Summary
Mrs C attended the Golden Jubilee Hospital for a modified Brostrom procedure (ligament repair) on her ankle. Following surgery, tests showed she had severe nerve damage. This was believed to have been caused by the popliteal nerve block anaesthesia (an injection of local anaesthetic near the nerves that go to the area being operated on) that she received for the surgical procedure. Mrs C complained that she was not informed the nerve block would be carried out or about the risks. She said that she did not see the consultant anaesthetist before the procedure. Mrs C complained that her injury was caused during the procedure and that staff failed to carry out the procedure to a reasonable standard. She said that the nerve damage had had an enormous impact on her life.
As part of my investigation, I obtained independent advice from a medical adviser who is a consultant anaesthetist. The adviser said there was no documented evidence in Mrs C's medical records of a discussion about the surgical procedure and its possible side effects, whether common but minor side effects, or rare but serious ones. The adviser noted that the General Medical Council (GMC) guidance on consent issues was clear that patients must be told about recognised serious adverse outcomes, even if they are rare. Nerve damage was a recognised side effect of techniques such as the nerve block so, even though the risk of permanent nerve damage was very rare, I considered it a failing that Mrs C was not warned about it. The limited interaction with Mrs C before her operation meant that staff did not obtain her informed consent and I upheld her complaint. I was concerned that these failings may have been caused by the pressures on the service. I recommended the board conducted a review to ensure enough time was spent with patients before procedures to obtain consent properly.
Regarding Mrs C's complaint that the procedure was not carried out properly, the adviser noted that there was no record taken at the time of the procedure of the anaesthetist's technique and practice. This was a significant failing. However, the adviser said the technique reported later (although without much detail) gave an indication of a reasonable technique by an experienced clinician. I agreed with the advice that there was limited documentary evidence to indicate that the practice and technique was of a reasonable standard. Although there was no clear evidence that Mrs C's injury was caused during the procedure due to a failure by staff, the lack of contemporary record-keeping meant there was no assurance of carefully considered practice and technique. On balance, I upheld the complaint.
Redress and recommendations
The Ombudsman recommends that the Board:
- bring the failings (related to explaining the risks of a popliteal nerve block anaesthesia) to the attention of relevant staff and ensure they are raised as part of their annual appraisal;
- review the service to ensure there is sufficient time to properly obtain (and document) consent for procedures;
- bring the record-keeping failings (related to carrying out the procedure in an appropriate manner) to the attention of relevant staff and ensure they are raised as part of their annual appraisal; and
- apologise to Mrs C for the failures my investigation identified.