The clinical negligence team at Penningtons Manches LLP is running a large number of negligence claims against Frimley Park Hospital in Surrey relating to care provided by one of its former consultants, obstetrician and gynaecologist Jayne Cockburn. This latest claim formed part of an informal group action that the team is pursing against the trust involving Miss Cockburn. She practised at Frimley Park Hospital until 2011 before officially resigning in December 2014 after it emerged that a number of her former patients had been recalled for review in July 2014 following a look-back exercise carried out by the trust. Nearly half of the patients who were contacted were advised by the doctors carrying out the review that the treatment provided by Miss Cockburn was ‘unnecessary’ and that ‘significant harm’ had been caused as a result.
In this case, Penningtons Manches’ client saw Miss Cockburn in February 2005 for advice on vulval varicosity. During the consultation, the claimant described symptoms of a prolapse with some occasional leaking of urine when doing any strenuous exercise, such as running. Previous urodynamic assessment had shown no evidence of stress incontinence. An examination confirmed an anterior prolapse and a mild posterior prolapse. Miss Cockburn advised that if the claimant needed surgery for the vulval varicosity, then it would be ‘sensible to think about surgery for her bladder’ at the same time. She was listed for surgery in September 2005.
Prior to this, Miss Cockburn went on leave and the claimant’s notes were reviewed by another consultant who advised against surgery until further investigations were undertaken. The claimant was seen again in clinic by another doctor when she explained that the urinary incontinence did not interfere with her life and things were improving with physiotherapy. She was advised not to have surgery and to continue with conservative management.
In June 2006 the claimant was reviewed by Miss Cockburn. The claimant explained that the stress incontinence was no worse. Miss Cockburn told her that, as she aged, the stress incontinence would eventually worsen and therefore advised her to have surgery as a preventative measure. The claimant consented and in October 2006 Miss Cockburn performed surgery, including posterior repair and insertion of Avaulta mesh and a transvaginal tape (TVT).
Subsequently, the claimant noticed an unpleasant odour from her vagina and suffered from heavy discharge. She was seen at Frimley Park Hospital and was advised that there was nothing wrong. The discharge continued and this had an impact on her relationship with her husband. Towards the end of 2013, she noticed some bleeding and returned to the hospital again. Further investigations revealed eroded mesh protruding from the posterior vaginal wall which was thought to be the cause of the vaginal discharge, pus and bleeding. She underwent surgery in July 2014 to remove the mesh, which was found to be infected and IV antibiotic treatment was prescribed.
All of the claims which Penningtons Manches is bringing for Miss Cockburn’s patients relate to urogynaecological practices and therefore involve hugely sensitive issues. Most of the women have sustained permanent, life-changing injuries as a result of inappropriate advice and treatment. The over-arching theme in the cases is Miss Cockburn’s willingness to proceed to extensive, major surgery without considering and trying conservative treatment first.
Penningtons Manches alleged that the patient in this case underwent unnecessary surgery in 2006 without recourse to conservative management; that she was poorly investigated by urodynamics; that she did not require a posterior repair, insertion of mesh and TVT; and that no informed consent for the surgery was obtained. It was particularly concerning that she was not aware that she had the mesh or TVT until her problems with erosion in 2014.
Expert evidence was obtained and Penningtons Manches submitted a detailed letter of claim setting out a number of allegations of negligence in the care received. Breach of duty and causation were admitted by the trust and the claim proceeded on the basis of quantum alone. In order to quantify this claim, Penningtons Manches obtained condition and prognosis evidence from an expert urogynaecologist. The claimant had experienced the pain and stress of major surgery twice and this could have been avoided. After the surgery, the claimant reported bladder problems including occasional stress incontinence and urinary urgency with urge incontinence on a frequent basis. These symptoms, for which the claimant had to wear incontinence pads, occurred from shortly after the surgery in October 2006 until the mesh was removed in July 2014.
As a result of the mesh erosion, the claimant had to endure problems with offensive discharge and intermittent vaginal bleeding for over two years. There are long-term risks associated with TVT. The scar tissue from the mesh erosion and surgery required to remove it may result in a number of problems, including colorectal issues.
Elise Bevan, senior associate in the clinical negligence team, who is running some of the cases against Miss Cockburn, comments: “While the trust and the NHSLA were sensible in their approach to this claim and settled relatively quickly, compensation cannot undo what the claimant has gone through. Her care was entirely unacceptable and she now faces the risks of additional complications. Her compensation will at least ensure that ongoing follow up can be undertaken by a private specialist of her choice given the understandable lack of confidence which she now has in medical advice.”