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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

Suing the NHS (*TW*)

123 replies

WhipperSnapperSteve · 08/05/2021 09:05

TW - I was raped at 14, the bastard also raped me orally.

I'm male if not obvious from the username, have been on MN for years, my sex should make zero difference.

I had an oral laparoscopic procedure called an OGD&Endoscopic Ultrasound done four years ago and due to the previous trauma was given propofol sedation (it's the general anaesthetic component they use first to knock you out, milky white emulsion) and I woke up the procedure complete with no issues.

I needed an OGD (it's an endoscope threaded through the mouth into the stomach and first part of the duodenum) at the start of the year and called the department to be told that they'd give me midazolam/fentanyl sedation and that the dr would give me more than usual and just to mention it to them.

The dr could see I was super anxious, I explained my history (a triggering challenge in itself) and was told I'd be comfortable and "it wouldn't last long). It was a nightmare, I lay there completely frozen; and I have flashbacks both to the original assault and the procedure daily. He gave me the standard sedation.

I need a follow-up and this is agreed to be under propofol.

I really want to sue but I'm well aware what people think of suing the NHS, and that money wouldn't make me feel better. Thoughts?

OP posts:
Porcupineintherough · 08/05/2021 10:29

And for those saying "oh no case to sue" I dont think you understand what consent is. The OP consented to the procedure done under one set of conditions, it was agreed that this was the way it would be done - and then it wasnt. No change was discussed with the OP, he was fobbed off/offered false reassurance. And if it wasnt in the notes, why wasnt it?

Motorina · 08/05/2021 10:30

@WhipperSnapperSteve

How do you know you only received the standard sedation?

Dosages noted on my patient letter.

I do a lot of work with sedation, so can possibly give some context. You are not my patient, so none of this should be taken as specific medical advice to your circumstances.

There is no such thing as a 'standard dose' of Midazolam/Fentanyl. Patient response varies hugely. So what we do is start with a small dose and then titrate to effect, by giving a little bit more, then a little bit more, then a little bit more, til the patient is in the sweet spot.

I have treated rugby players who are there after a dribble of the stuff, and 16 year old girls who need a bucketfull. It's a bit like alcohol - some people are 12 pint people, and some are under the table after a pint and a half. You can make an educated guess by looking at them, but you won't know for sure til you take them drinking.

I also have patients who are totally calm and relaxed whilst very lightly sedated, and others who need to be significantly more deeply sedated to allow any care.

It is hugely variable. The art is getting the dosing right, because it takes around 15 minutes to hit maximum effect, and you can't exactly suck the stuff out if you've given too much.

It is the first line choice of sedative drug because it is very safe for most people, and works very well for most people. There's a big window between an effective dose and a dangerous dose. None the less, too much can slow or stop your breathing, so it's not possible to simply keep giving more til you're deep enough to cope. You can very easily get into an unmonitored GA by doing that, which is dangerous.

It's not possible to tell from the dosages in a letter that you received the "standard sedation", because the appropriate dose varies so much from patient to patient. When I have to abandon treatment (which happens to all of us) it's because I recognise that giving the patient more of that drug will not override their anxiety and risks compromising their breathing. That may happen at a low dose. It may be at a high one. It varies from person to person.

It is recognised that Midazolam/Fentanyl does have a failure rate, but it is the first line approach for all the reasons given above.

I would add that I hate failing to complete treatment on a patient. It always feels like I've failed them. I don't know if it makes you feel any better or not, but I can be confident that the team involved wanted it to work and feel bad that it didn't.

In contrast, Propofol has a much smaller margin between safe and unsafe, so needs to be given by more skilled and experienced hands, with greater back up support. That means fewer services offer it and there's a longer wait. Given you have said that this procedure was urgent I can understand why Propofol may not have been available to you. Particularly if this was in the last few months: generally those who give Propofol are those with anaesthetic training, who may not have been available to sedation services because of Covid.

This is a roundabout way of saying that, whilst it is clearly miserable that you had a bad experience, it doesn't follow that that the team did anything wrong. To sue successfully you would have to establish that they did something wrong and you suffered harm because of it. It may be that that is so, but it's not obvious from what you've said. So you'd have to take careful advice before deciding whether suing is likely to be successful.

