Local anaesthetic toxicity via epidural during c-section - do I have a valid medical negligence claim?

[minimooo]

I had a bit of a scary labour/birth with dd 11 weeks ago and wondered if anyone could shed any light on whether I might have a valid medical negligence claim? Has anyone come across this situation before?

I was in latent phase of labour for 4 days. Was having strong contractions every 1 - 5ish minutes for the whole time, but only got to 2cm dilated. MLU kept telling me to stay at home but on the fourth day, because it had been going on for so long, they eventually said I could go to the labour ward to be assessed.

Labour ward assessed me and discovered that my hindwaters had broken. Because I thought they had gone more than 24 hours previously they said that I needed to be induced asap. I said that I wanted an epidural before the induction process was started and they agreed.

So, I had the epidural put in and induction was started. I was a bit concerned that one side of my body felt more numb than the other and dh said that one of my pupils was more dilated than the other. We asked the anaesthetist to check but she said she thought it was all normal.

Induction started off well, but after a while my contractions started getting really erratic. They would up the drip and my uterus would go crazy contracting all over the place uncontrollably, so they’d reduce the drip and my contractions would tail off. They kept the drip going though and we finally got to 10cm dilated and they started me pushing. After about 20 minutes or so, I was examined and told that actually I still had a lip of cervix that was in the way of baby’s head. They tried to hook it over her head while I was pushing but she was well and truly stuck. By now baby was getting distressed so I was rushed to theatre for either forceps or emcs.

Surgeon said forceps would be too dangerous because of the risk of cervical prolapse, so I had to go for emcs. No problem. I gave consent and was prepped very quickly. They injected the spinal block into my epidural thingy in my back. However, within a few seconds I started to feel my face going numb. Then my eyes and, scarily, my throat. I was finding it hard to breathe. I told the midwife, who told the anaesthetist, and everyone started panicking.

It turns out that the spinal block anaesthetic had leaked into my bloodstream. They kept telling me to keep talking to them and to definitely not go to sleep. They told me that they had to get a reversal drug into me quickly. I heard dd's first cries as she was lifted out and I saw dh go over to where they were weighing her.

Meanwhile the reversal drug was being pumped in which meant that the anaesthetic was wearing off and I could feel the cesarean procedure being carried out. At that point they discovered that my uterus wouldn't contract and they couldn't get it back into me and stitch it up. It felt like it was taking forever, and the anaesthetic was really wearing off. The pain became unbearable and I told them screamed that I couldn't cope with it, so they put me under general anaesthetic. I lost 2 litres of blood while they wrestled my uterus back in.

Next thing I know I was having hallucinations that I was in the jungle. I finally woke up about 12 or so hours after the emcs and hadn’t the faintest idea why I was in hospital. I remember asking dh if I had been in a car accident.

After he and the nurses filled me in on some of the details, I got to hold dd for the first time and start breastfeeding. They told me that during the first 24 hours after the procedure I was at high risk of heart failure. I also later found out that while I was unconscious I had been in very real danger of slipping into a coma. Dh told me that the whole time I was unconscious I had a nurse constantly checking all the machines I was hooked up to so that if I went into cardiac arrest they could act immediately.

I was kept in the high dependency/intensive care unit for 4 days while they monitored me. The anaesthetic and the reversal drug had caused havoc with my internal organs – my liver was badly affected, my bp was all over the place and my heartrate was 150bpm for about 3 days solid. I was on oxygen, iv antibiotics, fluids, iv magnesium and potassium, and I was on half hourly obs.

But it did all gradually start getting better, and they started taking me off all the machines. Eventually, I was taken to the postnatal ward, and finally discharged as an outpatient. I’ve been having regular blood tests and my liver function finally went back to normal 2 weeks ago.

