A local lawyer? And medical negligence advice

[Mharhi]

Would it be best to have a local lawyer who I could take eg. medical notes into to discuss, or one recommended to me (by a professional and friend who has worked on cases with)

Also if anyone would like to comment on whether this is clinical negligence or not,

Had lipoma in colon found in 2008, not properly informed, consultant told me 'we have found a lesion, don't think it's anything to worry about it's not causing problems and we're not going to do anything about it' Follow up letter to GP (discovered through getting copy of my hospital notes) states they think it's nothing to worry about, biopsies suggestive of lipoma, if symptoms worsen we could refer for CT...

Last year, have since moved GP, just got copies of record from there, "Polypoid lesion probably lipoma' is listed in their system as pre-existing medical condition,

The main symptom these cause is pain, then bleeding, serious complications such as perforation, no clinical guidance on these, are quite rare in area it was.

Started getting pains, then bleeding, went to docs no-one checked records, I did mention previous colonoscopy but that I thought it had all been ok. (as i did) however they are the expecrts and had the info on their system.

Eventually had to go to A and E with complications which are life-threatening after a day or two, due lack of blood supply. They didn't check previous records / medical history either, though this again was probably compounded bu me being unable to tell them much info, was also doped up on Tramadol and in a lot of pain at time. Sent me home. Had to have big operation nearly two weeks later, fever, swollen abdomen, think sepsis had started. At hospital had been told needed to go home, there were no available slots to examine me. GP to monitor, however they didn't ring or anything.

So anyway since that, a few months ago, I've had problems with small bowel obstruction caused by adhesions, this looks like an ongoing problem although I'm not sure. It would be wonderful not to be. However it seems once you have it it comes back or worse after an op to remove it.

I think I wouldn't have it or not to this extent if it had been diagnosed sooner that the lipoma was causing problems, it could have been removed before it started causing serious complications which meant I had to have a partial colectomy (which is one of the worst risk ops for small bowel obsruction afterwards apparently) Also with sepsis / fever adhesions are worse.

I'm so upset about this, it could even have been removed endoscopically when first found, but I suppose it wasn't causing problems then. there is no clinical guidance to use as a benchmark.

Any advice welcome. And thanks for reading.

[Mharhi]

Also there seems to be come confusion over what size it was when found. In the response it says it was 2-3cm and they would not have considered removing it endoscopically. However the histology report says it was 'very small' and in my follow up after Christmas I was told it was 1-2cm. (it makes a difference as the literature suggests removing them under 2cm is safe by endoscope and would have meant no op for me).

[Mharhi]

Hi again sorry back to this again!

I had my complaint reply back from the hospital and basically it hasn't replied to most of it (as explained in my original message in this post)

they have then turned it back on me, said they did inform me and I should have then told them in A and E about my previous condition.

I'm not sure what to do now. Any advice welcome.

[Mharhi]

Hi again thanks yes it is a relief the new GP is nice. yes in my case I just kept on vomiting with the tube in so there we go. They said it was probably not int he right place. i had to try and sip water at the same time but I wish they hadn't said about it sometimes going into the lung that made it worse!

Anyway let's not think about it. It's certainly keeping me away from the fruit n fibre. i am cross no-one gave me any dietary advice even through the doctors know about it...apparently it's 'usually nuts'. Now just having mainly yoghurt for breakfast, soup and ensure drinks..and fruit juice without bits that seems to be ok.

I am a bit scared as is next Wed the follow up appt with the surgeon. I feel this is quite good really I've heard not enough surgeons get to see the resulting effects of adhesions of their own ops, often it can be years later in a different hospital. However I made an official complaint about being sent home etc before Christmas which will be in the middle of investigation and it was him sent me home. My ICAS woman says it should not affect my treatment so hopefully not, when I wrote it i didn't think I'd be back in!

Hopefully it will have the same affect as on the GP and I get the same or attentive treatment because of the past mistakes, but I truthfully worry they might be dismissive of me or something. Hey ho. And combined with the panicky feelings the hospital brings. Need to stay clearheaded and not get upset. That won't hep anything. I keep telling DH the adhesions generally come back if operated on however he thinks I'm being negative and 'something needs to be done' 'Not to let them faff about again and get it sorted out properly this time' Hmm. It's not that simple is it?

Anyway I've heard of some kind of osteopath treatment called visceral manipulation which may help adhesions in the long term and going for a consultation about that. It is not cheap though. Also want to ask about adhesion barriers there is something called Seprafilm they use in USA and Germany not sure about here though,

Yes in terms of the shakiness / adrenalin I find swimming helps. gets it out a bit and also might be good to help stretch a bit. I know a clinical psychologist through someone and I might try and see her I think.

