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Case Number 5 Return to Case Studies

THIS IS THE CASE HISTORY OF JANET 
(LEAKING SILICONE BREAST IMPLANT)

  • Why did it take  the Health Authority five years to admit an obvious case of negligence?
  • Why did it take 3 years before Janet received remedial medical care?
  • Janet's compensation was derisory  - but how much were the combined legal fees of the Legal Aid Board and the Trusts NHS solicitors - all paid by the taxpayer?
Janet has been a member if SIN for almost two years. When the Health Select Committee announced  it was planning to hold an " Inquiry into the Safety of Breast Implants " on Thursday, 28th March 2001, SIN was able to inform Janet of this, and so gave her an opportunity to submit her statement, which she asked to do through SIN. On 5th March SIN faxed through to the Health Select Committee Janet's written evidence and a covering letter from SIN. This evidence is available for the public to read. Janet and SIN were sent complimentary copies of the result of the Health Select Committee's Inquiry.

 Janet has suffered from epilepsy all her life and has had to take strong medication to control the attacks. In the early nineties Janet, on medical advice, underwent a double mastectomy because of recurring painful breast lumps. She opted to have breast reconstruction with silicone implants.

On November 22nd 1996 a neurosurgeon fitted a "vagus nerve stimulator" with two wires attached ( 18" in length) below her left breast containing the silicone implant . This was for the purpose of controlling her epilepsy. During this operation the silicone bag was punctured causing seepage into her system. Janet immediately alerted her doctors to the fact that a painful swelling occurred within 8 weeks of this operation. The swelling continued to increase in size. The silicone implant was not removed until October 1999 - THREE YEARS after it was ruptured. Why the delay?

Janet developed agonising pains in all her muscles and joints which are most likely to have been caused by the silicone seepage. She decided to take legal action beginning in November 1996. Her legal action was finally concluded in March 2001, one week before the Health Select Committee held their" Inquiry in  the Safety of  Breast Implants"

Although Janet was far too ill to work, she was not allowed full legal aid because her husband was working. ( Many woman who are unable to work because of iatrogenic damage find themselves in this predicament and are unable to pursue their right to justice with legal aid because their husband is working, although it is the woman's medical case!) For 29 months Janet had to pay part of her legal costs to the  Legal Aid Board. This amounted to £159.81p per month and severely affected their household budget. Over the nearly two and a half years period of legal action Janet paid to the Legal Aid Board £5000

Janet's case would appear to have been extremely straight forward - an obvious case of negligent surgery, but it was bedevilled with long, unnecessary delays, poor medical care and inadequate communication. 

Janet says that at first the surgeon claimed he was unaware that Janet had any implants, but later had to admit it was clearly written in her medical notes. Janet, herself, was even blamed for not reminding the doctors of the implants as she lay on the operating trolley being wheeled to the operating theatre! 

Why was there such an unacceptable length of time - three and a half years - before Janet had the silicone implant removed? During this time silicone continued to seep into her system.
Her legal action appears to have been extended unnecessarily for several years. It took, for example, 6 months before the surgeon would release her medical notes to her solicitors. Did he have them or were the MDU retaining them, or were the Health Authority's solicitors holding on to them? In the meantime Janet's health and  quality of life , not to mention her peace of mind , were all deteriorating.

Eventually Janet won her legal action and received the princely sum of £5300 in an out of court compensation in March 2001, four and a half years after her implant was punctured. The £5000 she has already paid to the Legal Aid Board will be reimbursed.

SIN would like to know how much her solicitors charged the Legal Aid Board for Janet's case. How much did the Health Authority solicitors charge the NHS for their services? SIN imagines that their combined legal fees ( all paid for by the tax-payer) for nearly two and a half years of legal action, would be far in excess of the measly £5300 offered to Janet. Her case was so obviously a straightforward case of negligence, with only one doctor involved, that it is quite disgraceful that if took four and a half years before the Health Authority accepted negligence and settled out of court. What a lovely money earner for the lawyers!  An absolutely inexcusable waste of public funds. SIN has been campaigning for a Victim's Compensation Fund which should have settled Janet's case within 6 months at a fraction of the cost. Janet - not the lawyers - should have received the money. Janet's epilepsy is much worse, she sometimes has as many as 3 attacks a day and this could be related to the effect of silicone in her system, causing possible autoimmune disease; and also to the stress over the last few years.

