Mistake in recovery after surgery?
Discussion
Looking to see if anyone on here is qualified to give their thoughts on the below, ie a Surgeon or an Anaesthetist.
TLDR: Partners mother admitted to hospital after a fall which fractured her lateral femoral epicondyle (?) and then she had to be admitted to critical care with breathing difficulties.
I had to ask the Critical Care Consultant for an explanation of why she had to go on to the unit , as no explanation had been given 2-3 days after she was admitted, and it then took the anaesthetist a further day to call my Partner to explain that she had inhaled a fluid used during the op causing breathing difficulties.
Since then her Mother received this letter a few days ago:
“Reference: Duty of Candour
I am writing to you following our last conversation on X date. During the conversation we talked about the aspiration, unplanned, emergency intubation and Intensive Care admission during the anaesthesia for your emergency surgery for fixation of femur fracture on X date.
I wish to express my sincerest apologies again that this happened. X Hospital is committed to providing safe, high quality care and protecting the wellbeing of every patient.
When we discussed the incident I explained why this unfortunately happened to you. We are already in good understanding of why these types of incidents happen. We agreed the most appropriate approach would be to support you.
When we spoke, you had some questions and I believe I answered them. The risk of aspiration is a known but rare complication during anaesthesia and sedation, even with adequate fasting.
Unfortunately, this complication occurred to you, however there is no contraindication for general anaesthesia or spinal anaesthesia if you require it next time.
Again, I am very sorry that you suffered this complication and intensive care admission. Please do not hesitate to make contact if you have any additional questions regarding this process.
Yours sincerely,”
It appears the explanation in the letter differs from the one originally given in the earlier phone call, am I right in thinking that?
Also my Partner and her Mother are now concerned about how this may affect her recovery from the operation as she has also been told they won’t be able to treat any further injuries requiring surgery to her leg.
Her Mother wants to ensure she gets the help and support she needs to fully recover if that is going to take longer than the three weeks of support she’s so far been offered.
TLDR: Partners mother admitted to hospital after a fall which fractured her lateral femoral epicondyle (?) and then she had to be admitted to critical care with breathing difficulties.
I had to ask the Critical Care Consultant for an explanation of why she had to go on to the unit , as no explanation had been given 2-3 days after she was admitted, and it then took the anaesthetist a further day to call my Partner to explain that she had inhaled a fluid used during the op causing breathing difficulties.
Since then her Mother received this letter a few days ago:
“Reference: Duty of Candour
I am writing to you following our last conversation on X date. During the conversation we talked about the aspiration, unplanned, emergency intubation and Intensive Care admission during the anaesthesia for your emergency surgery for fixation of femur fracture on X date.
I wish to express my sincerest apologies again that this happened. X Hospital is committed to providing safe, high quality care and protecting the wellbeing of every patient.
When we discussed the incident I explained why this unfortunately happened to you. We are already in good understanding of why these types of incidents happen. We agreed the most appropriate approach would be to support you.
When we spoke, you had some questions and I believe I answered them. The risk of aspiration is a known but rare complication during anaesthesia and sedation, even with adequate fasting.
Unfortunately, this complication occurred to you, however there is no contraindication for general anaesthesia or spinal anaesthesia if you require it next time.
Again, I am very sorry that you suffered this complication and intensive care admission. Please do not hesitate to make contact if you have any additional questions regarding this process.
Yours sincerely,”
It appears the explanation in the letter differs from the one originally given in the earlier phone call, am I right in thinking that?
Also my Partner and her Mother are now concerned about how this may affect her recovery from the operation as she has also been told they won’t be able to treat any further injuries requiring surgery to her leg.
Her Mother wants to ensure she gets the help and support she needs to fully recover if that is going to take longer than the three weeks of support she’s so far been offered.
We had something not dissimilar with my then 86yr old father in law.
