Delay in diagnosis and treatment results in six-figure clinical negligence settlement

Our medical negligence team achieved a £325,000 out of court settlement for a 60-year-old woman (‘the Claimant’) from Betsi Cadwaladr University Health Board (“the Defendant”) in respect of a delay in diagnosis and treatment of a large peri-hepatic collection surrounding the right lobe of the liver with pockets of gas within, following a routine elective laparoscopic cholecystectomy.

Background to the case

The Claimant was under the care of the Defendant surgical team for gallstones and initially investigated in 2017. The Claimant underwent elective laparoscopic cholecystectomy surgery on 9 March 2018, which was uneventful.

She was discharged the same day but readmitted four days later with sudden worsening of abdominal pain. Despite CT imaging indicating a “large peri hepatic collection... with pockets of gas” and ongoing deterioration, the Claimant was not sent back to theatre until 30 March.

On 22 March 2018, the Claimant was presenting symptoms of sepsis and an ultrasound demonstrated substantial subhepatic fluid collection. However, it was not until 30 March that the Claimant was taken back to theatre where she underwent surgery from which “copious bile-stained fluid” was aspirated. A diagnosis of “severe biliary peritonitis with large fluid collections in separate areas” was made. She required seven more surgical interventions and spent a prolonged period in the Intensive Care Unit. She remained in ICU until 30 April and thereafter commenced physiotherapy. She was eventually discharged on 15 May 2018. The stent was finally removed on 29 May 2019.

She was reviewed again on 11 December 2018 by the treating surgeon, who noted that she had developed a large incisional hernia which was causing major discomfort. While the hernia could be fixed, there would be high risk for adhesions, chronic pain and failure, requiring compartmental separation to fix. The Claimant had been significantly affected both physically and mentally by the previous index events and was unwilling to proceed with further surgery.

Legal proceedings and expert evidence

Our medical negligence specialist Fiona Tinsley obtained expert evidence from a General Surgeon, Psychologist and Expert in Care and Occupational Therapy.

It was the Claimant’s case that no reasonably competent general surgeon would fail to undertake a return to theatre in a timely manner. In addition, when in theatre, they would have carried out a copious washout and leave drains to the site of the biliary leak. The preliminary signs of sepsis could have been adequately treated.

It was admitted by the Defendant that, following the results on 24th March 2018, the failure to undertake operative intervention constituted a breach of duty of care. But for the Defendant’s breach, the Claimant would have been treated successfully. She would have avoided admission to the ICU and a laparotomy, tracheostomy, the formation of a stoma and the consequent abdominal wall failure.

The Claimant suffered extensive injury and scarring and faces a lifetime of potential complications. Her laparotomy and a requirement for further treatment for her abdominal wall failure would have been avoided. Since discharge, she has had to wear an abdominal binder. The Claimant has suffered psychological injury as a result and is unable to undertake any significant activities of a domestic nature or return to work.

Maximum compensation

Our medical negligence team worked tirelessly with the Claimant and her family to ensure that she would receive maximum compensation for her pain, suffering, loss of amenity and past and future financial loss.

The Claimant and her daughter bravely explained how the negligence had not just impacted her physically and mentally, but how it had stolen precious time with her grandchild. Her husband had described how she used to be the “lynchpin” of the family, but now she feels like a burden. A just settlement was eventually reached which will enable the Claimant to have an enhanced quality of life.

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