Care and Treatment During the Procedure
12. Before we decide if we should carry out a detailed investigation into a complaint, we look at if there are signs the organisation has got something wrong. We do this by comparing what should have happened with what happened.
13. Mrs A has explained that before the procedure she was shocked to be told by a nurse that she ‘was in for a surprise’. She said she entered the operating theatre to eight people, who introduced themselves in an informal way. Mrs A has explained how she believes this was unprofessional. Mrs A says her regular surgeon did not perform the surgery and instead the other doctor did.
14. Mrs A says the Trust did the procedure under local anaesthetic when it usually used general anaesthetic for her.
15. Mrs A says when paramedics took her to hospital on 24 June, they told her they were concerned that she might have internal damage and would log this accordingly. Mrs A was then admitted to Mid Cheshire Hospitals NHS Foundation Trust. We are sorry to hear Mrs A had to go back to hospital. We recognise that was a distressing and painful experience for her.
16. The Trust said, in its response to her complaint, that Mrs A’s regular surgeon completed the procedure.
17. We discussed this case with our adviser. They helped us understand what guidance is relevant to the case. The WHO Surgical Safety Checklist was developed after extensive consultation, aiming to decrease errors and adverse events and increase teamwork and communication in surgery. The 19 item checklist has gone on to show significant reduction in both morbidity and mortality and is now used by a majority of surgical providers around the world.
18. The checklist includes steps organisations should take when carrying out surgery. Those include confirming consent, providing infection preventing antibiotics, checking anaesthesia, and checking equipment.
19. For surgeons to be familiar with the WHO checklist it is included in the RSC’s Good Surgical Practice. That provides general guidelines relevant for all surgery care. It says surgeons should: • ‘Carry out surgical procedures in a timely, safe, and competent manner • recognise and work within the limits of your competence • keep an accurate and accessible record of all your surgical activity wherever this takes place, including outcomes and complications’.
20. The medical records do not show that a different doctor was present during this procedure. The operation note says Mrs A’s regular surgeon, and their fellow, were present for the procedure. Mrs A’s account and the Trust’s complaint response are different. We understand Mrs A does not have further evidence from the time supporting that another doctor carried out the procedure.
21. We do not discount Mrs A’s recollection. However, when someone complains to us about events which are disputed by the other party, our role is to gather evidence and reach a view about what is more likely to have happened. The available evidence here includes the medical records the Trust completed at the time. Having weighed up the evidence available, it supports the Trust’s account. For this reason, we consider it is more likely than not the regular surgeon carried out the procedure.
22. The person who completed Mrs A’s procedure therefore seemed to be acting within the limits of their competence and so working in line with the guidance.
23. The Trust completed the procedure under local anaesthetic. Our adviser said this procedure can be completed safely this way. The adviser also said there is no evidence or guidance to say that the procedure must be done under general anaesthetic for patients over a certain age.
24. We understand the procedure may involve a certain amount of discomfort and it is important that informed consent is obtained and to fully explain to the procedure. There is evidence in the records the Trust did this and recorded it before the procedure started.
25. Mrs A’s records have a completed WHO checklist including the antibiotics, anaesthetic, and checks on equipment and anaesthesia. This evidence indicates the Trust provided those essential elements of the care.
26. Mrs A collapsed on her return home following the procedure, an ambulance was called, and she was transported to Mid Cheshire Hospitals NHS Foundation Trust. We have reviewed the records of that attendance to hospital. Despite the Trust giving antibiotics before the procedure, records from Mid Cheshire Hospitals NHS Foundation Trust indicate Mrs A developed a urine infection.
27. Mid Cheshire Hospitals NHS Foundation Trust treated Mrs A’s urine infection with a course of oral antibiotics. We recognise Mrs A’s recollection that the ambulance staff said to her she might have internal damage. There is no evidence of that in the ambulance records. As we have mentioned, the records from the hospital indicate Mrs A had a urine infection.
28. Our adviser told us the dose of antibiotics the Trust gave before the procedure would have reduced the chance of developing a post-procedure infection. However, antibiotics do not guarantee a patient will not get an infection later. This is supported by the research from the American Urological Association which says the antibiotics are intended to decrease the risk of infection. The antibiotics cannot always fully prevent infection.
29. We have carefully reviewed the records and discussed the case with our adviser. We have seen no record of any irregularities during the procedure. We have seen in the records there is full documentation of the patient’s journey covering pre-operative documentation, operative documentation, and post operative documentation. There is also no record of Mrs A being in distress during the procedure.
30. The evidence indicates the Trust acted in line with the relevant guidance from the WHO and RSC. It seems the Trust’s regular surgeon completed the procedure. RSC guidance requires the Trust to keep a record of any complications, but there are no records for this case. The records from the procedure suggest the Trust carried out the necessary steps required in guidance to provide safe and competent surgery.
31. We have carefully considered all the evidence for what happened against what should have happened, and it indicates the Trust completed the procedure as it should have. It indicates Mrs A developed a urine infection following the surgery but there are not indications this was because of a failing. There are also no indications Mrs A had any other complications from the surgery that could indicate a failing.
32. Based on this, we have not seen indications of failing. We will not consider this complaint further for that reason.
33. It is clear from our telephone discussions with Mrs A and from her complaint form, that this experience was very traumatic. We understand she felt the need to change surgeon for future procedures following her visit to the Trust. We hope Mrs A receives care she is happy with and has a good experience in future.