He was a fit and active guy. He played 18 holes of golf three times a week, including 3 days before his surgery - a routine TKR, his 2nd, at The Spire Hospital. Surgery went fine, but in recovery he got aspiration pneumonia (which could be what your partner’s mother had). They didn’t spot it straight away, he got blue-lighted to the nearby A&E, then contracted sepsis.
Almost died 3 times, we got two 2 & 3am “I’d get here quick if I were you” phone calls, bullied into signing a DNR (we refused), eventually threatened legal action to get him into Intensive Care, a week in there, another 5 weeks on the ward, then 2.5 months in a rehab hospital. All the while told he would never go home, and his next destination would be a care home.
We got him home, he was incontinent (due to being catheterised) and dropped from 12 stone to 9. He then gradually rebuilt his life, but had aged 20 years and is a shell of his former self. It also triggered Vascular Dementia and Alzheimer’s in his wife.
Everyone told us it was an open/shut medical negligence case, certainly in terms of getting him some support and a care package. We spoke to 3 different lawyers, but none of them advised taking it on as in their opinion is wasn’t as open and shut as the hospitals are able to defend their positions, and crucially it didn’t pass the test of 50% success to work on a contingent basis, so we’d have to gamble £25-50,000 in pursuing.
The documentation supplied to solicitors was different to what we had been told at the time….but we couldn’t prove it. They acted like snakes to cover their backs.
SO - as The_Doc says, ask for a sit down with the Clinical Director, but get the meeting recorded and build agreed contemporaneous notes.
He was a fit and active guy. He played 18 holes of golf three times a week, including 3 days before his surgery - a routine TKR, his 2nd, at The Spire Hospital. Surgery went fine, but in recovery he got aspiration pneumonia (which could be what your partner’s mother had). They didn’t spot it straight away, he got blue-lighted to the nearby A&E, then contracted sepsis.
Almost died 3 times, we got two 2 & 3am “I’d get here quick if I were you” phone calls, bullied into signing a DNR (we refused), eventually threatened legal action to get him into Intensive Care, a week in there, another 5 weeks on the ward, then 2.5 months in a rehab hospital. All the while told he would never go home, and his next destination would be a care home.
We got him home, he was incontinent (due to being catheterised) and dropped from 12 stone to 9. He then gradually rebuilt his life, but had aged 20 years and is a shell of his former self. It also triggered Vascular Dementia and Alzheimer’s in his wife.
Everyone told us it was an open/shut medical negligence case, certainly in terms of getting him some support and a care package. We spoke to 3 different lawyers, but none of them advised taking it on as in their opinion is wasn’t as open and shut as the hospitals are able to defend their positions, and crucially it didn’t pass the test of 50% success to work on a contingent basis, so we’d have to gamble £25-50,000 in pursuing.
The documentation supplied to solicitors was different to what we had been told at the time….but we couldn’t prove it. They acted like snakes to cover their backs.
SO - as The_Doc says, ask for a sit down with the Clinical Director, but get the meeting recorded and build agreed contemporaneous notes.
It sounds like she aspirated during recovery. It happens sometimes (as in it’s a recognised complication) but it’s not generally a good thing when it does happen.
It’s not clear from your post whether she has suffered any lasting damage from this? If she’s now out of hospital and all is ok, what exactly do you hope to achieve from involving solicitors?
As above, just phone them and ask if you’re not sure.
It’s not clear from your post whether she has suffered any lasting damage from this? If she’s now out of hospital and all is ok, what exactly do you hope to achieve from involving solicitors?
As above, just phone them and ask if you’re not sure.
TheHeadhunter said:
<snip> bullied into signing a DNR (we refused), </snip>
Huge apologies for O/T but could i just check this?My dad was recently in a similar situation where the Consultant said he would be classed as DNR. We all said "No, you can't do that!" and were told "It's not for you to decide, it's a medical decision. You can ask for a second opinion but you don't actually get to say whether or not we can class him as DNR".
So can next of Kin demand that a patient isn't classed as DNR?
Countdown said:
Huge apologies for O/T but could i just check this?
