IE v St Helens and Knowsley Teaching Hospitals NHS Trust
Hydrothermal endometrial ablation is a procedure which destroys the lining of the uterus using heated fluid.
Facts of the case
Our client attended the Trusts gynaecology clinic for review. She had heavy periods and pelvic pain during menstruation. She was on thyroxine and had no significant medical history. The original plan was medical treatment with subsequent options being the mirena intrauterine system and ablation.
A mirena IUS coil was inserted. This was removed because of constant heavy bleeding and an endometrial biopsy was performed. She was given cyclic norethisterone together with mefenamic acid for 6 months.
She was reviewed again and it was noted that the IUS had been removed. The return of symptoms led the Consultant to suspect endometriosis and he arranged for a laparoscopy and a D & C. Sterilisation was requested at the same time.
Laparoscopic tubal occlusion and D & C was carried out and the pelvis appeared normal.
The Consultant then recommended endometrial ablation.
Our client was admitted for hydrothermal endometrial ablation (HTA). Consent was obtained and general anaesthesia was given.
The procedure was described in the operation notes. Examination of the pelvis was normal and the cervix was sound before dilation to 6mm. A small endocervical polyp was avulsed and the curettage was performed. Hydrothermal ablation was undertaken using normal saline. A follow up was arranged for 6 months. Nothing untoward was reported to have occurred during the procedure.
Recovery was reported as uneventful and discharge home the same day was anticipated. Antibiotics were prescribed.
When our client awoke from the procedure she was however suffering from pain and discomfort in her vaginal area.
Prior to discharge she became concerned because when she was passing urine it was very painful as if something was either torn or burnt.
Prior to discharge she asked a nurse to examine her. She explained that she did not feel right and was in a lot of pain when she passed urine.
The nurse explained that it was not necessary to examine her and that it would simply be the trauma of the operation and that it would settle down. Consequently she was discharged home.
That night our client noticed a burn passing her vagina on to her buttocks. There was a bruise above the pubic area about the size of a large orange
She had an extremely restless night and re-attended hospital the following morning.
An internal examination was undertaken which was very painful. Our client queried how she could have suffered a bruise on her stomach and was advised that it was from an injection given to her. Her concerns were dismissed.
The doctor advised her that if she had been in pain following the procedure she should have asked to be examined before she was discharged. Our client explained that she did indeed ask to be examined but the request had been refused.
She was discharged home again and spent a terrible weekend in pain, especially when she tried to sit, walk or go to the toilet.
She attended the hospital again but her concerns were dismissed although she was prescribed flamazine cream and antibiotics.
She then attended her GP complaining of burns to the external genitalia.
Upon meeting the clinical director at the hospital it was eventually accepted that she had sustained some burns and damage during the procedure. This was however put down to a risk of the procedure because of a combination of “mechanical pressure from the speculum, heat from the hysteroscope and some warm water exuding from the hysteroscope as it was withdrawn at the end of the operation”.
We were instructed by our client. Following investigation and in particular a painstaking review of relevant literature and guidelines concerning ablation a Letter of Claim was sent to the Trust.
This in summary alleged that our Client suffered a perineal burn extending from the back of the vagina down the perineum and to one side of the buttock crease. This must have been caused either by heat transferred by a metal speculum, contact with the procedure sheath or as a consequence of scalding from leakage of the heated fluid.
It was highlighted that the guidelines for the Geneysys HTA pro-Cerva specifically warn that:
“leakage of heated fluid can cause serious burns or injury to the tissue contacted including tissue in or around the cervix, vagina, perineum etc. Failure to follow instructions or to heed any warnings or cautions could result in serious patient or user injury”
In regards to our client’s injury it was alleged that as consequence of the negligently performed procedure she suffered a thermal burn which was not identified at the time.
Liability was admitted by the Trust but our client was put to proof in regards to the extent of her injuries.
We instructed an independent plastic surgeon specialising in burns to examine our client and prepare a report dealing with the short term and long-term consequences arising from the thermal burn.
In the experts medical evidence he confirmed that following the ablation procedure our client suffered a severe burn and was eventually offered surgery to remove the skin which had been thinned as a result of the burn.
We additionally obtained independent psychiatric evidence. Our client described losing trust in doctors, feeling intimidated and angry and upset that she had felt driven to have to take legal action when she would have preferred the hospital to simply have acknowledged their mistake rather than dismiss her complaints of injury and then describe the incident as a recognised risk of the procedure. Our client was left to feel that she was not being believed which was very distressing for her. She felt intimidated.
In the independent expert’s opinion the consequences of the ablation procedure and the way in which the hospital treated her exacerbated an underlying psychiatric vulnerability.
After investigation of the impact of the negligently performed ablation procedure a Schedule of Loss was drafted and disclosed to the Defendant together with medical evidence in support.
Following negotiation between the Parties damages were agreed in the sum of approximately £30,000, plus payment of our client’s costs.