B E T W E E N :
LINDA JANE DUFFY Claimant
-v-
PENNINE ACUTE HOSPITALS NHS TRUST Defendant
URETERIC DAMAGE DURING HYSTERECTOMY - SETTLEMENT
Background to the Clinical Negligence Case:
Ureter Damage by During Hysterectomy
In March 2001 the Claimant, who was then aged 47, was referred by her GP to Rochdale Infirmary with a history of heavy painful periods with inter-menstrual bleeding. Clinical examination revealed evidence of small multiple fibroids. A cervical smear test was performed and treatment options discussed. The Claimant elected to undergo hysterectomy with removal of her ovaries.
A cervical smear showed mild dyskaryosis and the Claimant underwent further investigations, including on the 1st August 2001 a hysteroscopy with curettage.
On the 27th September 2001 the Claimant underwent total abdominal hysterectomy, bilateral salpingoopherectomy and removal of vaginal cuff.
During the course of the operation, the bladder was found to be adherent to the front of the cervix and once separated was found to have been damaged. Mr. Kourah, Consultant Urological Surgeon, was called to repair the bladder. No criticism was made by the Claimant in respect of the damage to the bladder.
The Gynaecologist removed an ulcerated area with a cuff of vagina, noting in the records:-
"top of vagina mobilised and the clamps to vaginal angles and uterus and cervix removed. V shaped incision to post vagina to remove ulcerated area. Vaginal angles ligated and vault left open after achieving haemostasis with interlocking sutures".
Post-operatively, the Claimant was unwell. Renal ultrasound showed bilateral hydronephrosis and on the 1st October 2001 bilateral nephrostomy tubes were inserted to drain her kidneys. Further investigations demonstrated obstruction in the right ureter and on the 11th October 2001 the Claimant underwent further surgery where Mr. Kourah attempted to bypass the ureteric obstruction with a stent. He found a stitch on the right side of the bladder wall, involving the right ureteric orifice, which he was unable to remove. He proceeded to explore and re-implant the ureter into the bladder via an abdominal incision. He left a stent in the bladder, which was removed on the 20th December 2001.
The Claimant remained in hospital for 3 weeks longer than would have been the case but for the ureteric damage. She made a slow recovery and continued to suffer from pain and aching from the operation wound made on the 11th October 2001. She developed an incisional hernia, which caused pain and discomfort, which prevented her from seeking employment or being able to resume her domestic or leisure activities in full. She underwent repair of the hernia on the 30th June 2003.
Allegations
The Claimant alleged that the operation performed on the 27th September 2001 was performed negligently. With regard to the removal of the cuff of vagina and ulcerated area, the Claimant contended that it was during this procedure that her right ureteric orifice was tied off. It was alleged that the Defendant failed to carefully identify and expose the ureters prior to removal or suturing of a vaginal cuff.
Outcome of Clinical Negligence Claim
A letter of claim under the clinical negligence pre-action protocol was submitted to the Defendant in December 2002. Eventually, the Defendant made an admission of liability in June 2003. Together with the admission, the Defendant made a Part 36 Offer to settle in the sum of £15,000.00. Eventually, following further negotiations, settlement was reached in the sum of £25,000.00.
Solicitors for the Claimant
JMW Solicitors
Manchester
Counsel for the Claimant
Sally Hatfield
Peel Court Chambers
Manchester
Solicitors for the Defendant
Hempsons
Manchester
Case Report Submitted By
Eddie Jones
Solicitor for the Claimant
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