What were the findings of the Health Select Committee? To read the full report with oral evidence  access the website: www.parliament.uk/commons/hsecom.htm
Perhaps it would be relevant to make a few quotes from the Report;

With regards to safety:
" In 1994 when we first raised concerns about the then Medical Devices Directorate's approach to the safety of silicone breast implants our correspondence was immediately passed to the D.o.H.'s solicitor. His answer was ......" that it is not appropriate ....to become involved in a lengthy dialogue.." Regrettably, this refusal to delve into issues put forward by women who believe they have suffered injuries from their silicone breast implants...has continued.....Accordingly , no action restricting the use of silicone implants has ever been taken. The conclusion we believe the Committee has to draw is that, as unpalatable as it may seem, the main objective of the MDA ( Medical devices Agency) since 1993 has been to stand by their initial view, thereby justifying their inaction, rather than to protect and inform women contemplating undergoing silicone breast implant surgery". page 74 para. 24 Conclusion

" It is our understanding that the MDA has not sought adequate safety data from the manufacturers for these products, nor attempted to impose any restrictions on their use until data has been provided. We would remind that Committee that in the USA, Australia and Canada manufacturers have not made any significant attempts to re-enter the market and would respectfully suggest that the Committee draws the inference that it is possible that the manufacturers have doubts about the safety of their product. It is in any event clear that the manufacturers are unable to demonstrate the safety of these products." page 73 para.9

" We are not convinced that the D.o.H booklet "Information for Women Considering Breast Implants" gives sufficient information as to the risks of these products. " page xiv para. 39

" We recommend that the revised edition of the D.o.H booklet draws attention to those countries banning silicone gel implants. Women contemplating this operation are entitled to this information." page xiv para. 40 [ The countries banning silicone breast implants are: the USA, Canada and Australia]

With regards to consent forms:
"We hope that the new consent form will encourage a more open dialogue between clinicians and patients and will ensure that issues relating to safety and costs are fully explored before a decision is made to proceed with surgery." page xvii para. 52
Would Janet have got a higher settlement if this highly critical Report had been published earlier?

Footnote:Trilucent Implants: Soya oil implants marketed under name of Trilucent are now banned in the UK in March 1999 by the MDA because of fears as to their toxicology "the products produced by the breakdown of the soya bean oil, which are known as aldehydes, were potentially carcinogenic" On 6th June  2000, the MDA recommended the removal of  Trilucent implants as a "precautionary measure  "  - risks of cancer or damage to an unborn baby could not be ruled out"    page xviii paras: 55, 56 & 57

Silicone Implants: Spontaneous implant rupture resulting in local migration of contents : 50% implants are ruptured at 12 yrs, 95% at 25 yrs.
 
  

 
Case Number 6: Return to Case Studies

THE CASE HISTORY OF  JULIA
DAMAGE DURING TRAUMATIC CHILDBIRTH
  • Obvious damage and trauma - yet  no  case 
  •  last minute withdrawal of positive expert witness
  • Excessive legal costs
  • obvious case for victim's compensation fund + investigation and accountability
  • incomplete records!
  • Why did solicitor not get a court order for missing records?
Until the 39th week Julia's  baby had been lying transversely in the uterus, but had moved spontaneously a few days before the birth started. Julia then spent  three traumatic days in labour during the birth of her second baby.

The birth began naturally, 10 days  overdue. However, Julia had to be induced twice during the labour. Throughout the 3 days Julia was denied any pain killers except for "gas & air" - pethidine and an epidural were refused. Although she has since seen documentary evidence  stating that her baby was getting very distressed, she was never told. She was wired up to numerous machines which made movement impossible. A junior doctor was in charge throughout the labour and it was eventually discovered that the baby was being presented with face uppermost.  This  is a very difficult birth presentation and indeed the baby 's face  can suffer damage. The doctor tried to turn the baby mid-way through the labour which was excruciatingly painful, and Julia could not help screaming in agony and inadvertently kicked the doctor. The doctor swore at Julia and she was  told off for upsetting the doctor.

Turning a baby in mid- labour is not advisable and it failed. Julia never saw her consultant once throughout the  3-day labour.

Julia's baby girl was eventually born with the aid of forceps and suction. her forehead and face were  badly bruised and swollen, the baby had two black eyes.  Six midwives were in attendance!

At her 6 week post-natal her consultant obstetrician told Julia that she had received inhuman treatment and that he should have been contacted and she should have had an emergency caesarean section.

Julia was left with a damaged rectum and has bowel incontinence with severe intermittent pain, and  a bladder which is  temperamental.  Although Julia experiences a great deal of intermittent pain her GP refused to give her any pain killers. ( Was this because to give her pain killers would admit that the damage had affected her quality of life?). Julia was offered a bowel repair operation, although the surgeon said that this would only last  4 to 5 years and after that she would have to wear a "bag".