I agree with thsoe who've said that addressing the underlying cause of your distress, which relates to your assault, it likely to be the way you will feel better in the long run. It sucks that you have to do that. It's not fair. I'm sorry. But that's likely to bring you more healing than getting tied up in a protracted legal battle.

korawick12345 · 08/05/2021 10:30

@Porcupineintherough

I think you should absolutely complain and if youd like to sue then consult a solicitor. They were negligent in their duty of care and you've been further traumatised as a result.

@Meowchickameowmeow are you dim or could you not be bothered to read even the first line of the OP?

Are you dim or could you not understand that @Meowchickameowmeow was pointing out that TW stands for trigger warning as opposed to trans woman which seems to be a mistake made by previous poster who she was quoting.
LumpySpacedPrincess · 08/05/2021 10:33

The need to sue could be linked to the anger you feel and need to seek some resolution. Therapy and counselling, work on yourself. I am so, so sorry that you were abused in this way. Complain, help make the service better.

Soontobe60 · 08/05/2021 10:33

@CovidCorvid

Even if you feel you were pressured into agreeing to the lower dose sedation from what you’ve written it sounds like you did agree to it. So I don’t think you’d have any success with suing. By all means complain.

The nhs aren’t very good with stuff like this ime. Dd needs a colonoscopy and she can’t tolerate it, they’ve tried. So they just said they can’t/won’t do it. No offer of better sedation, no offer of a camera pill colonoscopy. Just discharged as “refused investigation “.

How would a ‘camera pill’ help when the camera has to be inserted through the anus?
endofthelinefinally · 08/05/2021 10:35

If you sue the nhs you are looking at a minimum of 3 or 4 years reliving your trauma and the risk of costs unless you can find a no win no fee company, which, tbh, I think would be difficult. As I suggested in my last post, PALS is the best route and less stressful for you.

littleredberries · 08/05/2021 10:36

You can complain without suing. Although they do take it less seriously.
I was made to walk through a hospital with nothing but my pants and a hospital gown which was completely open at the back. Offered nothing to cover my behind up. Told to leave my coat somewhere else. Every single man I walked past goggled at me. I'm a sexual assault survivor.
I only received a standard formulaic reply to my complaint.

HowWeAre · 08/05/2021 10:37

Very sorry to hear this happened to you. I agree with the other posters that I’m not sure what you’d be suing for, I don’t think that doctor was negligent here.

I absolutely would contact the PALS department at your local hospital and explain what happened though and place a complaint so they can investigate what happened.

SoupDragon · 08/05/2021 10:38

Are you dim or could you not understand that @Meowchickameowmeow was pointing out that TW stands for trigger warning as opposed to trans woman which seems to be a mistake made by previous poster who she was quoting.

She didn't "quote" anything though. It looks like it's all her post.

Porcupineintherough · 08/05/2021 10:39

@Soontobe60 camera pulls are swallowed not inserted. They're just like a big tablet.

Porcupineintherough · 08/05/2021 10:39

pills

AwaAnBileYerHeid · 08/05/2021 10:39

Why would suing for money be better than putting in a complain (if you feel that a complaint is warranted), OP?

OwlTwitterings · 08/05/2021 10:39

I’m really sorry for what you have been through.

told that they'd give me midazolam/fentanyl sedation and that the dr would give me more than usual and just to mention it to them.

After telling the doctor, did you consent to having midazolam/fentanyl sedation? If you did then I can’t see any grounds for suing (unless there was any form of negligence during the OGD, and I’m assuming there wasn’t or else your OP would have said).

Do complain though. Hindsight, which can be both wonderful and awful, says you should have probably gone down this route before the operation if you were refused propofol due to your exception circumstances. Hopefully your complaint will at least mean another person won’t go through the ordeal of having to explain and accept an alternative.