The anaesthetist told me that local anaesthetic toxicity only happens to 1 in 100,000 people and that I was just the really unlucky 1 person. She said that they’d never had it happen before and it was so rare that she had her colleagues and her boss and her boss's boss all turn up to the theatre to see it all happening. She did a talk on it at the hospital a few days later and is now writing a journal article about it to further the research into it and teach other anaesthetists how to deal with it if it happens to other women again in the future.

I've asked to be sent a copy of the journal article. I've also been offered a "Birth Reflections" session to have a de-brief and the opportunity to ask questions, which I'm planning to do in a few weeks' time.

I’ve done a tiny bit of research and it seems very unusual for it to just be “bad luck” and that it most often occurs because the epidural is administered incorrectly. Of course, the hospital have told me that the epidural was administered correctly and that I must have dislodged it when I was pushing during the induction . I just don’t know what to think.

Has anyone else out there come across this situation? Is it genuinely "bad luck" or is it more likely that the epidural was administered incorrectly? Is it possible to dislodge an epidural while in the pushing stage of labour? And dislodge it to the point of it leaking into the bloodstream?

Sorry for the epic post - there’s loads I haven’t even included, but aware that this is already a majorly long story!

[peppapigonaloop]

I have no idea of the answer to your question but just wanted to say bloody hell! And we'll done for getting through what sounds like a horrendous experience and I hope you and your baby are doing ok x

[stargirl1701]

Bloody hell, OP. No advice but hugs. What an ordeal. You could send an exploratory email to a good medical negligence solicitor.

Congrats on your LO!

[MissMuffetisin]

It sounds horrendous, and how terrifying for you and your DH. The only thing I would say is what do you want to achieve from a medical negligence claim ? I used to work in liability insurance, claims can take years to settle , can bring back lots of distress and can involve invasive questioning. The reason most people give for making claims is so this won't happen to anyone else, but it does sound as if they are genuinely trying to learn lessons here. So sorry this was your experience at what should have been a joyful time

[minimooo]

Thanks both for replying. We are all ok now thanks. Tbh both myself and dh are suffering with PTSD, but as the weeks pass it gets easier. Thank goodness dd was never affected. I think it would have been massively harder to deal with if she had been affected any of it.

I think sending an email to a solicitor is a good call star, and that is definitely on the cards. I might wait until after I've read the journal article and had the Birth Reflections meeting, so that I'm armed with more info.

[3sadmice]

This sounds like a terrifying experience for you.

I would also advice caution regarding the medical negligence claim. You have to prove there was negligence, which is not easy. If you are awarded compensation then the money will come the the NHS litigation authority, and ultimately from NHS trusts, meaning there is less resource for patient care. As missmuffit also said, taking legal action can often hinder recovery.

Do you feel that the hospital managed the very unfortunate event which you experienced appropriately? Have you had any treatment for your PTSD?

[minimooo]

oops, sorry missmuffet I x-posted there!

It's a good question...and the answer is that there are 2 reasons.

Firstly, I think I want some kind of investigation into what really happened. I want my questions answered and to know exactly what happened and why. I think this would help me to process the experience in my mind. But because I have so little medical knowledge I don't know if they're telling me the truth that I was just unlucky, or whether there really was some form of negligence. I don't feel like I can trust what they tell me (the cynic in me thinks they are just trying to cover their backs).

There is another side to it: If I'm really honest with myself it's also because I'm just really angry about the whole ordeal and I want some kind of justice. But I do realise that this is more to do with how I'm dealing with it emotionally. And that pursuing a claim won't make those feelings go away.

I really appreciate your comments, I hadn't really thought through the reality that extensive questioning would be involved, and that it might take a long time to come to a conclusion.

3sadmice the staff themselves were lovely throughout the experience. The anaesthetist (who was in the surgery with me - not the one who put the epidural in place) in particular was very sweet and checked up on me a couple of times while I was recovering.

One of the midwives vaguely mentioned providing some counselling but it never materialised, and me and dh were too shell-shocked at the time to chase it up.

We haven't yet had any treatment for the PTSD. Dh is contemplating going to the gp to be referred to counselling. I'm as yet undecided how to deal with mine.

