I’ve just been denied medical management of a failed abortion

[Tinyteatime]

I had a medical termination last Saturday, 7 weeks pregnant after my coil failed. Thought it had passed relatively easily so came away on a short holiday with my family luckily only 1.5 hours away from home. Started heavy bleeding and bad cramps yesterday, came to a&e as as advised by the BPAS clinic as I was flooding a pad and blood leaking through my trousers. Passed some very large clots. Internal scan reveals what they think is a foetal heart beat still in there. I’ve been in hospital one night and they said they would do the surgery on me this morning. I’ve just been told that all the doctors available won’t perform the procedure due to religion. This in the U.K. in 2019, in a hospital that offers abortion services. They’ve said I can stay another night and have it tomorrow, I have a breastfed baby that I’ve already been away from for one night, I’m in pain, bleeding and I’ve already had sepsis last year from a womb infection whilst giving birth so I’ve raised infection risk as a concern. I feel so angry about this. Would they deny women treatment for miscarriage? Or is it because there may still be a foetal heartbeat present? Is it simply because I’ve chosen to end the pregnancy myself? How in an nhs hospital can women be denied healthcare like this?

it's cruel, misogynistic, outdated bullshit!!

@Graphista and that may well be the direction in which the OP should go with her complaint.

As it stands, there doesn't appear to be grounds for a negligence/malpractice case.

However, attacking the policy that allows doctors to object to performing these procedures in these situations probably won't get her very far either for the reasons highlighted previously

In Islam it is believed that Allah has known people since conception but is also believed that a foetus doesn’t get a soul until 120 days (17 and a bit weeks) so up to that point a termination is completely acceptable

This isn’t reflected in the laws of Muslim countries, most are extremely restricted!

I'm just saying none of this is negligence or malpractice as other posters have implied

I luckily didn’t develop an infection, but if I had it would certainly be a case of negligence. I believe that team are playing with fire. My main complaint is that if they didn’t deem it a medical necessity for me to have surgery, why did they add me to the surgery list for the next day in the 1st place? Had they simply said that having reviewed my scan and current symptoms I had a failed termination, I didn’t need surgery as a matter of urgency, I can go home to my breastfed baby, I wouldn’t have questioned that decision. I repeat, the doctors who reviewed my case in the evening suggested surgery and talked about infection risk. My care plan then changed because of religious objections. They didn’t actually discharge me until I had been on the ward for the whole of the next day 9 hours nil by mouth. The ‘objectors’ tried to get the emergency team to operate on me, potentially putting other patients at risk, why? It may not be actual negligence but it’s certainly unacceptable in more ways than one. I’m really sorry for anyone who has followed from the beginning and has had to hear me repeat myself 1000 x for those that still don’t seem to grasp why my care was substandard.

Absolutely, OP. I’m working on the basis that the only senior clinician to see you and be definitive about what was seen on scan, was the dr who operated on you. He said there were retained products, and clarified he was treating you as such. Clearly I can’t see the notes - but this is what you were told.

For anyone failing to understand this (including the other clinicians on the thread), this means that OP already had her TOP, and was admitted as an emergency with a complication of it. In her case, due to heavy prolonged bleeding (soaking through clothes) and history of uterine sepsis postnatally, she was correctly deemed to need emergency surgery. This was delayed by conscious objectors, VERY wrongly for 2 reasons:
Firstly, anyone needing emergency care CANNOT have this refused due to the doctors beliefs (only elective, non-emergency TOP).
Secondly, this was NOT a TOP, from the info the OP has been given. Again, no doctor allowed to withold any intervention (emergency or elective) to treat complications of a TOP that has already occurred.

As I clarified further up in the thread, it’s not possible for there to be a viable pregnancy seen within a collapsed gestation sac. If there was a heartbeat (which seems highly doubtable, given talk of a “possible flicker”) this would be seen in the context of a visible gestation sac and measurable fetal pole. Highly dangerous for inexperienced staff to guess what they can see ... and not to have sought senior advice at this stage.
OP, please do pursue for the reasons outlined. There is no defence for their mismanagement. I’ve worked in units like this for too many years - once saw a woman delayed and delayed due to staff refusing to take her to theatre in the name of religion....she eventually needed CPR on her way to theatre due to continued, low- level blood loss and sepsis over the course of a weekend. She survived.....just. Clearly things haven’t improved much. Very depressingly.
So glad the outcome was better for you.

I'm not denying that your care was distressing and unpleasant. I absolutely wouldn't wish it on anyone.

But negligence and malpractice both have defined, legal meanings and your care does not stray into the realms of either

If you are going to complain, you need to stick to complaints about the way you were made to feel, rather than the actual clinical care you received. I've handled many complaints within the NHS and I promise you that bandying around terms like negligence will only undermine your argument

In Islam it is believed that Allah has known people since conception but is also believed that a foetus doesn’t get a soul until 120 days (17 and a bit weeks) so up to that point a termination is completely acceptable

This isn’t reflected in the laws of Muslim countries, most are extremely restricted!

