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Case report - Settlement following negligent post operative care

24 May 2022

Lauren Hall, Senior Associate in our Clinical Negligence team at Hay & Kilner has acted on behalf of the Estate of a patient who passed away following negligent care post knee replacement surgery.

The patient, who’s medical history included kidney disease, was to undergo a knee replacement for arthritis. Anaesthetic review confirmed he was fit for surgery at the Defendant’s Hospital. Following surgery there was no plan to monitor his kidney function or the level of anticoagulation. At day 1 post-op he was suspected to be suffering from a pulmonary embolism. He remained on the full dose of therapeutic blood thinners and a CT with contrast (which carries a major risk of acute kidney damage) was arranged. His kidney function and anticoagulation levels were not regularly monitored.

The CT demonstrated a pulmonary embolism and a Consultant Haematologist advised discontinuance of aspirin. Despite this recommendation, the prescription of aspirin continued together with full doses of blood thinning medication. This all increased the patient’s risk of haemorrhage.

Later the patient suffered an episode of collapse with coffee ground vomit and his kidney injury became worse. His haemoglobin levels significantly dropped. Despite these significant red flags, no endoscopy or other investigations were carried out to rule out the possibility of an upper gastrointestinal bleed. His kidney injury continued to deteriorate. Haemoglobin levels did improve following transfusion but remained significantly lower than pre-operative levels. On day 8 post-op, the patient went into cardiac arrest following a significant drop in haemoglobin levels and sadly passed away. A post mortem confirmed the primary cause of death was an upper gastrointestinal bleed secondary to anticoagulation therapy for pulmonary embolism following surgery and an inquest was held which confirmed the cause of death.

Lauren was instructed by the patient’s family to represent their interests at Inquest and to investigate a potential clinical negligence claim. Expert evidence was obtained from a Consultant Intensivist and a Consultant Hepatobiliary, Pancreatic and General Surgeon, both of whom were supportive of the Claimant’s claim. A detailed Letter of Claim was served on the Defendant identifying numerous breaches of duty including failure to appropriately account for the patient’s history of kidney disease in managing his risk for embolism and haemorrhage post operatively, failure to monitor haemoglobin and renal levels, failure to ensure the patient was not being over-anticoagulated and failing to discontinue his regular medications after developing symptoms of pulmonary embolism.

Settlement following medical negligence

It was further alleged there was a breach in continuing aspirin contrary to haematological advice, failure to adequately control/reduce the patient’s increasing kidney injury and failing to suspect or investigate an upper gastrointestinal bleed. It was argued that as a result of the alleged breaches of duty, the patient became over-anticoagulated and became at increased risk of spontaneous bleeds. It was also alleged that had investigations been carried out, the patient would have been amenable to endoscopic treatment and anticoagulation therapy would have been revised and reduced. It was argued that with appropriate monitoring and treatment the fatal upper gastrointestinal bleed would have been avoided and the patient would have survived.

Following receipt of the Claimant’s detailed allegations, the Defendant continued to deny liability. Proceedings were issued at Court and served on the Defendant. Days before the Defendant was due to serve the Defence, negotiations commenced, and a financial settlement was reached on behalf of the patient’s Estate.

Lauren comments “This case has been particularly complex and robustly denied by the Defendant. I am very pleased to have reached settlement for the patient’s family and hope they can begin to put this litigation behind them.” Lauren’s client comments “Thank you Lauren for all the care and attention you gave to getting justice for us. Everyone has been so professional and caring.”

For more information or how we could help you or your family please contact Lauren, lauren.hall@hay-kilner.co.uk, or a member of our Clinical Negligence team.