[3sadmice]

Definetly see your gp regarding a referral.

CBT is very effective in treating PTSD

[rallytog1]

I'm sorry this happened to you. I had a very similar experience 2 years ago, although in my case the surgeon made an error and seriously permanently damaged some of my organs. I know exactly how you are feeling at the moment, but it is still very early days.

I half wondered about a medical negligence claim at some point but realised it wouldn't actually be in anyone's interest. Any birth like yours or mine will always be followed up by an internal clinical incident meeting, where the staff involved look at what happened and review whether any new measures need to be put into place to prevent it from happening again. So that will already be happening - lessons will be learned, even if you're not involved in that. And as a pp said, by suing an NHS trust you're effectively removing money and resources from the front line. You can make a formal complaint, which would hopefully lead to further reviews (and disciplinary action if necessary) without going down the legal route.

Second, making a legal claim is an incredibly stressful and drawn out process, during which time you'll have to re-live what happened to you over and over again. This won't be helpful to your recovery and it will be a horrible distraction from your precious time with your new baby.

I think having a birth reflections meeting will actually be incredibly helpful. You'll be able to understand why things happened the way they did and it will help you to start processing it all. You can ask for a consultant to be present. After that you'll have a better idea about what actually went wrong - some of what you've said actually sounds quite normal (although still horrible and scary) for an emergency cs. For example, it's common for your uterus not to contract back down and if you're under general anaesthetic there will generally be someone whose job it is to watch the machines like a hawk. Obviously in an emergency situation, there's no time to explain this, so having the hospital explain it all to you after the event will be helpful. I certainly felt it helped me to understand and process my feelings about what happened much better. I think also some kind of counselling or mh referral will also really help you both.

I really identify with feeling the need for justice but it really is early days and you have mountains to climb in your own physical and emotional recovery before you can really get to the nub of how this has affected you in the long term. You need to concentrate on yourself and your baby. It may not feel like it now, but I can promise you there will be days when you don't have flashbacks, there will be times when you realise you haven't thought about your birth in days, and as time moves on, you will gain the strength and peace you need to come to terms with what's happened. Then, you'll be in a better place to make decisions about what, if anything, you want to do.

[HappilyMarriedExpat]

3sadmice - the money comes from insurers, not from the NHSLA. I have no idea whether the OP's claim is valid or not, but guilt-tripping over depriving others of resources is not on. If there has been a fuck-up then the hospital should be held legally responsible.

OP I am a lawyer, but not a negligence specialist, although I have successfully sued my NHS Trust and GP personally over delayed diagnosis. As others have said, it is very difficult to prove medical negligence (despite all the "ambulance chasing" comments!) You would need to show not only that there was a breach in the clinician's duty of care to you but also causation ie that the lack of care caused specific harm/damage to you and/or your DC. It's harder than it sounds, especially where you have had a "good" outcome and are both alive and physically unharmed (although I know it doesn't feel that way!) Feel free to PM me but either way an email to a solicitor is a good place to start. Good luck.

[NewMrsX]

I have no advice but I would be looking to take it further in some way too. Good luck to you and your DH, I hope it all works out for you

[Brionius]

It's one of the things they advise you about when you request an epidural. Some hospitals give you a leaflet, others just have the anaesthetist talk to you quickly before starting. 1:100000 is a small risk but it's still a risk so they advise you beforehand. The problem is the consent is done verbally and usually when you're in pain so I'm not convinced everyone hears the risks.