[sneezecakesmum]

That was just crap for you with the hideous NG tube! Despite years of experience I have never got one down ever and just didnt attempt it in the end! Even drs struggle and junior drs are the worse! I always told the patients it was horrible and I'd failed, but it could be done in theatre under GA (so aseep!). I guess though if you were vomiting they had no choice but to do it then as the pressure build up in the abdomen from the obstruction can cause perforation, so however vile it was necessary. Anaesthetists are the best.

So glad you are getting a new GP, you can't go on if the trust is gone, especially as they are probably doing a bit of ass covering.

It really does help to discuss your problems with someone who has been through the same thing. Things do get better usually, but unfortunately it does take time. Good luck with your appointment.

[Mharhi]

Thanks for your messages again. Although these are awful experiences it's good to go through it with others who understand. Sometimes I feel i am upsetting others so although having it on my mind try not to talk about it. Aldo DH is a 'don't dwell on it' type of person so feel guilty if go on about it.

Today, I have changed GP to one highly recommended by a mum friend. It feels better not having to go to the other one anymore, I just had lost trust.

I am going to make an appointment with the GP my friend said was lovely, go through it with her a bit and ask about counselling. It is hard to start with someone new but good too. I felt really scared what if they can't take me on and would be left with no GP- that kind of helplessness feeling.. it was so reassuring when they said could put me on the system by tomorrow hopefully.


Yes I have those same feelings about the hospital, i need to stay calm and cool headed for my appointment on 9th, as need to discuss future surgery / treatment. bet we get the registrar again who is a bit vague which doesn't help.

Also get the tube thing, I had to have a nasogastric tube last time and it wouldn't go in, they kept trying it was horrible, said this always happens, it either goes into the lung or curls up at the back (which didn't reassure me) then they went off to get a thinner one it was like a torture. Finally we decided to leave it (me and the nurse) as just being sick anyway, but then she worried the docs said it had to be done and I felt guilty, said I would say it was me not her!

[sneezecakesmum]

Totally agree with happylander, it sounds as though you have PTSD Mharhi and happy what a hellish experience for you. My DD had a very traumatic birth with my DGS, though there was luckily no negligence involved but it puts you in a mindset of 'the worse thing will happen to me', rather than my used to be mindset 'it will never happen to me'. Now I am always waiting for bad things to happen when I used to be so positive

Mharhi, your GP should sort out some counselling for you, it is not the job of PALS as far as I know. My DD got it through her GP and also some extra support via the RCN union. It sounds like you are having panic attacks too so its really important you get help asap, the longer these feelings persist the harder they are to overcome. Luckily DD who is an ICU nurse doesn't worry about tubed patients! She is OK so long as DGS is well but gets acute stomach upsets when he's not! (politely put!) I am just so lucky she and DGS are still with us Being positive is much harder though if you've gone through surgery and a trauma that could have been avoided.

If I go anywhere near the maternity unit its like a black cloud descends, horrible memories of a very sick baby. Maybe when the sun starts to shine again I will exit the gloom as its not a nice place to be! Things do get better and just going through with a medical negligence team will be one of the ways you work through the trauma. It will be stressful and long drawn out but it will start to give you closure (hate that expression but its appropriate!)

[Happylander]

The CBT helped me enough to get back to work but it was hard going. They do something called reliving which is bad but helps you process the memories better. It is worth doing. I am not sure how PALS can help you with that I went through my GP. I would go back and just tell him/her that you want counselling and get them to put you on the list as you sound like you have PTSD.

It does get better and I am lot better than I was but have also been prescribed anti-depressants which have helped massively especially with the anxiety I was feeling. Before I went off sick I had to work in Resus and had to help intubate a patient which bought it all back by the time I got the patient to ITU I was hanging onto the trolley as I thought I was going to pass out and was nearly in tears.

When I am having a bad moment I concentrate on what is around me to bring me back in the real world so to speak. Clock ticking, colour of the walls, what I am sitting on etc all boring stuff but calms you down.

[Mharhi]

Thanks Happylander hope it goes well for you. Sometimes I don't know if I can go through 'going through it all again' and just seeing my files of medical notes makes me upset. Sometimes i try imagining it's someone else, a friend, what I'd do for them, when it comes to the facts of it, rather than getting all emotional.

That must have been hard when you work in a hospital too. yes, I had to collect my DH from a procedure recently and it was the same waiting room and I just burst into tears, felt adrenalin pumping round my body like I wanted to escape. Am not sure how will cope when have follow up next week there. It wouldn't be so bad if it was calmer but it is so hectic and last time was running hours late, frenetic. It just makes me stressed.

