Royal Marsden Hospital: £1m for family of woman not told of BRCA gene mutation risk
Mrs O had a strong family history of breast cancer. In 1993 when in her late twenties, Mrs O came under the care of the Family History Clinic at The Royal Marsden. She started having annual breast examinations until the age of 35 when in 1999 she started to have annual mammograms.
From around 1994 the BRCA 1 and 2 gene mutations had been identified and it was known that women who had the BRCA gene mutation were at high risk of developing breast and ovarian cancer. From the end of 1996 private testing became available for the BRCA gene mutation.
From 2004 NICE Guidelines recommended genetic counselling for women deemed to be at risk of having the BRCA gene mutation.
In November 2007 The Royal Marsden published a protocol which required all high risk women such as Mrs O to be referred for genetic counselling.
Due to her family history of breast cancer there should have been a strong suspicion that there may be a genetic mutation. However, Mrs O was not advised about her potential risk of the BRCA gene mutation, nor of the link to ovarian cancer at any time during her care at Royal Marsden. She was also not offered referral for genetic counselling at any time.
In summer 2010 Mrs O developed classic symptoms of ovarian cancer. Investigations confirmed a cancerous mass arising from the left ovary and suspected metastatic disease. Mrs O underwent chemotherapy followed by extensive abdominal surgery to remove the cancer followed by more chemotherapy.
Following her diagnosis of ovarian cancer Mrs O was advised about the BRCA gene mutation and the link between breast and ovarian cancer. In May 2011 Mrs O underwent genetic testing which confirmed she had a mutation in the BRCA 1 gene.
Sadly treatment for the ovarian cancer was unsuccessful and the disease recurred several times from 2012 onwards. Mrs O passed away from the disease in September 2014 at 50 years of age leaving a husband and three children.
The Trust denied that there had been a failure to advise Mrs O about the genetic mutation and ovarian cancer risk before November 2007 but admitted that a referral for genetic counselling should have been made in April 2008. The Trust defended the claim on the basis that even if properly advised, Mrs O may not have had genetic testing for the BRCA gene mutation and/or would not have had protective surgery to remove her ovaries and prevent ovarian cancer. The Defendant admitted that if Mrs O had undergone surgery to remove her ovaries by the end of 2009 she would have been cured of any disease and would have avoided her death.
After exchange of witness and expert evidence in the claim the Trust agreed to an early settlement meeting. At the settlement meeting Helen was able to negotiate a settlement in the sum of £1 million for Mrs O's family.
Mrs S had a history of chronic low back pain and intermittent sciatica which she managed with physiotherapy and painkillers. When the sciatica became worse in 2013, she consulted Mr Knight who proposed a complicated endoscopic spinal procedure at multiple levels of the spine (of which Mrs S was unaware).
Immediately following the operation in September 2013, Mrs S suffered excruciating pain and severe weakness in her left leg and her left knee, preventing her from putting weight on the leg or walking.
Over a number of months, Mrs S was advised by Mr Knight that the symptoms were temporary and normal following surgery. He then performed a further operation on her spine in November 2013 (which was also alleged to be inappropriate). Nerve conduction studies were performed which indicated an L4 nerve injury which was confirmed by other doctors Mrs S consulted privately.
Mr Knight, however, refused to accept there was a nerve injury or that this had occurred during the first operation in September 2013. He instead suggested that the injury had resulted from Mrs S having a fall which had occurred when her left knee gave way.
Mrs S suffers with significant pain and weakness in her left leg and the left knee continues to give way which has caused her to have falls and sustain other injuries. She is only able to walk with a rollator and her mobility is severely impaired.
Liability was strongly and fully denied throughout the claim and Mr Knight continued to insist that there had been no nerve injury. This was despite the Defendant’s independent spinal surgery expert confirming there had been a nerve injury and agreeing with the Claimant’s independent expert that no spinal surgeons in the UK would have performed multi-level surgery in September 2013 as it was not indicated. The Defendant’s expert referred to Mr Knight as ‘an outlier’ in the spinal surgery community.
A settlement meeting proved unsuccessful. Eventually, and only once she made an application for Summary Judgment against the Defendant, Helen was able to negotiate a settlement of £550,000 for Mrs S.
Mrs S said: ‘I would like to express my gratitude to Helen Thompson, who has worked tirelessly on my case with the utmost professionalism. Her expert knowledge, support and guidance was outstanding.’
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For further information about ovarian cancer claims, please call Helen Thompson on 03304606765 or email helen.thompson@fieldfisher.com.
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