[Brionius]

Sorry just to clarify: the risk that a human being may make an error is one of the risks associated with epidural. Yes you can try and check that the training was up to date etc etc but ultimately it's a dangerous and risky procedure and sometimes things go wrong, and very rarely things like this happen. The fact that the anaesthetist has been so open with you about how rare it is and how much action has been taken since is really important I think. I feel like you feel someone has to pay when ultimately having an epidural was your decision and what occurred is something that can happen. Medical negligence claim is a horrific thing to submit a doctor to: don't do it for revenge. Having said that I think it is entirely reasonable to ask the hospital if the anaesthetist has a history of this happening, if there are any other concerns about her/him and if the training is up to date, was there an issue with the unit being busy and the anaesthetist under extra pressure, was there an issue with number of hours worked, were they unduly tired etc. I don't think it's wrong to ask for a proper investigation and to set your own parameters for that, but medical negligence claims are NOT a proper investigation, they're a witch hunt for money.

[paxtecum]

HappilyMarried: The NHS does not have Insurance against negligence.

One quarter of its total budget goes in claims.
www.telegraph.co.uk/news/health/news/11402075/NHS-sets-aside-quarter-of-its-budget-for-medical-negligence-claims.html

[3sadmice]

happily married

www.nhsla.com/aboutus/Pages/Home.aspx

I'm surprised that you would contradict a claim without doing any fact checking first. The NHS self-insures against litigation.

My post was not about guilt tripping in the slightest, I was just pointing out what the op may not have been aware of. (Something which you were also apparently not aware of, despite being a lawyer, and having sued your NHS trust)

[rallytog1]

No one mentioned ambulance chasing. We're all trying to help the op think through whether taking legal action would help her and her family to recover from what's happened.

[Skiptonlass]

How utterly terrifying for you :(

I think you're understandably traumatised by this (I would be) but I'm not sure that a negligence claim is the way to go. Sometimes things happen that are vanishingly rare - just like lottery wins and lightning strikes, someone has to be that one in a million. The fact that your anaesthetist was open and is using this case as a learning point for themselves and others shows they are taking this very seriously. I work in drug research and every now and again we get one of these rare reactions - the amount of behind the scenes dissection, examination, reflection etc that goes on after a case is incredible, it's taken so seriously, as of course it should be!

Agree with brionious above that I'd want procedural investigation - did anything avoidable like staff fatigue lead to this, for example? It's good practice to have this done. That's different to perusing a negligence claim though.

I think if you, or your baby had been damaged and needed ongoing expensive care, that's when you'd seek damages - but I think here you will be better served by a very thorough debrief (when you're ready, don't rush it, do it when you feel physically stronger) and perhaps some ptsd directed therapy.

So sorry this happened to you.

[MuddyWellyNelly]

OP what a very scary experience for you. I'm glad everybody is on the mend now but do seek out whatever help you need longer term to process it all.

My gut feel as others have said here is that a medical negligence claim isn't the best all round solution, although I'm neither a lawyer nor doctor so it's not a professional opinion. I agree with the PP's who say that the hospital sound like they were genuine and are really trying to learn from it, and it was just "one of those things". However I also agree that some kind of internal review may be justified, for example as you raised your concern about the epi, should that require a second opinion (as an example, not saying that is either warranted or practical)

I did also want to share a story about someone I know who has a medical negligence claim. His wife died as a result of post-labour complications. There was pretty clear negligence (I won't discuss facts here) yet 7 years later things still aren't concluded. He decided to pursue as he knew the death could have been avoided, and wanted to ensure that someone was held accountable, but also to try to ensure it didn't happen to someone else. It's been an incredibly harrowing journey though and I'm not sure it helped him move on at all. I say this to point out how hard the process can be, both in terms of establishing proof and the impact on you. I think there are better ways for you to be able to process, understand, accept and move on. If someone made a mistake and either tried to cover it up or it was easily avoidable that's a different story; but I'm not sure that's what happened here. That's ultimately for you to decide though.

I'm glad you mentioned your DH is also looking into support; as physically hard as the whole thing was for you, it must have been utterly terrifying for him to be conscious through the whole event. You sound like a very strong family and I hope that you are all able to put this behind you soon, and enjoy life together.

[breakfastinbread]

Sorry that this happened to you.

Contact your hospitals PALS department for advice. I assume that you have done this already?

