Spencer Collier and Rachel Kirby of Geldards Medical Negligence team recently concluded a highly sensitive and difficult case surrounding the issue of “Informed Consent” to treatment. (NG v NW) The Claimant recovered £300,000 against the Defendant (NW) when the latter carried out a private hysterectomy plus removal of both ovaries on her, rendering the Claimant infertile and entering a premature menopause. At the time of the surgery, the Claimant, a native of the Republic of Ireland, was only 22 years old and there was no suggestion of any malignant disease.

This was a radical surgery done on a very young woman of childbearing age. She did not have any specific gynecological problems. Instead, she was suffering from severe depression. Her family believed, and the Defendant agreed, that this was due to pre-menstrual dysphoric disorder (PMDD). PMDD is a serious form of premenstrual syndrome. It causes many emotional and physical symptoms leading up to a period. In addition, the Claimant had a long-standing history of psychiatric disorder, self-harming, suicide attempts, difficulties with friendships and family relationships, admissions to psychiatric units, emotional instability, and impulsivity together with cannabis and alcohol misuse.

Initially, the Claimant had sought the treatment in the Republic of Ireland but the gynaecology services there declined to undertake it.

She approached a renowned Fertility expert in London who wanted to continue with hormonal treatment for her, accepting that doing a hysterectomy on someone at that age was “very early, even for me”. It was recommended that multi-disciplinary input was required before any decision on treatment could be reached. This included Psychiatric input.

In desperation, and having been advised that a hysterectomy would solve the Claimant’s severe symptoms, her mother made telephone contact with the Defendant who indicated that he would carry out the surgery. Pre-operative checks were made on 25 July 2018 at The Spire Thames Valley Hospital, but the Defendant was not present. Arrangements were then made for the surgery to be carried out on 3 August 2018. The Claimant, together with her father and mother, flew to London on the evening of 2 August 2018.

She attended the hospital at 8 am on 3 August 2018 and as stated in the Claimant’s case, the Defendant saw her for the first time. He spent a limited period of time with her and went through a surgical consent form, which she signed. The surgery was then carried out.

The Claimant’s case alleged that the Defendant, amongst other things, had not taken into account her psychiatric vulnerability and had wrongly given her the impression that the hysterectomy would address her psychiatric issues. In addition, he failed to give her any adequate information about the risks associated with premature menopause. He had also not accessed her extensive medical records from Ireland. Her case was that had she been so advised and made aware of all the risks with proper informed consent, she would have declined the surgery.

Experts in the case argued that there was an inadequate assessment of her condition and that the decision to perform such radical surgery should have been taken in a multi-disciplinary setting. They argued it was unacceptable if the Defendant only saw her on the morning of the operation itself. In short, the consenting process for this radical surgery on someone so young and highly vulnerable was completely inadequate and in breach of the duty of care owed.

The Defendant contended in his pleaded Defence and further documents to the Court that he had in fact, seen her the night before and fully discussed the risks. However, this was in direct conflict to the evidence of the Claimant, who was able to provide documentary evidence demonstrating that she did not meet that evening with him. The evidence included witness statements, flight manifest times from Dublin to Heathrow, car hire pick-up time, hotel check-in times and restaurant credit card receipts.

Although the Defendant continued to deny that the first time that he met the claimant was on the morning of the surgery, he did accept that there was no record of an appointment taking place on 2 August 2018.Spire Thames Valley Hospital had also confirmed there were no medical records relating to such an appointment.  The Claimant’s case was that their meeting could not have and did not take place. The Defendant, however, only accepted the position that there was no record of an appointment after a successful interlocutory application to the Court to order him to answer a Notice to Admit Facts.

A key breakthrough came in the case when the Defendant indicated that he would not be filing at Court any expert evidence from an independent gynaecologist to support his position on consent. Then in a case-changing U-turn, he admitted his consenting process was not adequate for this life-changing surgery. He accepted that this amounted to a breach of the duty of care owed. Judgment was then formally entered on liability for the Claimant. The claim was listed for Trial on 23 September 2024 but settled shortly prior in the sum of £300,000 plus costs. The main component of the settlement related to the Claimant’s ability to enter into a Surrogacy Agreement in the United States of America, which was the only prospect of her being able to become a parent.

In a final, but compelling and unique twist to the case, the Claimant was given the opportunity to speak directly to the Defendant’s representatives in an emotional victim-impact-type statement at a settlement meeting in Liverpool. She passionately and bravely set out the effects of the whole episode on her. This clearly moved those present but gave her empowerment and closure over a sad and devastating set of circumstances.

If you have any concerns regarding treatment you have received from medical professionals, please contact Geldards Medical Negligence team