On Wednesday 2 November 2016, C collapsed with acute abdominal pain. She was taken to the Accident & Emergency Department Doctors suspected she had a possible pyelonephritis, She was transferred to the Acute Assessment Unit (“AAU”) for surgical review in the early hours of Thursday 3 November, where that morning she was examined by D1… It is at this point that the parties begin to differ about what happened. What can be agreed is that on 3 November, there was a CT scan that showed that C had developed a condition diverticulitis with a localised perforation. D1 at first tried to treat the condition conservatively with intravenous antibiotics and fluids. But on Sunday 6 November, a second CT scan revealed a progression of the disease. On the morning of Monday 7 November, C underwent a surgical procedure performed by D1 laparoscopic lavage [5]
C’s condition appeared to settle until about 23:00 hours on Tuesday 8 November (Day 7). She collapsed with severe abdominal pain. D1 was called in and arranged emergency surgery. Very early on Wednesday 9 November, he performed a procedure called the Hartmann’s procedure. C was extremely unwell. She remained in the Intensive Care Unit (“ICU”) until 17 November and was finally discharged home on 29 November 2016. To this day, she suffers from chronic abdominal pain and several other conditions, including PTSD. [6]
C case is that she and her family repeatedly asked D1 to refer her for a second opinion from a specialist colorectal surgeon, which D1 failed to do, ignoring and obstructing their reasonable requests. Her case is that D1 s principally an emergency surgeon and certainly not a specialist colorectal surgeon. If D1 had referred her to a colorectal specialist, that surgeon is likely to have recommended the Hartmann’s procedure following the second CT scan on the evening of Sunday 6 November when surgery was inevitable, and she is likely to have given her informed consent to this procedure, notwithstanding that this would result in her having a stoma, that is a hole in her abdomen through which the bowel is relocated to collect waste into a collection (colostomy) bag. The agreed expert evidence is that a Hartmann’s procedure on that Sunday night is likely to have avoid the catastrophic deterioration C experienced late on the night of Tuesday 8 November which necessitated emergency life-saving surgery in the early hours of Wednesday 9 November. A prompt Hartmann’s procedure would have avoided the adverse outcomes she experienced and continues to experience. [8]
D1 [case] has expertise and extensive experience in colorectal surgery. There was no culpable delay in surgery between Sunday night and Monday morning. Upon surgical exploration on Monday 7 November, there was no faecal contamination and converting the “washout” (laparoscopic lavage) to a Hartmann’s procedure was not medically mandated. The deterioration that C experienced 36 hours after this surgery could not have been reasonably foreseen. Therefore, there was no breach of duty and no causative breach of duty. The claim against D1 should be dismissed. [10]
Claims against D1 and D2 dismissed [351 and 352]
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