Summary
Mr C had an abdominal tumour, and saw a consultant who recommended that the tumour should be surgically removed. The consultant started Mr C on medication that helps to prevent dangerous rises in blood pressure related to the surgery he was due to undergo. In January 2013 Mr C completed a consent form agreeing to undergo surgery to remove the tumour. The form did not specify any potential risks of the operation that the surgeon performing the procedure had discussed with Mr C, or that any discussion had taken place around any extra procedures which may become necessary. Surgery took place the next day.
Mr C was then reviewed the following month by the surgeon who wrote to Mr C’s GP to say that Mr C had reported difficulty with ejaculation but had experienced problems with this in the past. Mr C was seen by a urology doctor (specialising in problems of the urinary tract and reproductive organs) in November 2013, where Mr C said he was still having problems with ejaculation. Tests confirmed that Mr C had retrograde ejaculation (where semen enters the bladder rather than coming out of the penis). Mr C had further follow-up appointments with the consultant who had recommended the surgery, and the surgeon who had carried it out. Mr C complained to the Board about the lack of information he was given about retrograde ejaculation before the planned surgery, and that the surgeon had told him that he did not foresee any complications arising.
In the Board’s response to Mr C’s complaint, they did not clearly respond to Mr C’s complaint about the information he was provided with during the consent process. Instead, they focused on the reasons why they felt it was unlikely that Mr C’s operation was the cause of the retrograde ejaculation, and said that this was a problem Mr C suffered from in the past, which Mr C disputed. Mr C then complained to my office.
In considering Mr C’s complaint, I took independent medical advice from a consultant urological surgeon who specialises in sexual dysfunction, who said that whilst the medication Mr C had been prescribed prior to the surgery (to regulate blood pressure) does have a side effect of causing retrograde ejaculation, this would only last for the short time the drug was prescribed and administered. My Adviser said that the surgical procedure Mr C had was not very common, and, therefore, it is logical to refer to data for similar and more common operations which take place in the same region of the body but for different conditions. For operations of a similar nature, my Adviser said that retrograde ejaculation is a rare but recognised side effect and this should have been discussed with Mr C when consent was obtained for the procedure. The Adviser also noted that there are other potentially very serious risks to major arteries and veins when undertaking surgery in this area.
Whether or not Mr C previously reported problems with retrograde ejaculation prior to surgery, I found this was only documented in the post-surgery notes taken a month after the surgery was carried out. There was nothing in the notes leading up to the surgery about this. In relation to the information Mr C was given, I consider that the surgeon should have warned Mr C about the possible risks or complications. Whilst the risk of this side effect occurring is very small, General Medical Council guidance says that patients must be told about recognised serious adverse outcomes, even if they are rare. There is no clear evidence to demonstrate this was done or indeed that discussion took place about other major structures close to the operative area being at risk of injury with possible significant consequences.
Redress and recommendations
The Ombudsman recommends that the Board:
- (i) apologise to Mr C for failing to ensure that he was fully informed of the risks associated with his surgery; and
- (ii) ensure that their consent policy includes guidance on the importance of accurately recording conversations with patients regarding risks and complications as part of the consent process.