My dad was recently in a similar situation where the Consultant said he would be classed as DNR. We all said "No, you can't do that!" and were told "It's not for you to decide, it's a medical decision. You can ask for a second opinion but you don't actually get to say whether or not we can class him as DNR".
So can next of Kin demand that a patient isn't classed as DNR?
You’re fine as my question was answered by the first two responses so hopefully someone here will know the answer to your question.My dad was recently in a similar situation where the Consultant said he would be classed as DNR. We all said "No, you can't do that!" and were told "It's not for you to decide, it's a medical decision. You can ask for a second opinion but you don't actually get to say whether or not we can class him as DNR".
So can next of Kin demand that a patient isn't classed as DNR?
If it helps my Mother has an DNR in place and, my memory says, it was solely her decision but she was also told that if the medical Team decided there was little benefit in resuscitating her then they wouldn’t but I think that’s the same for many others.
Countdown said:
TheHeadhunter said:
<snip> bullied into signing a DNR (we refused), </snip>
Huge apologies for O/T but could i just check this?My dad was recently in a similar situation where the Consultant said he would be classed as DNR. We all said "No, you can't do that!" and were told "It's not for you to decide, it's a medical decision. You can ask for a second opinion but you don't actually get to say whether or not we can class him as DNR".
So can next of Kin demand that a patient isn't classed as DNR?
Now in fairness, they didn't know that at the time, we just refused to allow them to class him as DNR, then followed up with the LPA.
From my experience, in that circumstance, medics can be s
ts and totally ignore the Hippocratic Oath, especially the 'Non-maleficence' part. IMO....etcUnlikely you'll get an anaesthetist on here to admit it but aspiration pneumonia is a rare but a potentially deadly thing - hence the ICU admission. Or did it happen in the ICU, as that can happen as well sometimes?
How it happened isn't clear from what has been posted but it can happen, even when someone is fully intubated and it is more common when they haven't been (breathing not assisted during the procedure). I'm posting as a patient who has had several of these. Aspiration can happen from stomach contents, and or gastric reflux. Then there are things that make intubation difficult to do...
Was there a discussion with an anaesthetist pre-op about what their plan was? It seems they have admitted to something, not clear what though. The anaesthetic, its administration, interaction with the patient, is the risky bit of the operation, and rarely the operation itself.
Anaesthetists as a rule are fastidious at note keeping - so you could ask to see them. Anything adverse happening will have been recorded there.
How it happened isn't clear from what has been posted but it can happen, even when someone is fully intubated and it is more common when they haven't been (breathing not assisted during the procedure). I'm posting as a patient who has had several of these. Aspiration can happen from stomach contents, and or gastric reflux. Then there are things that make intubation difficult to do...
Was there a discussion with an anaesthetist pre-op about what their plan was? It seems they have admitted to something, not clear what though. The anaesthetic, its administration, interaction with the patient, is the risky bit of the operation, and rarely the operation itself.
Anaesthetists as a rule are fastidious at note keeping - so you could ask to see them. Anything adverse happening will have been recorded there.
Edited by Yahonza on Monday 31st August 19:28
DFNorfolk said:
You re fine as my question was answered by the first two responses so hopefully someone here will know the answer to your question.
If it helps my Mother has an DNR in place and, my memory says, it was solely her decision but she was also told that if the medical Team decided there was little benefit in resuscitating her then they wouldn t but I think that s the same for many others.
Thanks. That’s what I thought as well and that’s what’s on the NHS website.If it helps my Mother has an DNR in place and, my memory says, it was solely her decision but she was also told that if the medical Team decided there was little benefit in resuscitating her then they wouldn t but I think that s the same for many others.
https://www.nhs.uk/tests-and-treatments/do-not-att...
At the time we were absolutely distraught that the doctors could do this without our consent but the reasons why were explained to us. Fortunately Dad’s made a significant recovery.
We involve parties in DNACPR decisions but do not need consent to make them. Second opinion on the DNACPR decision is of course always offered.