BungleandGeorge · 08/05/2021 10:39

Sedation isn’t required for endoscopy, some people don’t have any and just have the back of the throat numbed so he did actually give you the enhanced sedation. Dosages are carefully calculated as too much is dangerous and there is a risk of rupturing your oesophagus if you’re totally unconscious. You can refuse any procedure you want to though, although obviously if you’re seen under a suspected cancer referral the consequences could be extreme. I
think it’s ok to sue the NHS if they have been negligent but I just don’t think you have any case, don’t pay money out on a solicitor unless you can get a recommendation or you can go no win no fee as they will only take the case if there’s a chance you will win.
I am really sorry this has triggered such horrendous memories, can you access support through one of the rape charities or a local treatment centre?

Silvercatowner · 08/05/2021 10:41

Sueing is extreme. You don't need to do that to make a complaint (and there's no point as you have no grounds).

LadyGAgain · 08/05/2021 10:44

I'm very sorry for what has happened to you. You are correct, your sex makes no difference when you have been raped.

I think I would write to the divisional director for surgery and explain your history and what you had been told and frame it as if you are wanting to prevent this sort of trauma from happening to another patient and the effect it has had on you. And explain that you would like an acknowledgment and response.

I hope you are ok Thanks

tentosix · 08/05/2021 10:46

Having seen many people sedated with Midazolam using standard dosages, the usual result is total lack of any memory of the procedure. Giving a higher than normal dose is potentially risky and isn't the norm, so safety was paramount. On those grounds any suing for negligence will get nowhere. You need to complain to PALS and ensure you are given a more sedating medication next time. Sorry for your situation, but suing isn't always the answer.

DIshedUp · 08/05/2021 10:46

I am sorry for what happened to you, however you have no grounds to sue.

There is no standard sedation, sedation is titrated to patient response. You say you accepted the midazolam/fentanyl because you were on the 2WW pathway, so they were investigating cancer. Presumably this means the wait for propofol was too long, and would potentially delay diagnosis of cancer.

Sorry, I think you can write to PALs but I don't even think the medical team have done anything wrong. As I said there is no standard sedation, and they were ensuring you got the investigation you needed quickly to prevent delay to a possible cancer diagnosis.

The person to blame for this is the person who assaulted you.

nancywhitehead · 08/05/2021 10:47

You should absolutely complain, and complain loudly until you are heard and apologised to and trust that they have learned from it.

Don't sue the NHS, though.

MrsMaizel · 08/05/2021 10:48

You agreed to that type of sedation 🙄

KurtWilde · 08/05/2021 10:49

I disagree with the posters saying there was no negligence. The doctor neglected to take Steve's very serious past trauma into account and insisted the sedation offered would be enough, despite extra sedation being organised prior to the appointment. That is most definitely cause for a complaint to be put forward.

Personally I would contact PALS and start a formal complaint and take it from there. As to whether suing them would be upheld I'm not entirely sure it would unfortunately.

EmbarrassingAdmissions · 08/05/2021 10:50

Motorina Sat 08-May-21 10:30:20

This is an outstanding explanation of sedation and dosages.

Porcupineintherough · 08/05/2021 10:50

@MrsMaizel the OP agreed on the basis that he was told that it would do the job. It didnt.

Pippa12 · 08/05/2021 10:56

Difficulty being over sedating a patient can cause airway compromise? Perhaps the anesthetiser didn’t feel it was safe to administer more Midaz/fentanyl which take much longer to come out of your system then an agent such as propofol.

I am sorry for your experience and hope your voice is heard more clearly if this scenario repeats. Although I feel the doctor will insist that clinical judgement prevails in this instance and your ground for a legal case non existent.

AnnaMagnani · 08/05/2021 10:57

I don't think you will find this will meet the criteria for medical negligence and you will struggle to get a solicitor to take it on - my DH has been left partially sighted due to lack of NHS monitoring and we couldn't get that picked up so the bar is very high for solicitors to take your case.

However I do think you should start by making a formal complaint as without feedback, how is the Trust going to learn?

What might make you feel better is knowing that actions have been taken by the department so this will never happen to you, or another person in the same situation again.

This might involve a better explanation to you of why the situation was urgent, the risks of delaying for x days/weeks while waiting for a propofol slot so you could make an informed decision rather than proceeding with a midazolam/fentanyl one or something else.

However you would know that what happened to you had been addressed by the Trust and some learning taken place.

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