that excessive force resulted in an unnecessary open procedure and that therefore causation insofar as a lengthened recovery period and scarring were denied.

A Condition & Prognosis Report prepared by the Orthopaedic Consultant confirmed that the Claimant developed a left slipped upper femoral epiphysis and a segmental area of avascular necrosis of the left femoral hip causing the Claimant to suffer from a significant loss of mobility requiring care and assistance, which would not improve without a total hip replacement likely within the next 10-15 years and that the Claimant's hip would degenerate at a much earlier age than normal.

The Claimant's symptoms would be alleviated following the hip replacement but that the replacement would not last for more than 15-20 years before a further hip replacement would be required and therefore the Claimant would be restricted on the open labour market as a result of her symptoms.

The expert referred to the opinion of a Plastic surgeon and a Psychiatrist to comment on the Claimant’s scars in her left hip and on the Claimant's psychological symptoms.

A medical report was prepared by a Consultant Plastic Surgeon noted that the Claimant reported both altered sensation and discomfort with her scarring which was unlikely to significantly alter. The expert confirmed that whilst the Claimant could benefit from training to apply camouflage make-up, revision surgery for the Claimant's scarring may not improve matters and should not be undertaken prior to her intended hip replacement surgery.

The Consultant Psychiatrist confirmed that the Claimant fulfilled the criteria for an Adjustment Disorder with a Mixed Anxiety and Depressive Reaction. Intermittently the Claimant's low mood would be consistent with a moderate Depressive Episode, the moods were largely due to her physical state.

The Claimant also suffered from some Post-Traumatic Stress Disorder symptoms and Obsessive-Compulsive Disorder symptoms which could be seen as part of the Adjustment Disorder. The recommendation was for Cognitive Behavioural Therapy which would allow a full recovery within 12 months from the date of commencement followed by a re-examination in 12 to 24 months as recommended.

An Occupational Therapist and Care Consultant prepared a care report outlining the Claimant's care needs, recommendations and costings. A report was prepared by an Educational Psychologist which confirmed that the Claimant had missed a great deal of school on account of her need for clinical intervention, her physical difficulty and associated psychological problems and that the Claimant could have achieved better GCSE results had her education not been interrupted as a result of the alleged negligence and the Claimant’s intended career had been delayed by at least 1 year.

The Orthopaedic Consultant prepared an addendum report outlining the risks associated with hip replacement surgery and concluded that the Claimant would require a left total hip replacement and possibly sooner than previously anticipated as the previous attempts to alleviate the Claimant's symptoms had not been successful.

Further comments were provided by the Orthopaedic Consultant clarifying the position with respect to both physiotherapy, pre and post hip replacement, and orthotics.

Subsequently an Orthotic report concluded that orthotic treatment would be appropriate, and that the Claimant required an external shoe raise with a total annual cost being £520.00. The expert noted that whole life costs could not be provided in light of the hip surgery required in the future.

In November 2022 the Defendant's counter schedule and expert evidence, including evidence from a Consultant Orthopaedic Surgeon, and Care Expert, were disclosed.

Supplementary reports were prepared, and it was necessary to instruct Counsel to finalise the Schedule of Loss.

Following a further medical report received from the Psychiatrist who confirmed that the Claimant's symptoms remained ongoing and that she met the criteria of a Mixed Anxiety and Depressive Disorder. The expert noted that the Claimant's psychological prognosis should run parallel with her physical symptoms and limitations, a further assessment after the Claimant's hip replacement surgery was recommended.

In January 2023 the Claimant's updated Schedule of Loss and additional evidence was disclosed to the Defendant.

Following a Joint Settlement Meeting between the parties in February 2023, a settlement was agreed in the net sum of £391,000.00.