IANAL but to prove medical negligence you need to be able to prove that the healthcare professional breeched their duty of care and that you suffered avoidable harm as a result.

No one on here can tell you if that happened for certain without seeing your medical records.

In answer to your questions above, it IS possible to dislodge your epidural during any stage of labour and local anaesthetic toxicity is a medical emergency that ALL anaesthetists are taught about in their training. It is rare, but is a recognised complication whenever local anaesthetics are used, even in the correct doses.

By all means go see a solicitor if you think that is the right thing for you, but have some notion of what you want at the end of this: is it money? Better training? An apology? Closure? What happens if you don't get the outcome you want? (For example if they find there was no negligence in this case? Would you be prepared to accept that and move on?)

Good luck, I hope it all works out ok for you x

[hydrangea78]

OP, all hospitals have an obstetric anaesthetic clinic. Usually this is for antenatal patients with potential anaesthetic issues, but patients who have had anaesthetic complications are reviewed, followed up and debriefed as well.
You need to ask your midwife to refer you to the anaesthetic obstetric clinic so you can discuss everything that happened and get the facts straight. Or make sure an anaesthetist attends your birth reflections meeting.

Then decide if you would like to take this further. Liase with PALS too.
Journal articles take a while to write and even longer to publish.. you could be waiting up to a year for that.

[herethereandeverywhere]

OP I am terribly sorry that this happened to you.

Do not be swayed from your feeling that you need to take legal action in respect of your care.

The NHS only has to make payments when it admits, or is found to be negligent. That means people were harmed or died because there were failings in the standard of care. This is very serious. It means that lessons would need to be learnt and compensation paid for the error.

It is not about 'ambulance chasing'. Med neg is a highly specialised area of law, the thresholds needed to prove med neg are high and onerous. Do not be guilt-tripped into thinking that you are doing some sort of utilitarian favour to us all by not taking any action. This sort of attitude makes me furious. It is not your responsibility to save the NHS costs if you have been wronged by med neg. Legal advisers will tell you if you have a good case.

I thought about suing for damage to my baby after a forceps delivery that I was coerced into. I have not gone ahead because I cannot deal with the stress of recalling DDs birth but I am furious with the 'you're costing the NHS money' argument when the arrogance of one consultant damaged me and my baby for life.

[reallybadidea]

Fuckity fuck, I wrote a long reply and lost it.

OP this sounds deeply distressing and I don't blame you at all for being upset about it.

In terms of investigating what has happened, I can pretty much guarantee that they will have already done this. It should have been classified as a serious untoward incident and would probably have been investigated by a senior consultant, overseen by a senior manager in clinical governance (ie someone whose responsibility it is to make sure that clinical practice is safe). I would ask to see this report.

From what you've said in terms of teaching sessions, journal article etc, it sounds as though they have learned from this. Have they kept in touch with you since to offer support? Has anyone apologised for what happened? This is best practice and it would be disappointing if they haven't done this.

Nothing you've said so far screams negligence to me. Your description of it working unevenly, difficulty getting the contractions at the right level are fairly common and don't really suggest that there was a problem early on with the epidural in terms of signs of LA toxicity.

What I would be asking however is whether they have ruled out any possibility that the epidural top up was put into your IV rather than the epidural catheter by mistake. This can and does happen, I've seen it and is one of the ways in which LA toxicity can occur. They may have given the top up via a syringe with special adaptors which prevent it being given through an IV, there may be other good reasons to know that it was given via the correct route, but I would be asking the question.

I can't tell you that you're wrong to want to sue, but I think at this stage I would want to continue with the process of finding out what the investigations revealed and getting help with counselling etc before deciding to put myself through the ordeal of legal action.

Congratulations on your baby, I hope that you are still able to enjoy this time despite what happened.

[LibrariesGaveUsPower]

So sorry for what happened to you.

Just one thing as a lawyer (not negligence ) , if you want answers and discussion, legal action is the worst way to get it. Claim goes in, shutters go down, no one will say a word to you.

