I recently acted for Mrs F, who had for most of her adult life been treated for progressive menorrhagia (heavy periods) and extensive pre-menstrual symptoms to no avail. In 2002, at 48, she was offered a total hysterectomy and decided to go ahead with this in June 2003. Mrs F was also keen to have a hysterectomy due to her family history of cervical cancer even though she had been told by medical professionals that she was not at an increased risk of developing this.
Mrs F understood that she underwent a total hysterectomy to include the removal of her cervix, fallopian tubes, and ovaries. Unfortunately, her medical records were destroyed in a fire at the hospital’s medical records storage facility but she kept a copy of her discharge note which confirmed she had undergone a total hysterectomy.
Over the next few years, Mrs F began to suffer from recurrent urine infections. In October 2011 she was referred to hospital where a pelvic scan confirmed that remnants of her cervix remained (ie the hysterectomy had been “subtotal”) . Mrs F was particularly distressed by this because of the risk she perceived of developing cervical cancer: she was under the impression that her cervix had been removed in 2003.
Mrs F was advised that a procedure at this stage to remove her full cervix would be significant and carried the increased risk of bladder and bowel damage, although the operation could potentially improve her urinary symptoms. She was therefore faced with either undertaking risky surgery or being left with the anxiety of the possibility of developing cervical cancer in the future due to her family history.
I instructed an expert gynaecologist to prepare a report in this case. In his opinion, if the decision to perform a partial (rather than total) hysterectomy was because of operative difficulties and/or a belief that there was a risk of a bladder of ureteric damage, then this was acceptable. If however, the decision to conserve the cervix was because of the preference of the operating surgeon and consent to a subtotal hysterectomy had not been obtained or explained, then this was negligent. In practice, because there were no medical records remaining except the discharge note, it was not possible to know either way.
In any event, the failure of the surgeon to inform Mrs F that her cervix had not been removed was undoubtedly negligent.
However, the expert was not of the opinion that the urinary tract infections were caused by the failure to carry out a total hysterectomy, nor did he consider that it was likely that Mrs F would develop cervical cancer.
Despite Mrs F’s concerns about still having her cervix, she felt that the increased risk of damage to her bladder and bowel was too great, on balance to undergo any further surgery.
So, if she did not intend to undergo further surgery, and if in the expert’s opinion, her remaining symptoms were not due to the failure to remove the cervix, what was the impact of the hospital’s negligence, both possibly in failing to perform a total hysterectomy and certainly in failing to inform Mrs F that one had not been undertaken?
Mrs F had been considerably distressed to learn that her cervix remained and, even if there was no increased risk to her in comparison with the rest of the population of developing cervical cancer, I therefore considered that she should be compensated for the psychological impact of her perceived increased risk. I instructed an expert psychiatrist. The expert diagnosed Mrs F with an adjustment disorder which had led to depression. He advised that Mrs F undergoes some counselling to help treat her depression, the cost of which could be included in her claim.
At this stage, the NHS made an offer to settle Mrs F’s claim which generously reflected the psychological impact of their failure and Mrs F was very happy to accept this.