Summary
Mr C complained to the board following treatment he received at Raigmore Hospital. He was admitted for a haemorrhoidectomy (surgery to remove haemorrhoids) and flexible sigmoidoscopy (a procedure to look inside the back passage and lower part of the large bowel). Polyps (small growths on the inner lining of the bowel) were found and removed during the sigmoidoscopy. Mr C was readmitted two days later, after experiencing considerable pain, and it was found that he needed emergency surgery for two holes in his bowel. Mr C said he was told that, if this second operation was not successful, he would need more surgery and a temporary colostomy bag. He said that the procedure caused him further pain, stress and anxiety.
Mr C said that he consented to surgery for haemorrhoids and to a flexible sigmoidoscopy on the understanding that the sigmoidoscopy was investigatory, and that he was not told polyps may be removed if identified. He said that, if he had known of the possibility of damage to his bowel, he may not have had the original procedure done. He was also concerned that, due to annual leave, the surgeon he had seen before his original day surgery did not perform the operation.
In investigating Mr C's complaints, my complaints reviewer obtained independent medical advice from a consultant colorectal surgeon who is experienced in carrying out the surgery Mr C had done.
My adviser noted that the board’s response to Mr C’s complaint said that the risk of bowel perforation from flexible sigmoidoscopy is low but increased with treatment for polyps. My adviser referred to General Medical Council guidance on consent which says that doctors must tell patients if an investigation or treatment could result in a serious adverse outcome. He said that, as the risk of perforation (and, therefore, a hospital admission) is a serious adverse outcome, not having discussed or made a record of such a discussion was unreasonable. He felt the question of whether polyps should have been removed was irrelevant as the consent process was inadequate.
Regarding Mr C's transfer from the care of the surgeon he had seen before his original day surgery to another surgeon, my adviser explained that it was the responsibility of the surgeon in charge of the case on the day to ensure that a procedure's risks had been explained. He said that the second surgeon should have ensured that the first surgeon had properly discussed the procedure with Mr C but the evidence did not show that this was done.
In light of the clear medical advice, I uphold the complaints and have made recommendations to the board.
Redress and recommendations
The Ombudsman recommends that the Board:
- (i) apologise to Mr C for the failings identified in this report; 28 October 2015
- (ii) consider introducing pre-printed consent forms for common procedures like this to ensure that such rare (but serious) complications are not missed, and report their findings back to the Ombudsman; and 25 November 2015
- (iii) consider introducing a review of case notes by the operating surgeon (before the day of surgery) where the patient has been transferred from another surgeon's list, to ensure that the operating surgeon is satisfied the appropriate consent is in place, and report their findings back to the Ombudsman. 25 November 2015