^^
Well it was reflected exactly in the Muslim country I lived in; although I had no idea why their TOP laws were limited to 17 weeks until I read this thread.

So glad Tiny and her baby are OK.

They will have kept you nil by mouth in case of a sudden space on the theatre list. This is standard practice.

If there had been space available with a consenting surgeon you would have had the surgery that day. As it was, no space became available so you came back for the procedure the next day.

This happens all the time with elective surgery in every single specialty. It's crap, it's a waste of time, it's distressing, but it isn't negligent.

justchecking, you may be clinical, but it seems you are wilfully failing to grasp the crux of the matter as per my recent post.
I have seen this happen many times over 20 years as a gynaecologist, specialising in provision of terminations. You may not want to believe woman are mistreated due to some doctors having a very over-optimistic view of what being a conscientious objector means they can opt out of - but it is still the case, and commonly. Women die of mismanaged retained products, whether after TOP or miscarriage.
The OP had incorrectly delayed emergency surgery, not elective. Unfortunately, because most TOP care is contracted out to BPAS and other providers, some clinicians now think anything to do with a termination is someone else’s business. Disgraceful.

@quince2figs it clearly wasn't an emergency or the OP wouldn't be here to tell the tale! Her surgery was delayed, but physically she's fine (although understandably very upset) so there's no way you can claim she was denied emergency, life-saving surgery

I have seen this happen many times over 20 years as a gynaecologist

Are you genuinely a qualified gynaecologist? In the UK? Because your understanding of this case as the OP presents it would suggest not

Many of the clinicians commenting on this post seem very concerned the OP may make a claim for negligence, do they work at the hospital in question? Are they trying to cover their backs?
Just asking.

Are you genuinely a qualified gynaecologist? my thoughts exactly.

I luckily didn’t develop an infection nor did you die, or in fact come to any harm at all , which is why you don't have a case for negligence or malpractice. Prolonged discomfort and inconvenience are not reasons to claim for negligence or malpractice.

It seems a bit peculiar to recognise as a medical emergency only those incidents which in retrospect have catastrophically bad consequences.

That's not how risk assessment and management work. You have to assess things up front, not with the benefit of hindsight. And you have to think not just about the situations where the worst outcome did happen, but also the situations where the worst could have happened, but you got lucky this time. That's why airline pilots, for instance, have to record near misses.

OP lasted another day and successfully went through surgery. But surely any clinician worth their salt should have Savita Halappanavar's tragic case in the back of their mind. Haemorrhage, retained products of conception, past history of uterine infections - we've got at least one gynaecologist on this thread confirming that these are indeed indications that you don't waste time, you get on with doing an ERPC. The clinicians got lucky, and OP mercifully is well and healthy - but it seems to me going from what the majority of HCPs on this thread have said, that this could have gone badly wrong.

I'm not a medic, but I am a scientist, and you get a feel for when people are giving details which come across as the sort of plausible account a scientist in the field would give, and when they're just bullshitting. Quince comes across to me as someone who knows their stuff. Other posters on this thread... possibly not so much.

Many of the clinicians commenting on this post seem very concerned the OP may make a claim for negligence, do they work at the hospital in question? Are they trying to cover their backs?

No and no.
She can go ahead and make a claim if she likes, but she won't get anything, because there is nothing to claim for. Complain that the service was shocking......you'll get a standard NHS "we are sorry that you are unhappy with the care you received but we are already short staffed, realistically can't do anything to change it in the future because we have no money and no staff, and have wasted a shit load of time replying to yet another complaint we hope you have fully recovered.

There is no defence for their mismanagement. I’ve worked in units like this for too many years - once saw a woman delayed and delayed due to staff refusing to take her to theatre in the name of religion....she eventually needed CPR on her way to theatre due to continued, low- level blood loss and sepsis over the course of a weekend. She survived.....just. Clearly things haven’t improved much. Very depressingly.
So glad the outcome was better for you.

This is why the OP needs to complain. Once the culture of a clinical unit becomes to wait a bit, if you can, because of non-clinical reasons like religious regions, then clinical decision-making becomes muddied.

The OP was clearly bleeding a lot when she came in, her plan was changed because of TOP objections. Sure, it was fine in the end - for her - but another large bleed on the ward that night may have led to a less good outcome. TOPs are common and frequent and there can be complications, refusing to deal with those complications acutely is not addressing an important component of women’s reproductive care.

That’s why there needs to be a compliant.

