County Durham and Darlington NHS Foundation Trust

4. Mrs E complains her surgeon did not warn her she might experience a permanent loss of sensation following a hysterectomy carried out on 18 August 2020.

5. She says she lost the feeling in her upper left thigh and groin following surgery and these symptoms have affected her ability to work and her relationship with her husband. She says that being unprepared for this happening has made it more difficult to cope with.

6. By bringing her concerns to us Mrs E would like the Trust to pay her financial compensation and learn from her experience by improving its consent process for this type of surgery.

7. On 18 August 2020, Mrs E attended the Trust to undergo a hysterectomy with bilateral salpingectomy (an operation to remove her womb, fallopian tubes and ovaries). Following surgery, she had no sensation around the surgery site, her upper left thigh and the left side of her groin. Clinicians at the Trust advised her to allow 12 months for these symptoms to resolve.

8. Mrs E returned to see the consultant in August 2021. The consultant reassured Mrs E that it can take some time for the cut nerves to regenerate, and she needed to give this a little more time. They planned to discuss her case at the local Multi-disciplinary Team (MDT) meeting. The MDT concluded Mrs E should be reviewed again in six months.

9. In March 2022, Mrs E reported no improvement in sensation. The consultant planned to discuss with his colleagues whether they had seen anything similar which could indicate a plan for further management.

10. By September, there was no change in her symptoms and so she complained to the Trust. She said she wanted to know why it had happened to her, if feeling would return to her thigh and groin, and why she was not warned it could happen.

11. Mrs E attended the clinic again the following month, reporting no difference in her symptoms. Following the clinic appointment, the surgeon arranged for Mrs E to have an MRI scan to assess for a hernia at the surgery site.

12. The Trust responded to Mrs E’s complaint before the MRI scan had been carried out. It said it had taken steps to investigate her loss of sensation however, it could not give a definitive answer as to why she had lost sensation or whether it would return. It added that she was not warned this could happen as her symptoms were very unusual. It had reviewed her consent form and considered it was acceptable as it included all the risks with a high likelihood of occurring. It said once the MRI scan had been carried out, she would have a further clinic appointment to discuss the results.

13. After the scan, the consultant told Mrs E that it did not show any treatable cause for her loss of sensation and, unfortunately, nothing further could be done.

14. Mrs E paid for a private neurologist to give her an opinion about the symptoms. They told her the symptoms were almost certainly as a result of the surgery and it was very unlikely feeling would return to the affected area.

Surgical consent

18. Mrs E told us that she was not warned that she might have a loss of sensation as a result of the surgery, and this meant she was unprepared when this happened.

19. The Trust said that Mrs E’s symptoms were very unusual and not something it routinely saw in its gynaecology post-operative patients, therefore it was not included as part of the consent process. It had reviewed the consent and found it to be of an acceptable standard. Therefore, it said, it had identified no learning or actions it needed to take as a result of her complaint.

20. Our adviser explained that the consent process begins when a patient is first seen and told that a procedure would be appropriate to treat their condition. People need time to digest the information they are given so they can make an informed decision about whether to proceed with the recommended procedure. Normally the most serious risks and the frequent risks would be documented on the consent form itself. The patient should also be informed of a number of less frequent risks in accompanying literature and verbal conversations.

21. The Trust’s policy on consent 5.2 ‘provision of information’ mirrors what our adviser said:

‘Patients and their relatives or carers, will vary in how much information they want: from those who want as much detail as possible, including details of rare risks, to those who ask health professionals to make decisions for them. There will always be an element of clinical judgement in determining what information should be given. However, the presumption must be that the patient wishes to be well informed about the risks and benefits of the various options.’

22. Our adviser explained that a surgeon who takes consent from a patient prior to carrying out a hysterectomy should follow RCOG 4. Section 4.2 lists frequent risks from the surgery which include ‘numbness, tingling or burning sensation around the scar (the woman should be reassured that this is usually self-limiting but warned that it could take weeks or months to resolve)’. A self-limiting condition is one which resolves itself without treatment.

23. We reviewed Mrs E’s consent form and the accompanying leaflet ‘OG01 Abdominal Hysterectomy’. Neither document mentioned any risk of numbness, as the Trust confirmed in its response to Mrs E’s complaint. This is not in line with either RCOG 4 or the Trust’s policy on consent. This falls so far short of what should have happened that it amounts to a failing, although we think this is limited to mentioning that the area around the scar would be affected. We went on to consider whether there was any impact on Mrs E.

24. Mrs E said that, although she would still have gone ahead with the surgery, she was unable to mentally prepare for the loss of sensation she experienced afterward, however rare this occurrence may be. She told her consultant that the symptoms had made it difficult to be intimate with her partner. She said it also impacted on her mental health. Clearly knowing this might happen would not have changed the outcome, but Mrs E could have been better prepared for the symptoms she experienced if she had known there was a chance of it happening.

25. We think that if the consent process had included the frequent risks documented in RCOG 4, she would been told she might experience numbness around the scar which would likely resolve itself. Mrs E did go on to experience numbness around the scar. Unfortunately, she also experienced numbness in the left side of her groin and upper thigh, which appear to be the symptoms which she had most difficulty with. Mrs E’s case appears to be unusual in that the numbness did not resolve and RCOG does not consider loss of sensation in the groin or thigh a frequent risk – in fact, the Trust said that its clinicians had not seen a case like this before.

26. We found that Mrs E might have been prepared for the possibility of a loss of sensation following her operation, but not that she would have been prepared to be affected to the extent she was. Nonetheless, she would have been somewhat better prepared for this unfortunate outcome. This is likely to have caused a degree of distress to Mrs E. We therefore considered what the Trust should do to put that right.

1. We found that the surgeon should have told Mrs E that having a hysterectomy could lead to a loss of sensation in the area of the operation as part of the consent process, even if that risk was rare. Not doing so meant she lost the opportunity to prepare for some of her symptoms, but not all of them, and therefore we partly uphold her complaint.

2. We have recommended the Trust improves its consent process for hysterectomy so that patients are prepared for this eventuality. We have also recommended the Trust pays her £100 to put right the impact being unprepared had on her.

3. We were sorry to learn about the unfortunate symptoms Mrs E experienced after her surgery and the significant impact these had on her life. We hope that Mrs E is reassured that the Trust is taking our findings seriously.

27. In considering our recommendations, we have referred to our Principles for Remedy. These state that where poor service has led to injustice or hardship, the organisation responsible should take steps to put things right.

28. The Trust did not consider that anything had gone wrong with the consent process or identify any learning. Therefore it has not yet put things right for Mrs E or learned from her complaint in line with our Principles.

29. Our Principles say that public organisations should look for continuous improvement, and should use the lessons learnt from complaints to make sure they do not repeat poor service. In line with this, we recommend that within three months of this report the Trust reviews its consent process and/or accompanying literature for patients undergoing hysterectomy to ensure it is in line with RCOG 4. We were pleased to hear that the Trust has already begun this review following us sharing our provisional views. We think that this will mean that future hysterectomy patients are less likely to be unprepared for some of the symptoms Mrs E experienced should they be unfortunate enough to experience them.

30. Our Principles state that public organisations should put things right and, if possible, return the person affected to the position they would have been in if the poor service had not occurred. If that is not possible, they should compensate them appropriately.

31. To decide on a level of financial remedy, we review similar cases where the person has experienced similar injustice, along with our severity of injustice scale. Following this review, we have decided the Trust should pay Mrs E £100 within one month of this report in recognition of any distress caused by the loss of opportunity to prepare for the symptoms she experienced around her scar.