Decision Report 201508044

Summary

Mrs C complained about the care and treatment she received in relation to her labour at Forth Valley Royal Hospital. Mrs C had a long and difficult labour, and her baby was born with the use of forceps. An episiotomy (a surgical cut of the area between the vagina and anus) was performed and Mrs C suffered a fourth degree tear (a severe tear in the vaginal tissue), which was repaired that day. A few months later, Mrs C was diagnosed with a recto-vaginal fistula (an abnormal connection between the rectum and the vagina) and disrupted anal sphincter (muscle that surrounds the anus), for which she underwent several unsuccessful operations. Nine months later, Mrs C was referred to a specialist at Glasgow Royal Infirmary, who decided that a colostomy bag (a pouch placed over one end of an intestine) was required to allow healing before further procedures to repair the fistula.

We took independent obstetrics and gynaecology advice and surgical advice. In relation to Mrs C's complaint about the standard of obstetric care and treatment provided, we found that the fourth degree tear was properly identified and repaired within a reasonable time, but that the board failed unreasonably to arrange an obstetric review before discharge from Mrs C's first admission to hospital (which also had an adverse effect on communication) and that there was confusion about postnatal appointments and delays.

Regarding the standard of surgical care and treatment provided, while we were satisfied that medical staff managed the fistula in a reasonable way, we found that they failed unreasonably to obtain consent for one of Mrs C's operations. Finally, we were critical that the board failed to respond formally to the surgical aspect of Mrs C's complaint.

Recommendations

We recommended that the board:

• ensure that consent is obtained and documented in line with the relevant guidelines;
• raise the failings this investigation identified with the relevant staff;
• inform us of the actions taken to address the complaints handling failings this investigation identified; and
• apologise for the failings this investigation identified.