I’ve never actually said Im going to ‘make a claim for negligence or malpractice’. I’m not so naive that I think that would get anywhere at all. What I’m saying is that I think those doctors took a risk (maybe slight, but maybe not in a patient with recent history of womb infection and sepsis) delaying my treatment when their colleagues the night before had clearly deemed it a necessary procedure. They didn’t review me and then decide to postpone my care based on clinical need, they had made the decision that they would not operate before they even saw me on the ward the morning my surgery had been scheduled. HAD I developed an infection, then it would certainly have been negligence and women have died from complications of this situation, that’s why I’ve posted this on a feminist board. This shit potentially puts womens lives at risk. Its not good enough for clinicians to take those risks based on their personal views alone and then say afterwards ‘well they came to no harm so it must have been fine’. As I said, ticking time bomb.

Unfortunately, because most TOP care is contracted out to BPAS and other providers, some clinicians now think anything to do with a termination is someone else’s business. Disgraceful.

This ^^ 100% is the case. It’s been an eye opener I can tell you. I know the 1in 3 statistic has been debated but the fact is a lot of women will have a termination. This is a massive part of women’s healthcare.

This is a massive part of women’s healthcare

This. The doctors who want all the bits they like, but not the awkward, uncomfortable, challenging bits.....well that option isn’t open to women. We get the whole package, and anyone who wants to specialise in providing health care for women needs to be prepared to deal with the whole package too

One more time....

1. OP presented with heavy bleeding following TOP. Exactly as she should have done, no arguments about this.

1. Once in the hospital she stabilised and was no longer considered an emergency. Was listed for surgery the next day. If she had been in life threatening, emergency situation she would have had the procedure right there and then so even the original doctor thought she could wait overnight with no ill effects

1. Scan completed. Dr diagnosed there was still a live foetus in situ (either because he felt he could detect a heartbeat {most likely scenario} or because he was part of some huge conspiracy to thwart the OPs care so he and his colleagues could avoid doing any work/could go and play golf {less likely scenario})

1. Surgeon declined to operate on personal grounds. OP remained clinically stable and was kept nil by mouth on the off chance that a space on the theatre list became available. It didn't. She was discharged (so the medics clearly didn't feel there was really any risk at all at this point otherwise the last thing they'd have done is let her go home!)

1. Readmitted the next day. Scan confirms no live foetus (but clearly this doesn't mean the original scan was wrong as OP had had a TOP and we'd therefore expect this outcome sooner or later) and procedure performed. At this stage the procedure could have been carried out by any member of qualified staff as the foetus was no longer live. OP goes home.

Which part of this do people feel meets the legal standard for negligence or malpractice as outlined by the GMC??

Agree re culture. This is why I'd make a complaint to the GMC.

It may well be right that the OP doesn't have a legal claim, because for a case to be made out someone must have a duty to her, the duty must have been breached and she must have suffered damage. The first two conditions are satisfied here (the clinicians had a duty of care, and they were almost certainly in breach of their duty by playing Russian roulette with the risk of infection) but very thankfully the final one is not: OP is well, by very good fortune. I am appalled that there are people on this thread claiming to be doctors who say complaining is a waste of time: NHS trusts are meant to learn lessons from this kind of near-miss.

OP, hope you're feeling much better now.

OP I'm not getting at you. I wouldn't blame you for feeling like making a complaint, no one wants to feel judged while seeking medical care.

I'm getting at the many PPs who are encouraging you to complain because your care has been negligent/dangerous/substandard, etc

It genuinely hasn't been any of those things and making a complaint based on anything other than hurt feelings will get you nowhere.

The GMC will not be particularly interested either as it sounds like all the 'duties of a doctor' as outlined in the GMC handbook have been fulfilled

To the 2 drs above: absolutely, yes, I’m a gynaecologist and work in TOP most days. But I’m getting on a bit, and don’t subscribe to the current NHS misogyny of assuming women are fine with clinically poor care, because “they’ll cope” “made of stern stuff” etc. Same with childbirth.
Emergency care is non- elective - it does not mean you need to die, or nearly die, or have sepsis. I cannot believe that a doctor seriously has stated that because OP “is here to tell the tale” that it’s not an emergency - really that naive??!
I’m guessing neither of you have seen at first hand how easy it is to pretty much bleed out due to some products or tissue stuck in the cervix. That was happening to the OP and thankfully stopped. But a good outcome is a retrospective diagnosis. You have a very warped view of doctors’ power if you believe every good outcome was directly as a result of their chosen course of action.

Op, sorry to derail. I wish you all the very, very best, and hope your milk supply is recovering.

Complain OP, you have grounds

Dr at which point did the OP say she wanted compensation? My feeling is she, quite rightly, wants an investigation into what happened and a clear message sent to the people who refused to treat her that their actions were unacceptable.

“Felt he could detect a heartbeat” - hmmm, don’t recall being trained in ultrasound to interpret far from clear scan findings with my emotions......