Cervical Cancer - Negligent treatment - Death

GK

(Widower of the deceased CK)

and

PENNINE ACUTE HOSPITALS NHS TRUST

Background to the Claim

29 year old C first consulted her GP with irregular periods in 1983. Over the following 10 years she had 3 cervical smears, all of which were reported as negative.

C's periods became progressively heavier and more painful and in November 1993 her GP referred her to a consultant gynaecologist (Mr B). A cervical smear taken at this time showed mild squamous dyskaryosis with inflammatory and wart virus changes.

(This smear was re-examined for the purposes of this claim and found to exhibit numerous squamous cells showing mild dyskaryosis suggestive of CIN1 and some changes due to the human papillo virus).

In January 1994 C was examined by Mr B and found to have a bulky uterus with cervicitis. A smear taken at this time was reported as negative (This smear is not available for examination) Shortly afterwards she had a dilatation and curettage (D&C)

In March 1995 C was referred back to Mr B with persistent menorrhagia. After discussion she elected to have a sub total abdominal hysterectomy, but she subsequently changed her mind as she was moving house and her husband was unwell.

C managed to cope with the heavy periods until October 1998 when she started to get bleeding after intercourse. She consulted her GP and a further smear was taken. This was inadequate so a repeat smear was done in December 1998 and reported as normal.

(This smear was also re-examined and found to contain epithelial cells that appeared normal at screening magnification but at higher magnification a very few squamous cells showed borderline nuclear changes similar to the previous smear.)

In July 2002 C presented to her GP with a history of continuous vaginal bleeding for the previous 6 weeks. A high vaginal swab was taken, which grew group B haemolytic streptococcus. Appropriate antibiotics were prescribed.

A smear was taken shortly afterwards, which was reported as showing no dyskaryotic cells.

Because C had had 3 normal smears since the abnormal one of 1993 she was returned to routine 3 yearly recalls.

(This smear has also been re-examined and found to contain numerous severely dyskaryotic cells in a heavily blood stained sample. These changes are suggestive of CIN3 but invasive squamous carcinoma cannot be excluded)

C's symptoms continued and she became more and more concerned. She requested a referral and in October 2002 was seen by the gynaecologist, Mr A, who noted a bulky uterus but made no mention of the cervix. An ultrasound scan confirmed a fibroid uterus.

In January 2003 C underwent a procedure for hysteroscopy, endometrial biopsy and insertion of a Mirena coil. The histology report on the biopsy showed CIN3 and possible invasive cancer.

A cone biopsy undertaken shortly afterwards confirmed a poorly differentiated invasive carcinoma of the cervix exceeding a stage 1A tumour. (i.e. less than 7mm in width and invading the cervical tissue by 3-5 mm.)

C was then referred to a specialist in Manchester (Prof K) for further surgery. A radical hysterectomy was proposed, but on examination under anaesthetic prior to the procedure it was realised that the cancer was more extensive that had been suggested by the previous histology report and it was decided that radical chemotherapy and radiotherapy were the more appropriate treatments.

Histolgy on the uterus showed invasive, well differentiated squamous cell carcinoma within the ishthmus with focal lymphatic invasion of the left parametrium.

C underwent the treatment as planned but 18 months later (July 2004) an MRI scan showed a small recurrence in the left pelvic area. By July 2005 her condition was considered to be terminal but, in view of her increasing pain and disability, she received palliative chemotherapy until the following November.

Unfortunately, an MRI scan in December 2005 showed further progression of the tumour and C died on 9 June 2006. She was 51 years old.

Case for the Claimant

Initial investigations were commenced whilst C was alive but sadly she died whilst medical evidence was in the process of being obtained. Following C's death, the claim was pursued by her husband, G. Once the evidence was finalised it was claimed that the Trust was negligent in failing to arrange via the GP appropriate follow up smears after the abnormal smear of November 1993. They failed to follow the NHS guidelines then in place that advise that a woman with a mildly dyskaryotic smear must have a minimum of two consecutive normal smears 6 months apart before being returned to routine screening recall.

One follow up smear was undertaken in January 1994 and although it is not available for re-review the opinion of the claimant's team of experts was that the reported normal result may well have been correct. However, had a second follow up smear been done in/ around July 1994, as it should have been, it is G's claim that it is highly likely (given the events that followed) that this smear would have shown early abnormal changes and C would have been referred for further investigation and treatment, which would on balance have been successful and in those circumstances the deceased would have had a normal life expectancy .

It is also alleged that the Trust failed to correctly report the grossly abnormal smear of July 2002, negligently reporting it as normal. It is the claimant's case that had this smear been correctly reported C would have been referred for treatment four months earlier than in fact happened. She would have had a radical hysterectomy and quite probably would not have had to undergo radiotherapy and chemotherapy treatment.

C reacted to the chemotherapy quite badly and described the internal radiotherapy treatment as a horrendous experience. She developed radiation fibrosis and as a result suffered frequent bouts of urinary tract infections. Sexual intercourse became painful and difficult, if not impossible, and this put a lot of strain on her marriage. Not surprisingly she also became quite severely depressed.

With prompt referral in either 1994 or 2002 C would, on the balance of probabilities, have received effective treatment for her cervical cancer. She would have had a normal life expectancy, and her husband would not have suffered bereavement.

Case for the Defendant

Both breach of duty and causation were initially denied by the defendant . The basis for this was that the November 1993 smear had been taken by the GP and the gynaecologists at the trust had not been informed of the abnormal result, and that the July 2002 slide contained so few abnormal cells (45) that they could easily have been missed.

Court Proceedings

Court proceedings were issued following which a full admission of breach of duty and causation was made by the defendant. Following exchange of witness statements, a negotiated settlement in the sum of £175,000 was reached of which £5,000 was awarded to the claimant for the loss of the companionship, love and support of his partner. A letter of apology was also sent to C's husband by the Trust.