University College Hospital agrees compensation for failing to advise on treatment options before cardiac procedure which led to patient’s death

Posted: 11/10/2016

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Penningtons Manches’ clinical negligence team has settled a claim against University College London Hospitals NHS Foundation Trust on behalf of the husband of a woman who died as a result of failures in the cardiology care which she received.

In January 2012, the woman was found to have a heart murmur and a pancreatic mass, which was presumed to be malignant. She was advised that she required surgery to treat her heart murmur before a biopsy of her pancreatic mass could be carried out. A transcatheter aortic valve implantation (TAVI) was recommended but alternatives to the TAVI procedure to permit laparoscopy and biopsy of the pancreas were not explored. 

During the course of the operation, the woman became hypotensive due to a rupture of her infra-renal aorta. After the TAVI procedure had been completed, it was noted she had poor circulation in her right leg and surgeons therefore performed a femoro-femoral bypass graft to correct this. As a result of the extended time for the procedure and the additional surgery, the woman was transferred to the intensive care unit (ICU), sedated and ventilated. Several attempts were made over the following days to take her off ventilation by removing the endotracheal tube but on each occasion she became agitated and required re-intubation.

The consultant anaesthetist in charge of the ICU decided that it was in the woman’s interest to have a tracheostomy to help wean her off the ventilator and optimise her sedation. Although he was unable to obtain her consent due to her condition, he did not seek to consult her family.  While the tracheostomy was being performed, the surgeon ruptured the woman’s right subclavian artery, causing profuse bleeding. He made arrangements for an emergency transfer to theatre and manual pressure was applied within the incision for 30 minutes in an attempt to reduce the bleeding. When the theatre was ready, the surgeon performed a sternotomy during which her innominate artery was clamped for about four minutes. As a result, the blood flow to the right side of her brain was interrupted, causing a cerebral infarction and cerebral oedema.

In the early hours of the following morning, a CT scan confirmed that the woman had suffered an acute cerebral event. Her condition deteriorated over the following days and she died. At post-mortem, her death was found to have been caused by a massive cerebral infarction.

Penningtons Manches was appointed to carry out investigations on behalf of the woman’s husband and obtained supportive expert evidence. The firm’s clinical negligence team presented a claim to the trust, alleging that if the alternative treatment options to the TAVI had been explained to the woman, she would probably have elected to undergo one of these after considering issues such as risks and recovery time. In that case, her pancreatic biopsy would have taken place uneventfully and none of the events relating to the performance of the TAVI would have occurred. 

It was also alleged that if the tracheostomy had been performed correctly, the woman would have recovered from the procedure and that she should have been able to leave hospital within 10 days, returning home to lead a normal life.

As liability was disputed, Penningtons Manches issued court proceedings to progress and resolve matters. The case was settled following negotiations, although no admissions were made by the defendant.

Rebecca Morgan, an associate in Penningtons Manches’ clinical negligence team, commented: “This was a very sad case. The patient and her family experienced an extremely traumatic time following her TAVI procedure and ultimately these events led to her death. Although we began by investigating the technical standard of care provided, it became apparent that there were other options available to the patient which would have achieved the same aims but would have been more attractive to her.  It is mandatory for doctors to discuss not just the risks and benefits of a proposed course of treatment but also whether there are any appropriate alternatives and in her case, this did not occur – an error which was then compounded by later failures surrounding the tracheostomy.

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