Claim against hospital for delayed diagnosis of endometrial cancer

The claimant was reviewed at her GP surgery after an episode of vaginal bleeding. It was noted that this was a ‘one off episode’ and that she was now experiencing clear, occasionally pink vaginal discharge. A cervical smear and a high vaginal swab were performed to exclude any abnormality.

After her cervical smear and vaginal swab were reported as normal, the claimant attended her GP surgery again as she had suffered from a few episodes of post-menopausal bleeding over the previous three weeks. Her GP made an urgent gynaecology referral.

A month after her initial GP appointment, the claimant underwent a pelvic ultrasound scan at Wrexham Park Hospital. The results showed that the claimant’s endometrium was thickened at 12mm, but no obvious adnexal abnormality was seen. She was listed for an outpatient hysteroscopy.

A few weeks later, the claimant underwent a hysteroscopy and resection of an endometrial polyp at Wrexham Park Hospital. Histology showed nothing of concern and she was discharged back to her GP. No guidance was provided to her in relation to seeking advice from her GP if she continued to suffer from bleeding.

Five months later, the claimant attended her GP surgery again as she had been suffering from post-menopausal bleeding for several weeks. It was agreed that she would be referred for an ultrasound scan and that gynaecological advice would be obtained. Later that day her GP completed an advice and guidance record notifying the gynaecology department that the claimant was suffering from ongoing bleeding and requesting their advice as to whether she needed a further gynaecology review in light of her previous hysteroscopy.

The gynaecology department confirmed to the GP that she should proceed with the ultrasound scan and that if this revealed an endometrial thickness of more than 4mm, the claimant should be referred via a rapid access clinic referral.

The results of the ultrasound scan showed a 13mm posterior wall fibroid, a thickened endometrium at 9mm, and a possible polyp. A gynaecology referral was advised for further assessment of the endometrium and to ensure that there was no sinister pathology. The claimant then had a telephone consultation with her GP who explained the findings to her. Following this consultation, the GP sent an urgent referral letter to the gynaecology department at Wrexham Park Hospital. It is understood that the GP made the referral to the rapid access clinic in accordance with the advice previously received and marked the referral as urgent, noting the history including post-menopausal bleeding.

The referral was not triaged by the gynaecology department for some six weeks when it was triaged as an ‘urgent’ priority and the claimant was scheduled for a gynaecology appointment – but not until several weeks later.

Due to the delay in obtaining an appointment with the gynaecology department, and her fears that her symptoms might be caused by something of concern, the claimant requested a private referral. Following this referral and investigations, she was diagnosed with endometrial cancer.

The claimant made an official complaint to the trust which carried out an investigation noting the following failures in care:

• there was a failure to ensure that the claimant had appropriate guidance following her hysteroscopy and specifically advice to return to her GP if the bleeding continued;
• the information provided to the GP specifically directed re-referral via the rapid access clinic rather than under the two-week rule;
• the advice to the GP that the claimant could not be referred back to the gynaecology team within six months of the hysteroscopy was incorrect – particularly in the context of a patient suffering ongoing post-menopausal bleeding after a hysteroscopy;
• there was a delay in appropriate assessment of the referral and inappropriate categorisation given the symptoms reported resulting in a delayed appointment.

We sought expert input from a gynae-oncology expert and presented a letter of claim making allegations similar to the findings of the internal investigation. It was alleged that, with appropriate care, the claimant would have had an earlier diagnosis and required less extensive surgery, avoiding chemotherapy and the associated side effects – although her overall prognosis was unaffected by the delay .

The trust investigated and made full admissions, following which we were able to negotiate a settlement. Partner Philippa Luscombe, who acted for the claimant, comments: “This was a sad case where the claimant had been proactive in seeking advice about her symptoms and her GP had been prompt in seeking specialist guidance but on multiple occasions the gynaecology team failed to provide the right advice and take action in a timely fashion. It was reassuring to the claimant that our expert felt that her prognosis had not been affected by the delay but understandably this was a worry to her. She had to suffer all the side effects of extensive surgery and chemotherapy which otherwise would have been avoided. However, we were grateful that the trust investigated this case quickly, made early admissions and were sensible in the negotiations.”