A friend in need

Ms N, a 33-year-old female accountant, presented to Mr X, a consultant orthopaedic surgeon, with severe lower back pain radiating to both legs. A clinical diagnosis of a central disc protrusion at L4/5 was confirmed on MRI scan. Mr X advised laminectomy with discectomy, to which Ms N consented. Mr X did not record the details of the consent process, but has since stated that he would have warned of potential complications.

Mr X recorded the operation as uneventful, but Ms N rapidly became hypotensive postoperatively and an ultrasound scan revealed a large retroperitoneal haemorrhage. Mr X requested an opinion from Mr Y, a consultant general surgeon, who assessed the patient and advised an emergency laparotomy.

During the laparotomy by Mr Y, retrocolic exploration revealed a clot adjacent to the abdominal aorta. Removal of this clot caused a gush of blood and haemodynamic collapse. The aorta was found to have been transected just below the left renal artery. Mr Y clamped the aorta above the renal artery which controlled the bleeding, and the patient’s condition improved.

Mr Y then attempted to perform an end-toend anastomosis of the aorta, but this failed. There was bleeding from the left kidney, which proved uncontrollable, so Mr Y took the decision to remove the kidney. Miss Z, a consultant vascular surgeon, was called in and successfully repaired the aorta with a synthetic graft.

Ms N subsequently made a good recovery. She later brought a claim against the orthopaedic surgeon, Mr X, alleging that there had been an indisputable act of gross negligence in damaging the aorta and in causing the left kidney to be removed.

Expert opinion

Medical Protection’s medicolegal experts considered the case carefully and concluded that it would be difficult to defend the fact that the aorta was transected during an otherwise straightforward laminectomy procedure. The decision was made to negotiate settlement of the claim as swiftly as possible in order to minimise costs.

The case was therefore settled on behalf of Mr X for a substantial sum.

Learning points

• Work within the limits of your competence. In line with the GMC’s guidance Good Medical Practice, doctors must recognise and work within the limits of their competence and refer a patient to another practitioner when this serves the patient’s needs. If an emergency arises in a clinical setting you must take into account your competence and the availability of other options for care. Specialist input was sought in this case, which helped to avoid a more serious outcome for the patient.
• Make clear and detailed notes. When things go wrong during a surgical procedure, the absence of any documentation of the consent process makes a claim very difficult to defend. Patients must be given clear, accurate information about the risks of any proposed treatment, and this must be clearly documented in the medical records.
• Vascular and visceral injuries are a recognised complication of surgery for herniated lumbar disc disease, and frequently result in the death of the patient.
• In this case there were clear vulnerabilities and it was considered unlikely that it would be possible to successfully defend the claim. Medical Protection’s legal team therefore made every effort to avoid incurring unnecessary legal costs and focused on achieving a satisfactory settlement of the claim as soon as possible. As well as saving costs, this also reduced the stress and anxiety to Mr X by shortening the time it took to resolve the matter.