I asked the GP about counselling to try and get through this and they told me to go and speak to PALS. Would that help I wonder?

I don't think doing CBT in the past was helpful, as it teaches you 'most of the things we worry about never happen'. Then I was told i had something, nothing to worry about and it causes major problems. No wonder I'd feel anxious after that.

There was a poor old man dying in the SAU last time I was there, in the side room at the end of the ward (right next to me). Every time there was a ward round his relatives and the doctors would discuss things outside his room, so next to my bed. End of life care they called it. He had a bowel perforation. They weren't going to operate, or give him is meds just food/drink and painkillers. They were all waiting for him to die. Brought the reality of things home a bit to me.

[Happylander]

I was just about to recommend AVMA as they put me in touch with my solicitors but I see you have already contacted them. It is a long and upsetting road but keep going. I had a traumatic birth in Nov 2009 and the surgeon was very negligent as recently struck off by the GMC because of his treatment of me and my compensation case is still going on and that is with the trust admitting liabilty.

Do get some counselling as it really helps. I work in A and E and had to have 10 months off sick after I went wibble as I could not stand being in a hospital. I am now back at work but can not go into resus or deal/see any intubated patients. I had to give counselling a break as it was getting too distressing and I couldn't cope but hope to go back to it soon so that I can do my job fully.

Good luck and stay strong.

[Mharhi]

Yes the one I'm looking at is on the AVMA site, and they have helped me with my complaint letter and that has been very supportive. They seem to have quite a few cases with the same hospital on their case histories and also a GP's with the same inititals. Interesting.

[Mharhi]

Thanks for your replies, yes that would be great. I do think I probably need some kind of counselling as like I said they won't seem to go through it with me maybe PALS would help (but it's at the hospital and I get all upset going there it brings back the memories)

I will have a look make sure the one I'm looking at it recommended. Yes the psychologist who has been involved in several cases recommended the avma site.

[sneezecakesmum]

Hi there. I can come back tomorrow as I have to go to work ...it is me, i have a split personality as I cant be bothered to log in and out of MN on ipad and PC.

I will go through the stuff that went on from the 'other side of the trolley' perspective as you need to really understand what happened to you and to find closure. The SUI (Serious Untoward Incident) review will examine all the sides and you will get to see it, probably with your solicitor there. I can only go on the info you give me (very comprehensive though!) so am having to make a few informed guesses. I would def recommend counselling as the affect on your ability to have a baby must be devastating.

You can also go onto the adult health section of MN and post the medical side there, as the legal section is a bit limited re med neg. I think you will get a lot of helpful responses there as there are people who have been through the same type of thing.

ps, fever, tachycardia and swelling/inflammation probably sepsis and sepsis is a major killer, and NICE have been looking at guidelines.

[Mharhi]

Thank you Snoozecakesmama I actually got quite emotional reading your reply there it's great to hear from someone medical as none of the ones here will talk to me! Yes it was scary, it started quite suddenly, the pains, just as I stopped breastfeeding in the Autumn (I have read b'feeding hormones and preg like relaxin, progesterone can relax the gut and reduce motility and wonder if that's why it managed to go on so long without affecting me sooner)

The pains were vv strange, like being in labour, at about 7-8cm dilated.. had to breathe hrough accompanied by wierd 'popping' burning sensation I get it must have been close to perforating! I have never had anything, not IBS, have constitution of an ox!

I was in tears at the GP, said i thought something was exploding! I hadn't been there before though and they actually got me to see the nurse first as they weren't sure I needed the doc. then she got me to come back see the gyne specialist GP later that afternoon. Who did get me to stand up point to where pains were and ask if i got wind. Gave me Mebeverine. When I asked was anything else could do she referred me for womb ultrasound.

In a way it's good to hear it was an emergency, so my gut (hm) instincts were right all along!

The worst thing was though, in casualty, then the SAU after, (where they sent me home) I tried several times to alert someone that something was badly wrong, but they kept on trying to encourage me to eat, take the lactulose. I said to one of the nurses the blood with the cramps had turned jelly like and started to smell bad, she said not to worry about it. They thought I had the 'rectal polyp prolapse' then though. I now realise there is an 'emergency list' that i was on..and another thing for real emergencies, 'proven' cases if you like is that right? For example more recently when I had the small bowel obstruction I actually didn't feel like such an emergency after it started to ease, but they treated me like I was...

I think that's one of the hardest things as I felt so helpless and like no-one was listening. Another nurse, when I said i didn't think I could go on much longer, and i holped they could take the 'polyp' away soon, said it must be inconvenient! It felt like I was on another planet!