Julia decided to take legal action and obtained her medical notes. As usual there were critical pages of notes missing and personal, disparaging remarks . She wrote to SIN: "I have just had the 'pleasure' of reading my medical records - after a while I had to stop as it was very distressing and seriously damaged my self confidence."  It was not long before two expert witnesses were found to support her case - a Bowel specialist and an Obstetrician. The bowel specialist wrote that her condition would get worse and there was a bleak prognosis. The expert obstetrician stated that  Julia had received incredibly inhumane treatment and that the consultant should have been called and an emergency caesarean operation carried out. He claimed that  few babies and mothers survive such a birth presentation.

Julia went on her own to the barrister's conference very confident that she had enough evidence to win her case. She as shocked and traumatised when the obstetrician without warning announced he was retracting his statement on the grounds that if the birth had been as bad as was thought Julia and her baby would be dead, and therefore, the birth could not have been as bad as he had stated. Julia, not her solicitor, challenged him and said he could not retract his statement as it was a legal document and he had signed it. He retorted he would simply write another.  Julia asked her solicitor to obtain another expert witness, but was told that there was little point in doing this as it was notoriously difficult to win a case on damage during child birth
Why was this said £38,000 later?.

Julia wrote to SIN: " As you have probably gathered, your prediction came true as my case was dismissed at my study conference which unfortunately I had to attend alone. It was a rather humiliating and traumatic experience, the doctors who were to prove my case even made jokes about women in childbirth and how things "went wrong" because they gave birth in the middle of the night  rather than at a "civlised hour"."

The parting "joke" remark of the expert witness , the Consultant Obstetrician,  was that he hoped he was not called out to deliver any babies at 3 am in the morning, because he would certainly not be there ..ha, ha, ha". Not a joke which Julia appreciated! Julia was pleased  that she  managed to control herself during the conference, but she broke down later in the ladies loo, where she found a quiet space to herself. Would these guys like to have  bowel incontincence, and  damage so bad  that remedial surgery is required and even then the prognosis is so bleak that a colonectomy  was very likely within a few years, together with a bladder problem? In addition Julia has been told that she has so much damage to her vagina that she must never have another vaginal birth.

Not surprisingly, Julia no longer has any trust in doctors and  has decided not to have the repair bowel operation. She is now putting her faith in homeopathic medicine. Whether it was related to the traumatic birth which  her little girl suffered, but her baby  screamed for no reason for two years and seemed very unhappy. Julia is very grateful that, against the odds, her  little daughter and she survived.

Another "cast iron" case which failed.

  • two consultant obstetricians, one verbally and one in writing, have confirmed that she suffered inhuman treatment, that the birth was dangerous and that a consultant should have been called and she should have had an emergency caesarean.
  • the damage to her bowel is obvious (bowel incontinence + severe pain)  -  she is in need of a repair operation and  a written statement says her prognosis is bleak.
  • she is in severe intermittent pain with a temperamental bladder
  • her vagina is so badly damaged that further vaginal births are not recommended.
  • the consultant never once  made an appearance  during the three day labour, not even at  the dangerously prolonged  second stage
  • incredibly the junior doctor never called the consultant - although the situation was clearly beyond her competence. The birth began on a Friday and continued over the weekend. ( It is obviously not advisable to become ill at night, at the weekends or on high days and holidays - when specialist cover is low).
    Surely an expert witness who retracts a very positive statement at such a late hour should have to pay some monetary sanction? Julia lost  a large some of money trying to take legal action. Although she was too ill to work, Julia had to contribute towards her Legal Aid bill because her husband  was working. The total  legal bill was £38,000, of which  Julia had to contribute £4000, which she could ill afford. SIN has always  maintained that the only  sure  winners out of medical litigation are the lawyers.( NB The Trust's solicitors would no doubt also have been involved and received some payment)
The questions remain: WHY DID JULIA RECEIVE SUCH SUB-STANDARD CARE, WHICH PUT HER LIFE AND HER BABY'S AT RISK? IN SPITE OF SUFFERING PERMANENT AND SERIOUS DAMAGE, WHY HAS SHE HAS BEEN UNABLE TO OBTAIN EITHER COMPENSATION OR ACCOUNTABILITY?

SURELY SUCH A CASE WOULD HAVE BEEN IDEAL FOR MEDIATION AND A VICTIM'S COMPENSATION FUND + AN INQUIRY INTO WHAT WENT WRONG  + ESTABLISHING ACCOUNTABILITY AND SENSIBLE SANCTIONS IF NECESSARY + WHY GIVE THE MONEY TO THE LAWYERS?
 
 

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