Should I complain? Hospital related

[MrsPotts18]

Sorry this is long but I'll try to be brief. I'm so confused.

• last Sun became unwell around 5pm with what I thought was gastro bug. Vomiting, spasms etc. Managed until 1.30am when I got a sharp pain in my right hand side and was in agony. Took more painkillers but was worse by 2.30am so went to triage (30weeks pregnant)

• got the by 2.45am and was seen immediately. Bloods done and seen by midwives. Dr eventually came after 2hrs as they were v busy and initially thought gallstones. Got adequate pain relief at this point as was in agony. CTG on baby was great thankfully.

-6am was transferred to antenatal ward. Slept on and off all day and was on morphine, dihydrocodeine and paracetamol at this point. Various bloods ran all day and was suspected gallstones and ?cholestasis. Had ultrasound Monday pm which showed normal gallbladder/liver.

Tuesday Am rounds consultant comes and says she's discharging me. Says the pain on my right side is pulled muscles from being sick and I've had a gastro bug. I'm still being sick at this point but only after very small meals. She says CRP (infection markers) are 168. Anything over 100 would suggest bacterial but she def thinks I've been unlucky with a gastroenteritis infection. Tuesday night I beg to stay as I'm still in horrendous pain and cannot eat at this point. Reg agrees. I ask for antibiotics and was told 'can't find original source of infection so what's the point'. I'm too weak to discuss more.

-Wednesday 1.30am. I wake up in total again. I was sobbing and couldn't breathe. Midwives get SHO who refuses to call consultant. I beg for pain relief or to be knocked out. Pain was only on my right side under ribcage again. They tried for 6hours to get blood from me. 28 attempts later (even from my feet) only 1 was successful. Refused to call anaesthetist or senior dr. 8am and SHO finally decides to call the surgeon.

-Wednesday 9am. Surgeon comes. Spends 5 mins with me and I'm in MRI with surgeon personally doing it by 10am. Was told by 10.45am my appendix has perforated and I have pus pockets everywhere. CRP is now at 268 and I need to go to theatre. Everyone is worried and preparing for c section as told early labour is almost guaranteed. By 1.30pm I'm in theatre. Overhead brief conversation between surgeon and obstetrics and he told them it was basic negligence but I can't be sure of exact conversation

Thursday - in HdU. Finally round from op but GA has aggravated my asthma and I'm really ill. Baby is thankfully amazing and didn't need to do a c section. Staff in HDU are amazing!!!

Today spent all day in HDU due to no bowel sounds but finally got those moving. Kidney function returned to normal. Now back on original antenatal ward.

Had a slight debrief with surgical team (im still a little out of it). Had an open appendectomy and have 24 staples in situ. Op that was meant to be an hour was 3.5 due to complications. My appendix was black and gangrenous and the infection had spread much further. They had to go into my bowel too and repair due to infection.

The surgeons have been amazing. I have never felt so safe since they came on board Wednesday morning. But from Sunday night to that point I feel neglected. Things wouldn't have got this bad if they had run the appropriate blood tests or even called the right team. On the other hand should o just be grateful that I was got to in time and my baby is healthy. It could be so much worse and all I keep hearing is how lucky I am. I'm so emotional tonight hence this post and just need a hand hold I think.

Separate room - get one if you want OP but after my first section I found I was completely alone and isolated in that room whereas on a ward after DD2's delivery, the women were looking out for each other so if a nurse ignored calls for help, any patient fit enough would wade in and say oi she's been waiting for help what are you up to?

This may also be the case. Just remember, if it wasn't for the NHS the care you have had so far wouldn't have cost you approx ten thousand pounds!

This is just not the case. I had 2 pregnancies in the US and the standard of routine diligence was higher because the hospitals are scared of getting sued and the attitude is much more patient focused. Also the health insurance companies monitor hospital performance to keep their costs in check - this acts as enforcement of basic care standards and risk management. It does not "cost thousands" because just as we pay NI here in the US I paid income related health insurance (did still have capped co-payments granted).

Surgeon prob (def didn't) do the MRI but likely went down and watched the results immediately having recognised the urgency.

Yes make a complaint - care should have been escalated very obviously on the Tuesday night and TBH diagnosis of need for surgical review was prob there on the Tues morning.

Without access to your notes it's hard and inappropriate to comment further but it may well be that the surgeons think the diagnosis was clear from earlier.

I'd complain and ask for this to be investigated as a critical incident.

That sounds really poor. The consultant wanting to discharge you in particular is pretty bad.

Appendicitis doesn’t have a specific blood test of its own, but is instead a diagnosis based on clinical findings. My suspicion is that it didn’t LOOK like an appendicitis in the early days. And because you were seeing obstetricians rather than a general surgeon it didn’t get suspected probably.

That’s my suspicion as a doctor (of a very different specialty). I’m not defending this is in any way - you absolutely should complain. I’m just trying to understand how this happened.

Sorry that this has happened to you, and I hope you’re through the worst of it.