After a doped up week at home in the bath, bleeding into an industrial toilet roll (as it got more painful I was unable to squat or anything like that) unable to eat, sleep I was like a zombie. Somehow crawled back in for a flexible sigmoidoscopy procedure as an outpatient to remove the polyp- even then they didn't realise what was going on and told me had huge tumour of 12 plus cm and couldn't find the base! Wierd thing happened where nurse told me to go home now (afterwards, when i was in tears that it hadn't been taken out) hobbled out, to have another nurse run after us the clinician needed to see us.
Tummy swollen, but still allowed home. He said had never seen case like it in developed world, most would have presented sooner!

Finally got the op the following Monday. Laproscopic surgeon said had not seen before in the hospital (he's head one and v experienced)

Had to say in a week with fever/tachycardia/swollen abdomen. Surgoen said likely as contaminated, do you think that sounds like Sepsis Sneezecakesmama if you're still there?

[Sneezecakesmama]

No not a lawyer. I,m too poor for that. I am a nurse with too many years experience for my liking and lots of years in a&e! Did do gcse law though mainly in relation to medical negligence as continuing educational requirement .

Reading your experience is upsetting as there was so much opportunity for this not to be happening to you if correct procedures had been followed. Most gp s are very good but I think some do get into a mindset where they see a healthy young person and just go with the most likely diagnosis rather than investigate properly.

In your case as soon as you presented with the colicky pain and your history of colonoscopy they should have referred you as an emergency. It's obvious that the lipoma continued to grow and began obstructing that part of the bowel, and as it progressed the telescoping effect of the intussusception occurred (more commonly seen in babies). This is an acute surgical emergency and should have been recognised then. That is where your case will hang, this lack of recognition of the emergent situation. Absolutely right never give laxatives to someone with a bowel obstruction as it can result in perforation of the bowel and peritonitis. A lot of GPs go down to IBS and the gynae route with abdo pain in young women, again they virtually had the diagnosis in front of them if they had the colonoscopy report. If not the red flag was there with your information that you had had a colonoscopy in the recent past and they should have followed this up.

At least they are taking you seriously now even though the horse has bolted! But you are right to persue compensation, as this has changed your life forever but also that they can learn some lessons. I am interested in medical negligence cases more in terms of mishandled births and there is a procedure carried out in hospitals called a SErious Incident Report (something like that) these are reviews carried out by the hospital following complaints where all contempory records are reviewed and looked at. I think this is what your med neg solicitor is waiting on, all these procedures take forever. PALS is the service liaising with patients in your situation so I would also contact them. Be prepared for a long haul as these cases take forever but your case is very strong, sadly

[Mharhi]

Snoozecakesmama are you a lawyer, you sound fab!

[Mharhi]

PS Any comments on above welcome, it's just my own thoughts not as an expert. It has been very informative getting copies of my notes from both the hospital and GPs. Has made things much clearer.

I still can't belive the response from the GP's recently though, after weeks "The information mentioned was available and highlighted for the GPs to see." . No wonder they are taking so long to reply.

[Mharhi]

It's seems it is a combination of-
1.Slapdash consultant at first, me not being properly informed

1. Admin probs meaning info not being on computer in time, also not all info there, eg consultants name and how to proceed (CT) being missed.
   

3 GP's not looking at the info, maybe as they'd got on their trains of doing the other stuff.

Should have either 1) been removed or monitiored in the first place, as was small enough to do so with an endoscopic loop, and polypoid not sessile.
2.) Been referred immediatelly for CT / Ct colonoscopy at start November when I started presently with the pains. It would have picked up a 6cm polypoid lipoma in the descending colon which could have been removed laproscopically in a controlled way, less chance infection, smaller op. There was a a whole month (Novmber) before the bleeding started.
3) At very least bleeding from bowel at end November should have resulted in urgent emergency referral. The colon lipoma def being on their system by then and my only previous bowel condition. Then entering it as a new condition hmm 'rectal polyp prolapse' I was also prescribed a huge bottle of lactulose and encouraged to eat during the time havign the bleeding which was horrible but I tried to do as instructed. I have looked it up and is contra-indicated in bowel bstructions. Think they thought I was constipated

Also, the GPs have now advised me not to fly, due to the pressure on the SBO, they are now taking great care monitoring me each week, making a big fuss if they can't get hold of me on the phone, had given me number to call GP secretary of feeling bit off. All great but very too late! This was the last year we can have another child as don't want to after 37 and am that this year. However it would be too risky with the chance of future obstructions / ops. Which is all making me very sad. It is lucky though I wasn't pregnany last Autumn, that well, would have been terrible.

