A patient, who wishes to remain anonymous, has secured an out of Court settlement in a clinical negligence claim after alleging that he was not properly consented to the risks of septoplasty surgery. It was alleged that the risks associated with septal perforation, and the symptoms associated with this complication, were not properly explained to him.
He instructed specialist Clinical Negligence Solicitors, Setfords Solicitors, to conduct an investigation into whether or not he was adequately consented to the risks of his Septoplasty surgery. His case was conducted by Adam Wright, a specialist Clinical Negligence Solicitor, and Emma Llanwarne, a Clinical Negligence Paralegal.
The patient had been experiencing chronic nasal obstruction due to a deviated septum, and so was referred to the Ear Nose and Throat Department (ENT) at Sheffield Teaching Hospitals NHS Foundation Trust.
The Patient was reviewed by a Consultant Rhinologist Surgeon in October 2018, and upon examination of his nasal cavity, the surgeon confirmed that he had a gross septal deviation towards the left and offered him septoplasty surgery, a surgical procedure to straighten the bone and cartilage dividing the space between the two nostrils (septum). The Patient recalled how the procedure was explained to him by the surgeon. The impression was that this was a very straightforward and simple procedure. The patient gave evidence that he saw the consent form on the Surgeon’s desk with the surgeon telling him that there was a very low risk of septal perforation. He alleged that nothing more was said to him in relation to this particular risk, or what would happen if this risk materialised. The Patient signed the consent form for the surgery, but subsequently cancelled the procedure due to work commitments and because his current symptoms were not acutely troublesome for him.
7 months later, in mid-June 2019, the Patient returned to his GP complaining of headaches and he queried whether it might be related to his septal deviation. He was referred back to the ENT department at Sheffield Teaching Hospitals NHS Foundation Trust. He was seen by the same surgeon whom he saw in October 2018. Whilst his headaches were thought to be unrelated, he was again offered septoplasty surgery and he agreed to proceed in order to resolve his worsening symptoms.
At this time, the patient recalled how he was asked to sign a new consent form, which he did. The consent form recorded “septal perforation” as a known risk of the surgery, but he alleged that there was again no detailed discussion in this respect and he was not provided with any written information explaining the risk of septal perforation and the consequences should it occur.
The surgery was scheduled for the end of October 2019.
The Patient was admitted for his septoplasty surgery at the end of October 2019 and he alleged that there were no further discussions with him on the risks of his surgery, despite the period of time which had elapsed since his last consultation in July.
The Patient undergoes the surgery and is discharged home the same day.
Several days after the surgery, the Patient presents at the ENT Walk in Centre complaining of pain, tenderness, discharge and a hole in his septum. He is seen by a member of the ENT team and reassured that there is no perforation and no infection. Despite reassurance, the Patient continued to be concerned about his nose and was subsequently seen again by the operating surgeon. The Patient was examined and again reassured that there was no sign of septal perforation, and advised to continue with the nasal douching and cream, with a plan made to review him in a couple of weeks.
In early December 2019, the Patient attended the ENT clinic as planned for his follow up. His nose was examined and it was confirmed that there was a perforation present. He was advised to continue saline nasal douches for another 6 weeks, and was discharged.
At the beginning of January 2020, the Patient contacted his GP and explained that he had been diagnosed with nasal perforation, that he was concerned because the hole was getting bigger, but he had been discharged from ENT. The Patient asked the GP to refer him back to ENT for management of the perforation, which the GP agreed to do.
The Patient was then seen by the operating surgeon once again, who confirmed that there were three separate holes in his septum, two small holes and one larger one. He was told that these would not be problematic for him and he was reassured and discharged.
The Patient was unhappy with the advice he had received and felt as though he had been abandoned, so he attended his GP to ask for a second opinion. Due to NHS waiting lists, he paid to see a Private ENT surgeon, who he saw in September 2020. It was documented by the ENT surgeon that the Patient was experiencing a whistling sensation when breathing, that the right side of his nose now felt obstructed, and that he was frustrated that he will still having to douche his nasal cavity using saline and apply creams. He was informed that treatment options were limited, and that if the perforations were to increase in size, a septal button could be placed to try and improve his symptoms. The Patient wished to consider his options.
Thereafter, the Claimant attended his GP again to ask to be referred to ENT on the NHS, so that he could receive treatment. Following the referral, he was advised that his septal perforations were difficult to treat and that he should continue with conservative management.
The Patient felt that he was in a worse position after the surgery than before; before his surgery he had a slight obstruction on the left side, however, he now had symptoms of whistling when breathing and talking, a greater sense of nasal obstruction on the opposite side, nasal crusting, bleeding and discomfort in the nose. He was also frustrated that he had to regularly douche his nasal cavity with saline and apply creams to try and prevent inflammation, which he found to be painful. He was also now suffering with nasal tip sensitivity, which caused pain when he touched his nose, such as when washing his face. These new symptoms were very troublesome for him.
He therefore instructed Adam Wright, an expert Clinical Negligence Solicitor, and his team at Setfords to investigate the standard of care he had received.
His medical records were obtained and a detailed witness statement was taken. Thereafter, an independent Consultant ENT Surgeon expert was instructed to report upon the standard of care the Patient had received.
The expert opined that the operating surgeon had a duty of care to ensure that the patient fully understood the material risks of the proposed surgery, and that this duty had been breached as there was no evidence that the patient had received a detailed discussion on the risks of septal perforation in order to allow him to make a fully informed decision on whether or not to proceed with the surgery.
Accordingly, a formal Letter of Claim was submitted to the Defendant Trust, detailing the allegations of breach of duty (negligence) and how the Patient would have declined the surgery had he known the material risks.
The Defendant Trust subsequently served a formal response, denying the allegations. The Defendant Trust argued that the Patient had been properly informed of the risks, that a detailed discussion had been held with him, and they relied on the fact that he had signed consent forms which listed “septal perforation” as a risk of the surgery.
A number of correspondences followed in an attempt to clarify and narrow the issues between the Parties, but the Defendant maintained its stance on liability. A conference with a specialist Clinical Negligence barrister was therefore held, together with the independent expert, where the facts of the case were analysed in detail. Thereafter, Court proceedings were issued to protect the Patient’s right to continue with the claim in light of the 3 year limitation period soon to expire.
Shortly after commencing Court proceedings, negotiations ensured and a we were able to agree a suitable sum of damages to compensate the Patient for his injuries and financial losses, thus bringing the claim to an end.
On achieving settlement the Patient said “Adam and Emma were brilliant. What mattered was that they believed me and fought my corner. I would never have agreed to go ahead with the surgery had I been told of the possible complications. I felt really let down by the surgeon because he did not warn me of these risks. I am very happy with the damages secured, they go some way to helping me come to terms with what I have been through and the symptoms which continue to trouble me. I feel as though justice has been done, and that the Trust will have learned from this and be more careful in the future when consenting their patients to septoplasty surgery.”
Speak to a Clinical Negligence specialist on 0330 058 4011
