In 2007, Ms A was referred by her GP to Wexham Park Hospital with symptoms of urinary incontinence. Ms A was examined by a physiotherapist, who noted a significant drop of her anterior wall on coughing and a second-degree rectocele. Ms A was referred to the urology team for further management.
Ms A subsequently attended an appointment with a consultant urologist with an interest in pelvic organ prolapse, to consider her surgical options. The consultant drew a diagram showing how the mesh would be inserted and explained how it would provide support. The consultant advised Ms A that the mesh could erode, but did not explain what erosion meant or the consequences associated with mesh erosion. Ms A was made to feel that it was her only treatment option and a perfect solution. She therefore agreed to undergo prolapse repair surgery with the insertion of mesh.
Ms A was admitted to Wexham Park Hospital for surgery in March 2008. She was seen by a registrar to obtain consent. The consent form did not record the intended benefits of the procedure, nor did it record that mesh was going to be used or the type of mesh. No further information was provided to Ms A by the registrar and she did not see the consultant urologist before he performed the surgery. It was recorded in the operation note that Ms A underwent a Transobdurator Sling (TOT) and posterior colporrhaphy with mesh reinforcement procedure. The note records that an Apogee mesh kit was used for repair and a Monarc TOT sling was inserted.
Following the procedure, Ms A developed symptoms of numbness and pain in her buttocks. Her left leg felt heavy and would not work properly. She also had an irritable bladder and flatulence. She reported these symptoms at the post-operative appointment in April 2008 but was reassured that these symptoms would resolve and her surgery had been a success.
Ms A’s symptoms persisted and she reported them at further appointments with the consultant urologist and the urology team in November 2008, July 2009 and January 2010.
She continued to suffer from intermittent buttock and leg pain, as well as bladder and bowel symptoms. In 2013, she started to feel scraping inside her vagina, as if something was falling out and she was concerned about malignancy. She attended an appointment with the consultant urologist as a private patient in February 2013. At this appointment, the consultant urologist conducted a clinical examination and detected no erosion of the sling or cystocele but found that the posterior vagina was very tender. He requested an urgent MRI scan.
In March 2013, Ms A saw the consultant urologist again as a private patient. Her pelvic MRI was normal but the consultant told her that he thought the mesh could be eroding. She subsequently underwent surgeries to remove portions of vaginal mesh from the posterior wall, which had eroded, in March 2013 and August 2014.
Following these procedures, Ms A suffered with pain in her buttock and difficulty walking. Ms A was subsequently referred to another surgeon outside of the trust and underwent surgery to remove the mesh completely in May 2016. Since then, she has suffered bowel problems and is still undergoing investigations into her ongoing symptoms.
Ms A decided to bring a legal claim against Frimley Health NHS Foundation Trust and was represented by Emmalene Bushnell, a medical negligence solicitor and Charlotte Pettman, a trainee solicitor at Leigh Day.
As part of the claim, Emmalene obtained a supportive expert report from a consultant urologist, who was of the opinion that Ms A had not properly consented in respect of the use of mesh. The expert was of the view that Ms A should have been offered a native tissue repair in the first instance. If the native tissue procedure were to fail, Ms A would still have had the option to proceed with mesh as a secondary repair. The native tissue repair surgery did not carry the risks of protrusion, extrusion, urge incontinence, difficulty urinating and chronic pain, all of which were risks associated with mesh insertion.
Liability was strenuously denied by the trust, who made an offer for Ms A to discontinue her claim with the parties to bear their own costs, at the time of serving their defence. The claim eventually settled prior to exchange of witness evidence, without any admissions of liability.
After lengthy negotiations, Ms A's claim settled for a six-figure sum. The final figure was over three times that originally offered to Ms A by the Trust in compensation for her injuries.
"Whilst we are pleased that Ms A’s claim has settled, one cannot underestimate the effect that the surgery, involving mesh, has had upon her physically and emotionally, as well as the impact her injuries have had on her family and her employment. It is important that when mesh is used the risks, benefits and alternatives are properly discussed with the patient so that they can make an informed decision.”
Ms A said:
“Emmalene, Charlotte and the team at Leigh Day have been wonderful from the start. It isn’t easy to talk about issues like this, but they have always been extremely understanding and aware of my distress. They have worked tirelessly on my behalf and provided support every step of the way. My medical problems are far from resolved and the settlement has given me peace of mind that I will be able to access advice and treatment when I need it.”