Biopsy
12. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not seen any indication that something has gone wrong.
13. Mrs H complains in 2016 she was experiencing breathing difficulties and had a biopsy on her right lung, during the procedure the surgeon damaged her lung.
14. According to the BTS Guidelines, a biopsy is indicated to obtain a tissue diagnosis and establish the most appropriate treatment.
15. Our adviser said Mrs H presented with bilateral lung nodules. Lung nodules may be related to cancer in other areas of the body or to lung infection. Nodules are lumps or abnormal growths which can develop on various parts of the body.
16. From the records, we can see a nodule was present in Mrs H’s 2016 appointment. This nodule was not present in a scan completed in 2010.
17. Our adviser said this may be an indication of malignant process (development and behaviour of cancerous tumours) in the lung. Mrs H’s ongoing breathing symptoms were a concern for underlying lung issues.
18. We can see from the records the Trust saw Mrs H in the thoracic surgery clinic at the beginning of 2016. The radiological finding of the nodule and surgery were explained to Mrs H together with the risk of complications from the surgery. The Trust performed a lung biopsy via keyhole surgery. Keyhole surgery is minimally invasive surgery which involves performing surgical procedures through small incisions on a patient’s body.
19. Mrs H’s surgery was performed in line with BTS Guidelines, which support the use of keyhole surgery and to perform a wedge resection for lung nodules. A wedge resection of the lung is a surgical procedure to remove a small triangular section of the lung tissue.
20. We confirmed with the adviser from Mrs H’s operation notes, it appears there were no intraoperative complications. Our adviser confirmed there is no indication of damage caused to Mrs H’s lung during the surgery. There is also no evidence of bleeding or any injury caused to her lung.
21. Our adviser commented Mrs H’s long term breathing symptoms are potentially related to her underlying lung conditions - histoplasmosis and bronchiectasis. Histoplasmosis is a fungal infection, usually of the lung. Bronchiectasis is a lung condition characterised by dilated airways, which causes a recurrent cough, an excess of phlegm, and frequent chest infections.
22. After the surgery, we can see from the records Mrs H developed a temperature. Mrs H’s drain was removed after her surgery, and her chest X-ray showed a fully expanded lung. Mrs H’s temperature settled with IV antibiotics with improvement of her symptoms. Mrs H was switched to oral antibiotics. Our adviser said lung infections after lung surgery can occur in up to 20% of patients. The postoperative images did not show any effusion (accumulation of fluid) around the lung or any new area of scar tissue.
23. The Trust’s decision to perform a surgical biopsy appears to be in line with the BTS Guidelines. This was because Mrs H had lung nodules, and breathing symptoms which were concerning for cancer or ongoing infection. The surgery itself was conducted by a senior consultant with no issues or intraoperative complications.
24. We acknowledge how difficult Mrs H’s ongoing breathing difficulties are for her, and that there appears to have been some confusion around the cause of her ongoing symptoms. We have seen no indication of a failing in how the Trust performed the lung biopsy. We hope Mrs H will be reassured by our explanation here.
Inaccurate information
25. Mrs H complains the Trust provided inaccurate information in its response letter about who completed the surgery. We acknowledge Mrs H believes the Trust has lied about who did the operation. She has raised specific concerns about two documents – the ‘Operating Theatre Patient Profile’ and the ‘Pre-operative Checklist’.
26. We have considered the documents she has referred to as evidence someone else completed the surgery, along with the rest of her medical records for this period. We can see Pre-operative Checklist were completed for the day before and the day the surgery took place. (It appears from the records that the Trust planned to undertake the operation, but it had to delay this by a day due to resource issues.)
27. The checklist notes it can be signed by the Consultant, or a nominated deputy who would be present during the operation. We therefore have no concerns that the person who signed this was not the named consultant.
28. The ‘Operating Theatre Patient Profile’ contains the name of the assistant during the surgery. It seems they have left a space blank for the main surgeon to sign but this was left uncompleted.
29. We have also seen the operation notes contained in Mrs H’s records for the day her surgery went ahead. This clearly indicates which surgeon completed her surgery. The named consultant is the person who completed the operation and is the surgeon Mrs H expected.
30. We are not persuaded by the documents Mrs H referred to show the Trust lied about who did the surgery. We do believe this led to some confusion, and we can understand why Mrs H is worried about this.
31. We do not want to dismiss how Mrs H is feeling. We understand Mrs H has experienced a long difficult period in relation to her lung problems. We acknowledge how upsetting it was to not clearly understand who may have performed her surgery.
32. The Trust appears to have acted in line with relevant guidance in relation to the lung biopsy and we have not seen any indication it caused damage to her lung during the procedure. It has also documented who completed her surgery in the medical records, and we have seen no indication it lied about this.
33. As we have seen no indication something has gone wrong, we will not consider the complaint further. We hope we have explained our decision clearly.