A poorly woman has been left devastated after she was given a hysterectomy without her consent.
The procedure means the patient, early 40s, will not be able to have children.
She had the operation after getting ongoing treatment for Crohn’s disease.
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The op took place in March 2022 at Liverpool Women’s Hospital after she was referred there by Betsi Cadwaladr University Health Board.
The case had only just come to light.
Complaints were made by the patient, who is known as Ms A and is from north Wales, against Betsi Cadwaladr University Health Board, Liverpool University Hospitals NHS Foundation Trust and Liverpool Women’s NHS Foundation Trust.
The Public Service Ombudsman for Wales said there had been serious failings that had caused the patient a “significant injustice”, as reported by Need To Know.
Michelle Morris called for a review to be carried out by Betsi Cadwaladr, which commissioned the care and Liverpool University Hospitals NHS Foundation Trust and Liverpool Women’s NHS Foundation, which carried out the treatment.
Following the investigation the Ombudsman found “significant shortcomings” in the patient’s care were caused by failings across various aspects of her treatment.
This included failings in colorectal care and in relation to gynaecological referrals, investigations and treatment.
The report states: “Our investigation found multiple failings across various aspects of Ms A’s treatment and care, including failings in colorectal care, and in relation to gynaecological referrals, investigations and treatment undertaken by another English Trust.
“This led to Ms A having persistent infection and ill health for nearly three years before she received surgical treatment in March 2022.
“We found that Ms A did not give informed consent for this surgery – she only signed the consent form on the day of her surgery and there was no record of prior discussion with her of the possibility of her having a hysterectomy during the surgery.“
Ms Morris said: “I am mindful of the profound injustice caused to Ms A as a result of the significant failings that have occurred in her case.
“I am extremely concerned about the process by which Ms A gave her “consent” for the surgery in March 2022.
“The relevant guidance makes it clear that consent is not simply a matter of completing and signing a form.
“Instead, consent is a process which should begin well in advance of the day of the surgery and any discussions should be clearly and separately recorded as part of the consenting process.
“This did not happen here.
“This sad case also highlighted the wholly inadequate contract monitoring arrangements in place at the Health Board.
“Public bodies must have robust governance arrangements and must ensure that patient safety and the monitoring of the quality of services is in place.
“The Health Board’s failure to monitor patient safety and service quality led to it missing crucial opportunities to address poor performance.
“With more effective contract monitoring, many of these failings could have been prevented.”
The Ombudsman made five recommendations for the Betsi Cadwaladr University Health Board to implement:
Apologise to Ms A and share the report with relevant Health Board members.
Request the Liverpool Trusts review Ms A’s case, remind clinicians of informed consent and their professional obligations and share key learnings through a case study of this case.
Request the Trust’s surgeon to reflect on the case and discuss improvements to her clinical practice at her next revalidation.
Seek written assurances from the Trust’s Chief Executive that clinical failings are being addressed and provide compliance evidence to the Ombudsman.
Health Board to prioritise, complete and implement a Commissioning Assurance Framework which gives proper consideration to patient safety.
Dr Jim Gardner, Group Chief Medical Officer for NHS University Hospitals of Liverpool Group, which runs the Royal Liverpool University Hospital and Liverpool Women’s Hospital, said: “On behalf of NHS University Hospitals of Liverpool Group, I apologise for the failings identified in the report.
“And I acknowledge the profound effects they have had, and continue to have, on the patient and her family.
“This was a very complex case involving multiple clinicians and departments across several hospitals. We have already made improvements, and we will ensure that the lessons learned from this are shared with our clinical teams to prevent something like this happening again.
“We are working through the ombudsman’s recommendations, which we accept in full.”
Carol Shillabeer, Betsi Cadwaladr Health Board’s Chief Executive said: “I sincerely apologise for this patient’s poor experience and the Board is fully committed to taking forward learning from this case.
“It is essential for the health of our population, we work with other health boards and trusts. It is clear we need to improve our oversight arrangements for these commissioned services and we fully accept the Ombudsman’s findings.
“We have already started to make those improvements and our new commissioning approach will help that further.”
The Public Services Ombudsman added that while its role and remit covers Welsh NHS bodies, as Betsi Cadwaladr University Health Board commissioned care from the English Trust, the Ombudsman’s investigation reviewed the care and treatment which Ms A received from the English Trust.
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