Only the Court of Protection can overrule a clinician or hospital's decision. Not an LPA for Health.
Once you've been to a hundred or so failed CPR attempts on pensioners, you start to see the rationale. Sudden unexpected death, and it's exactly and only this that it covers, is sometimes just the end.
Intensive Care admission is also not a right or patient/family choice.
As my friend and respected colleague, in charge of our ITU put it, "for families, this might be their first meeting with death, or the concept of, so it's frightening and filled with misinformation. But sadly death is both commonplace and inevitable in my job, and my experience is not wielded lightly."
Only the Court of Protection can overrule a clinician or hospital's decision. Not an LPA for Health.
Once you've been to a hundred or so failed CPR attempts on pensioners, you start to see the rationale. Sudden unexpected death, and it's exactly and only this that it covers, is sometimes just the end.
Intensive Care admission is also not a right or patient/family choice.
As my friend and respected colleague, in charge of our ITU put it, "for families, this might be their first meeting with death, or the concept of, so it's frightening and filled with misinformation. But sadly death is both commonplace and inevitable in my job, and my experience is not wielded lightly."
DFNorfolk said:
"When we discussed the incident I explained why this unfortunately happened to you."
So the explanation given was that she "had inhaled a fluid used during the op causing breathing difficulties".Either way up, there's no point pushing further without a clear understanding of what you're trying to achieve. The past cannot be changed, and even if you were to argue there had been "negligence" you would firstly have to prove that negligence existed and secondly demonstrate that some "damage" had resulted from it. Claiming for "worry that something might go wrong in the future" won't really stand up on its own.
I anticipate they've used words like "sorry" and "apologise" because that's what people want to hear rather than because they think they've done anything wrong.
It sounds like the surgery was performed under spinal anaesthesia initially. She then aspirated requiring them to convert to a general anaesthetic. Patient's can aspirate on their own vomit/ saliva and when it enters their lungs causes breathing issues and aspiration pneumonia. It's a known complication with any form of surgery which is why people are kept nil by mouth. These days there is a push to keep patient's hydrated by allowing them clear fluids until closer to the surgery.
As others have said, what is the reasoning for talking to solicitors? Has there been longterm harm?
As others have said, what is the reasoning for talking to solicitors? Has there been longterm harm?
Panamax said:
DFNorfolk said:
"When we discussed the incident I explained why this unfortunately happened to you."
So the explanation given was that she "had inhaled a fluid used during the op causing breathing difficulties".Either way up, there's no point pushing further without a clear understanding of what you're trying to achieve. The past cannot be changed, and even if you were to argue there had been "negligence" you would firstly have to prove that negligence existed and secondly demonstrate that some "damage" had resulted from it. Claiming for "worry that something might go wrong in the future" won't really stand up on its own.
I anticipate they've used words like "sorry" and "apologise" because that's what people want to hear rather than because they think they've done anything wrong.
What we’d like to know is when and how it happened which I think is a fair question considering she ended up in critical care.
DFNorfolk said:
Thanks both really helpful and I ll let her know what you ve said.
I think it might be an idea for us to get some time with a Solicitor, ahead of sitting down with the hospital, to get an idea of what questions they think they d want answers to to see how to proceed if at all.
go for itI think it might be an idea for us to get some time with a Solicitor, ahead of sitting down with the hospital, to get an idea of what questions they think they d want answers to to see how to proceed if at all.
pull more money from the NHS...
Gary C said:
DFNorfolk said:
Thanks both really helpful and I ll let her know what you ve said.
I think it might be an idea for us to get some time with a Solicitor, ahead of sitting down with the hospital, to get an idea of what questions they think they d want answers to to see how to proceed if at all.
go for itI think it might be an idea for us to get some time with a Solicitor, ahead of sitting down with the hospital, to get an idea of what questions they think they d want answers to to see how to proceed if at all.
pull more money from the NHS...
Gassing Station | Health Matters | Top of Page | What's New | My Stuff