I am not saying don't explore it, but be aware it is unlikely to lead to diologue and answers.

Personally I would only sue if I needed the money to support long term health issues. Otherwise I'd want answers and, if appropriate, an apology.

[Sparky888]

How scary. I hope you do get to talk it through and get some cbt if it's still affecting you, the hospital might pay for it if you ask.

If there was a failure and it caused you harm (including or only psychological), you could sue. It can place extra emphasis on the event, and focus, and can help them to learn lessons sometimes. The Nhsla is essentially an insurer.

But I agree it can take a long time and be an emotional drain, so on balance you might not want to. It can feel very confrontational.

The key really is whether
1 all reasonable steps were taken, but you just suffered a rare reaction ie there was no failure or breach/negligent action. OR
2 whether a reasonable precautionary step was not taken, or the doctor actually did something incorrect/unreasonable (even if innocently or well meaning).

There is a duty if candour and if the doctor actually did something wrong they are obliged to tell you. However it's not actually always easy for them to know which it is,

I think the best way to find out is to:
meet the doctors and talk it through,
write a list of questions in advance (the CAB can help, or AVMA),
and ask for a copy of their investigation report.

If you're then not convinced, seek a lawyer who can obtain an expert report from an anaesthetist (they are not always reliable) but can give you an idea whether there was a failure or not.

[minimooo]

Thank you everyone for your comments. It's so helpful to hear everyone's opinions. Sorry for not replying sooner – it’s tricky to get onto mn with an 12-week old baby!

brionius I was given a leaflet (which I still have) before the epidural was put in which covered potential risks of having an epidural. Neither local anaesthetic toxicity nor a risk of the epidural becoming dislodged featured on the leaflet. They were not verbally communicated at any point either. Of course, human error is always a risk and I appreciate that. A witch-hunt for money has never been my intention. What I would like to get out of this situation is an investigation into what really happened. I don’t feel confident that I would get honest answers from the hospital because I feel they would try to cover their backs whatever questions I asked. That is why I am considering legal action – in order to get an independent third party to investigate.

However, reading some of the replies here (and thanks to everyone for their input on this) perhaps legal action isn’t the best way to do this. It does sound like it might be a difficult, complicated and long process and I may not get the answers I need anyway. Thank you to libraries in particular – I hadn’t thought of it that way, but of course, if I put in a claim, the hospital will put shutters down immediately which wouldn’t be helpful in the slightest.

herethereandeverywhere I really appreciate your post. I’m sorry you had a traumatic time too. I agree with you that, if someone suffers genuine negligence, they shouldn’t feel that they can’t make a claim just because it’s the NHS (and I appreciate that is not a popular opinion). For me, compensation isn’t at the top of my list of things I want to achieve in making a claim, although I can’t deny that some financial help towards counselling wouldn’t go amiss.

hydrangea I had no idea about that – thank you for pointing it out. I will think about getting a referral and possibly a meeting.

reallybadidea That kind of report would definitely be really helpful, and I will think about contacting the hospital to get a copy.

Sparky your post is really helpful – thank you. I think that sounds like a really sensible approach.

PALS was mentioned too…I haven’t yet made any contact with them, but I will definitely do so.

Thanks everyone for sharing your stories and giving your opinions. It’s sad to discover how common it is to experience a traumatic birth and I’m sorry for everyone who has suffered. I’m going to have a talk with dh and have a think about everything you’ve all said before deciding whether to take this any further.

[ladybunnikins]

I'm sorry you had such a horrible experience Minimoo. Just to add, epidural catheters do move, there is nothing fixing the flexible tube inside you. Also, from what you've said, I would question the diagnosis of LA toxicity, it sounds more like a high epidural block/almost a total spinal (but then managed like LA toxicity) and high blocks are much more common. The uneven pupils you describe sounds like Horners syndrome, which can be associated with high epidural blocks. Something to ask them to consider at the debrief, although it would ruin their publication!