[Mharhi]

Thank you for the messages especially Sneezecakesmama, that was really useful. It didn't perforate, but it did cause an intussusception of the bowel for a large way and that menat I had to lose a large amount and have an end to end colorectal anastamosis. I feel if they had referred me back to the consultant mentioned for the CT mentioned, when I started presenting with the colicky pains, I could have had it taken out, before the bleeding started and intususception. Until now I have been really upset with the hospital thinking it was their fault for sending me home with painkillers, when I ended up there. However they did ask the GP to monitor me, and they had no slots to examine me. I am in the SW.

The GP's did have the info on their system by 14th November, which is after they had me on a fortnight's double course of antibiotics and awaiting an ultrasound of the womb...all the time the cramps continuing and all the tests they were doing coming back negative except the inflammatory markers, until the start of December when I started bleeding, they still didn't check the info when it was on their system, even when I mentioned I had had a previous colonoscopy 3 yrs previous (but thought it 'was ok') They should have checked that, the bleeding should have given confirmaton it was a bowel problem not gyne, I then had two further appts in the following two days where one doc gave me tramadol and thought c-diff, the next day he thought inflammatory bowel disease...

they were supposed to monitor me when sent home from A and E and didn't hear anything from them, all week, my partner had to ring when in the end when they did come out finally, I was bedridden by that stage, asked them for special drink as had been unable to eat for nearly 3 weeks as had had the obstruction..and stringer painkillers. It's all given a new code and put as 'rectal polyp prolapse'

this is a bit grim but there is stuff in the hospital notes saying that when I had the op they had to cut adhesive tissue, the omentum, away before they could get to the site. I have had no previous operations, or reasons to have inflammation, such as previous disease. Am a oung healthy woman who should heal well, but had infection with a swollen abdomen which I head the surgeon say was 'likely as the site was very contaminated' as he discussed the intusussception with his medical students. It was the first adult case he had operated on apparently. The lipoma was 6cm plus, over 14cm colon was taken out meaning a conversion to open surgery and 14cm scar for me.

I have made an intitial contact with someone checked as being ok, validated, on the ICAS website, they are in the next square. However they are waiting till i do through the NHS complaints procedure which is taking ages. the hospital is extending theirs due to staff leave and the GPs has yet to let me know a timescale but my email complaint there was the start of March.

Anyway thanks for reading.

[Sneezecakesmama]

As others have said you need a medical negligence specialist solicitor. These firms also have experts who will assess your documents and records and discuss whether you have a case.

Regarding your case. The lipoma In your bowel is rare and the risks associated with it are perforation and obstruction. Being a benign fatty tumour it obviously continued growing since 2008 and I assume perforated causing your symptoms and peritonitis. I think the original gastro enterologist gave the right advice as a wait and see but think you should have been given better warnings. Not major negligence but very slapdash. Your legal advisors will be looking at the lack of communication between your gp s and whether they negligently disregarded your previous medical history. Hence you did not receive prompt and adequate medical treatment...which you didn't btw.

Incidentally a&e departments don't usually have ready access to patients medical notes, even when the colonoscopy was done in the same hospital, also no access to gp records.

I think you were negligently treated by not having your endoscopy results taken into account when you presented with abdominal colicky pain, it should have been a red flag for treatment and would have avoided all the ops you had and the adhesions, which are caused by inflammation and also surgical procedures, and are so difficult to treat as surgery just creates more adhesions. I think they can be endoscopic ally removed using diathermy or someing less invasive than surgery.

For negligence it needs to be proved that 1 you were harmed by the care you received 2 negligence happened 3 the drs caring for you had not given the care one would expect from somEone in there profession. I think you have a case for sure.

Excuse typing not used to iPad :-)

[catsareevil]

You need to speak to get specialist medico-legal advice about this. You would only be successful in a claim if negligence on the part of the staff was what led to your problems, so the lawyer is likely to want to seek a independent medical opinion to clarify whether the care that you had fell below that level.

[Mharhi]

Also I've just found that the GP's did not enter the info about the previous condition onto their database until 14 November which is about a month after I started presenting with colicky pains! And I have asked them and they sent me a letter saying the information was on their system at the time! Am so upset. Also a fax from the walk in out of hours where I turned up over half term saying about me having 'waves of abdominal pain'- faxed 28 October, entered onto the GP system 14th November.

Wonder if this kind of thing happens a lot. What use is it of all the info solls in when it's too late.

Also the information about the name of my consultant and that I should be referred for a CT if the symptoms worsen is not there.

Serves me right for changing GP's - but, em, that was last March! Surely that should have been time enough to get info on their system, it says something along lines of 'notes are here' in the Spring!