Your first post suggested appendicitis. You really have had awful care.
Of course surgeons go to mri with the patient in an emergency. They arent going to hang around waiting for a written report.

Yes by all means complain to PALS and if that doesn't get you anywhere then the health ombudsman
However appendicitis in pregnancy is very difficult to diagnose and a delay of 24-36 hrs would not be uncommon in such circumstances
CRP should have been investigated further
Very little in way of damages if you were to try and sue ( claim likely to be no more than £1500) as there was no 'loss', although care was suboptimal
Going private would unlikely to have made any difference in this case either...dh who deals with these cases says private care is just as likely to be subject to negligence
Hope you're feeling better now and get a debrief from head of midwifery

If you complain now then extra care can be put in place for once your baby has been born.

Plan on the assumption that your mental health takes a hit after this experience. If it doesn't, then, great, but, if it does, then it's good if the community midwives, health visitors and GP all know about your experience.

Get your husband to call in to the GP and update them now.

I am glad you are doing ok and hope you are home soon.

Midwife with background in clinical risk management here.
This should be treated by the trust as a Serious Untoward Incident. Clearly the surgeons think so.
Make a formal complaint by letter of email to the Head of Maternity.
There are several failures in your care, all potentially serious.
This is the sort of incident (with the poor care on the ward) that happens in units that are starting to fail.

You and your baby, thankfully, will probably be fine. The next woman might not be lucky.

As a nurse I suspected appendicitis immediately. It's difficult to see how any Doctor of any speciality missed this as a possible cause of your symptoms, you need to complain and follow procedure to request notes. I am surprised you are not on a surgical ward with midwife/ obstetric review there especially as your baby is ok. Hope you've had antibiotic cover.

With all complaints, the most useful thing is to think about what you want to get out of the complaint.

From your scenario, a really good outcome would be an understanding on the antenatal ward of how to recognise sick patients, when junior staff should escalate to seniors and when to get surgical reviews.

This would all be brilliant outcomes - while going to solicitors for a claim would be much more longwinded and probably limited in the financial settlement. There would also be the discussion about appendicitis in pregnancy being hard to diagnose. Which is true - but at some point in your hospital stay it was clear you were very ill and appropriate actions didn't happen til the SHO calls the surgeon on the Wednesday morning.

So sorry that you have had to go through this OP, but you and that baby must have really strong constitutions.

Definitely complain. They need to review your care and make sure no-one else goes through anything similar.

I also think there's a tendency to assume that an obs/gynae problem is sometimes a bit of an assumption with female patients with abdo pain. I bet if a man had gone in with the same symptoms, they'd have diagnosed the appendicitis much earlier.

Your initially triage sounds ok. bloods and scans done in time but It looks like it all went wrong tuesday onwards when they tried to discharge you with a CRP of 168 (the normal level is < 8)
Appendix pain is usually lower right side, so maybe the description of high right side pain under ribs threw them, but the fact you were still so unwell and 28 attempts at cannulation would suggest they you were very shocked as your veins had shut down.
You should not have been left 6 hours without senior assistance being called. A high CRP and difficult venous access should have alerted the staff to the possibility of evolving sepsis and the SHO should have escalated this sooner. Fortunately the surgeon seems on the ball and recognised the severity quickly and arranged an urgent scan.
Did you have any observations taken during the tuesday night when they were attempting cannulation. Did you at least have your Blood Pressure checked?
I would complain to PALS and ask to be moved to a surgical ward. As other have mentioned a lot of the current midwives are direct access and have very little or no surgical nursing experience. Your issue is a surgical one and you will be forgotten about as an outlier on a maternity ward.

Going private would unlikely to have made any difference in this case either...dh who deals with these cases says private care is just as likely to be subject to negligence

Agree with this. I used to live with a midwife. Her unit frequently had to pick up the complications referred back to the NHS from the local private hospital. Having used UK private a couple of times what they are good at is scheduling things around patient rather than themselves and slightly prettier surroundings but underlying care no better and not necessarily as well equipped to cope with complications / emergencies.

I also think there's a tendency to assume that an obs/gynae problem is sometimes a bit of an assumption with female patients with abdo pain. I bet if a man had gone in with the same symptoms, they'd have diagnosed the appendicitis much earlier.

Also agree with this. For ref, DD1 is in hospital at the moment having started with similar symptoms. She is not pregnant. She has been improving since Thursday but they are not rushing to discharge her until they are sure they have not missed anything.

Firstly, based on the information provided, it appears your initial care was sub standard and could well have been negligent. The choice to complain is entirely yours, but I certainly would. I’d do it in writing, formally and moreover, I’d commence the complaint ASAP. I’d provide the facts in an unemotional and objective dialogue ensuring how the treatment impacted on you....such as pain Levels, distress etc. paraphrase conversations and how your family concerns were responded from the staff.

