We have recently settled a claim against an NHS trust for a delay in diagnosing and operating on ovarian torsion.
This claim related to care received by the claimant, who was in her twenties, after being admitted to a hospital run by the defendant trust with severe abdominal pain on her left side, vomiting and haematuria.
The claimant had a CT scan of the urinary tract for a suspected renal stone, which identified a mass in the lower abdomen, consistent with an ovarian dermoid cyst. A gynaecology referral was recommended.
The scan results were reported during the evening of the claimant’s arrival but no one in the emergency department reviewed the results or made a referral to a gynaecologist before the following morning. The claimant stayed in overnight, remained in significant pain and required morphine. The next day her pain levels were improved, and she had an ultrasound scan, which confirmed the presence of a dermoid ovarian cyst.
The claimant was reviewed by a gynaecology senior house officer who informed her about the cyst, and that she could be discharged home because the pain was not as severe as the previous day.
At home the following morning, the claimant awoke in considerable pain and had difficulty walking. In the afternoon the pain worsened, and she began to bleed. She went to A&E at a different NHS trust where ovarian cyst torsion was immediately suspected, and she was transferred to a specialist gynaecology team in the early hours of the following day.
After being reviewed by the gynaecology team, torsion was again suspected and the claimant was taken for a laparoscopic ovarian cystectomy that morning. During the urgent laparoscopic procedure, she was found to have a torted left necrotic tube and ovary containing a large dermoid cyst. The surgical team was unable to preserve the ovary or fallopian tube in view of the necrosis.
During the claim, expert evidence was obtained from a gynaecologist who confirmed that ovarian torsion was the most likely diagnosis following the CT scan when the claimant first attended hospital. Had the scan been reviewed in a timely manner, the claimant would have been seen by the gynaecology team on the evening she attended hospital, and would have likely undergone emergency surgery no later than the following morning.
Timely surgery would have resulted in a confirmed diagnosis of ovarian torsion and removal of the cyst to prevent further torsion and damage to the ovary and fallopian tube. The claimant would have avoided an additional 48 hours of pain and her ovary and fallopian tube would have likely been saved. This put the claimant at risk of entering the menopause marginally earlier than she otherwise would have done.
She also sustained a psychiatric injury (PTSD and adjustment disorder) which the psychiatric expert confirmed was not due to the need for surgery. This would have been required in any event. Her injury was instead due to the following: the fact that the claimant suffered increased pain and discomfort over a period of 48 hours; the fact that she had lost her ovarian and fallopian tube and the concern this has caused her regarding future fertility; and the feeling that her concerns and level of pain were ignored on her initial A&E attendance. As a result of this injury, the claimant felt unable to continue in her high pressured job and did not return to her pre-negligent earning capacity for some time after the event.
After supportive expert evidence was obtained, a letter of claim was sent. In response, the trust admitted breach of duty but denied causation in its entirety. After reviewing the arguments put forward in the letter of response with our medical and psychiatric experts, we proceeded to quantify the claim. The defendant was agreeable to limitation extensions to allow the claimant to finalise her quantum evidence, and to allow the parties to commence settlement negotiations prior to it becoming necessary to issue proceedings.
The claim was subsequently settled for the sum of £75,000. This settlement represented a good result for the claim, especially as causation was denied by the defendant in its entirety throughout. Despite this, and in light of the risks involved in proceeding with a case firmly denied in respect of causation, the settlement represented a good recovery of the schedule of loss, which included a substantial loss of earnings and loss of pension claim arising from the claimant’s psychiatric injury.
The claimant was also pleased to have concluded matters before it became necessary to issue proceedings. This was a good example of a pragmatic approach being taken by both parties in agreeing sensible limitation extensions, and allowing settlement discussions to take place before the costs of issuing proceedings were incurred.