The fact that you are complaining is not personal. Errors need to be identified in order to develop better protocols and prevent this type of error occurring again. Furthermore, individuals need to be accountable for decisions they have made. This isn’t about attributing blame, but developing and maintaining a just culture.

An investigation may have been commenced already. But if this hasn’t been reported and investigation proceedings ongoing, it’s likely the safety culture in the hospital you’re being treated at is poor.

Good luck op.

What a catalogue of disaster. I'm not a HCP and your appendix was my first thought at your OP. Please complain - calmly, without emotion and factually. Photographing your notes is an excellent idea.

TBH a private room isn't a particularly great idea as it would make it easier for them to forget/ignore you. And you should most Defoe on a surgical ward, to put you on antenatal is madness. I do hope you're better very soon. 💐

Be on - not bloody Defoe!

Hi all. Woke up to quite a few replies so I will try and answer as much as poss.

I'm in quite an emotional state this morning but I think it's all catching up with me.

To the poster who questioned what I heard said between the surgeon and obstetrics.. this was on the ward immediately after he told me I was going for surgery. He walked from my bed to the desk outside my door. Everyone heard this conversation. I didn't pick up on it all due to the pain of a ruptured appendix.

When I got to MRI also, the radiographer got me on the bed and explained it all. She was the one who told me the surgeon (by name) was in the booth and would be doing it. Alfred it was done she also told me it had taken a few extra shots because baby was moving and one slide was blurry and because he (the surgeon) wanted up close shots of one particular area.

I got myself slightly together mid morning. I told the ward round I wasn't coping, needed adequate pain relief and highlighted that I'm a general surgical patient not surgical and I can even bend. I pointed out (senior midwife was there too) that staff have left my buzzer out of reach, my meals and water were just left and no consideration has been given that I can't sit up unaided or without huge pain. Lots of apologies were made and so far I've had lots of HCA and my own midwife pop in asking if need something. Maybe I should have done that sooner.

My surgeon popped by also and said he'll make sure he or his team do rounds with me until they decide I'm fit for discharge. My bows sounds are still slightly quiet so the plan is to work on that today. He did say I need to take it easy and in people who aren't pregnant it takes 4/6 weeks for recovery. Think this will be the start of my mat leave journey.

I think I will go ahead with the complaint. I'm angry mostly about Tuesday. Blood readings at 168 and being sent home with a diagnosis of pulled muscles just doesn't sit right. That I can do through Pals.

Any other treatment (or rather mistreatment) on the ward I will be raising there and then. If I'm not strong enough DH is more than capable of bringing up too. We can do this without being hot headed though. I think the staff have been careless in their thinking and treating me like an antenatal patient which isn't suitable.

Thanks for all the replies. They have been very helpful. And just had another CTG and baby is still wonderful!

Just realised lots of spelling errors in that last post but I'm back on the dihydrocodeine. And absolutely knackered!

Well done! Sounds like you are handling your current situation really well by stating your situation and needs. Make sure this is kept up though particularly with shift changes.

Wonder how many problems go undiagnosed in pregnancy. I had undiagnosed gall stones. Heartburn, pain and sickness are all normal in pregnancy!

My SIL has an ovary removed around 28 weeks pregnant for severe abdominal pain - turned out she had a massive dermoid cyst on it!

Rest up, and when feeling better contact PALS.

So glad you are okay OP. Have been following your progress.
It’s good you are on the mend. Best of luck with healing, the remainder of your pregnancy and the baby x

Glad to read your update on the care you are now receiving. If it deteriorates again insist on seeing the midwife in charge of the unit and complain loud and clear.

As regards a formal complaint, yes, but not right now. Let the dust settle and consider asking for a formal meeting with the staff involved via PALs when you make your complaint. Keep a record of events as detailed above.

The senior staff will have been very badly shocked by this, unfortunately surgeons aren’t well known for their humility and rarely come and apologise,in this I mean your obstetrician. You are perfectly entitled to ask to switch to the care of another consultant and this will be facilitated.

Very best wishes with your recovery. Take it slow and easy.

You sound like you feel a bit more in control of your care and that you’re being listened to. That’s good. Remember: keep asking for help if you need anything at all. If no one from the surgical team comes to check on you, make sure a midwife chases them up. You shouldn’t have to ask for these things, but sadly you probably will.

Also remember this:

Just because it's the NHS does not mean that the one competent thing they did in the midst of this horror show means you owe them your everlasting gratitude

Whenever someone on MN complains about an NHS shitshow, you always get people saying “the NHS is wonderful”, “be grateful you didn’t have to pay”, “at least you are OK now”, “a healthy baby is the only thing that matters”.

Fuck. That.

Gosh OP that is horrendous. I hope you feel better soon.

I also would complain. This is all sorts of wrong and you've been treated despicably by some staff (not all obviously). That's incredibly poor and extremely dangerous lack of care and cutting corners. Not on.

You have been through trauma, I know baby is going to be here soon and it will be joyful, wonderful and you will be super busy but please see someone to help you through the trauma you've just experienced