For several years, SB was biochemically, but not clinically, thyrotoxic. She had a family history of thyroid cancer and had been regularly reviewed by clinicians. In 2012, she noticed a lump in her neck, later identified as a multi-nodular goitre (swelling from an enlarged thyroid gland). A conservative approach had been adopted, where she had undergone investigations and received regular follow up.
In July 2012, SB had an ultrasound scan and was referred to the surgical department to discuss a thyroidectomy. She subsequently had a CT scan in August 2012.
On 17 September 2012, SB saw an Endocrine Surgeon at Hillingdon Hospital, who reviewed the CT scan and said there was no goitre, but advised SB that she required a total thyroidectomy. She signed a consent form which advised that the intended benefits were "cure", and that the serious or frequently occurring risks were "infection, bleeding, scar, ↓Ca, hoarse voice". She was not advised, either verbally or in writing, of the material risks of:
- Damage to a nerve, specifically a laryngeal nerve
- Bilateral laryngeal nerve damage
- Tracheostomy following nerve damage
- Loss of voice following nerve damage
- Difficulty with breathing following nerve damage
Neither did the surgeon advise SB that there were non-surgical alternatives available, including doing nothing, and/or having radioactive iodine treatment.
On 2 October 2012, SB underwent surgery. She confirmed her consent by re-signing the consent form, but again, none of the above risks were explained to her, either verbally or in writing.
During the procedure, SB sustained injury to her recurrent laryngeal nerves, leaving her with permanent bilateral recurrent laryngeal nerve paresis. When she was finally released home, SB could not speak but had to write messages on pieces of paper to communicate, as well as receive speech and language therapy.
Her sons continue to have to look after her. SB cannot breathe properly and feels weak, preventing her from being involved in family activities, including picking up her grandson. She cannot walk long distances, preventing her from being able to walk her two dogs. She has difficulty going up and down stairs and has ongoing issues with her voice. She has become socially withdrawn, no longer leaves her house and her personality has changed. She has been diagnosed with a Major Depressive Episode.
It was SB's case that she had not been appropriately advised of the risks or the alternatives set out above, and that if she had, she would have declined to undergo surgery, particularly in circumstances where there were other options, including doing nothing. She would have avoided:
- An operation under general anaesthetic
- Bilateral laryngeal nerve damage causing bilateral vocal cord palsy
- Respiratory distress and other complications in her post-operative recovery causing SB to require an inpatient stay in the Intensive Care Unit
- Ongoing care and therapy needs
We took over the claim in late 2016, once it had been issued and served, and a defence received. No quantum investigations had commenced.
The defendant accepted that there had been a breach of duty in not advising SB of the risks. However, they did not accept that she would have declined to undergo surgery. Further, SB's treating surgeon told her several times that he ought to have informed her of the risks and that she should be compensated for her injuries. An early offer of settlement of £75,000 was made.
Once we took over the case, we instructed relevant experts to comment on SB's condition and prognosis, including psychiatric injuries, care, occupational therapy, physiotherapy and housing needs. Medical evidence indicated that SB could undergo surgery, either a tracheostomy or laser cordotomy procedure, to relieve some of her ongoing symptoms. However, both had disadvantages, and SB was terrified of further surgery after what had already happened to her.
A claim was put forward based on four scenarios, ranging from undergoing either of the two procedures above, not having surgery at all, or deferring surgery for 10 years.
After exchanging evidence, it was clear that the parties were some way apart in their assessment of quantum in the case.
Experts' meetings were arranged to negotiate the issues and trial was listed for April 2018. On 6 February 2018, the parties attended a Round Table Meeting where the six figure settlement was agreed, negating the need for trial.
The damages will allow SB to purchase a CPAP machine to ease her breathing, engage in occupational therapy and physiotherapy, and employ a carer to provide support and assistance with activities of daily living.
At the end of the case, SB's son said: "I just want to say we couldn’t thank you enough for the hard work you’ve put in and you did a tremendous job in getting what mum deserves. We are so glad we took counsel's advice to instruct you to act for mum – from the first day we spoke to you, we were reassured we were in safe hands and trusted the advice you gave us. Your diligence, perseverance and late nights in the office certainly paid off for us, and we will never forget what you achieved for mum."
Arti said: "At the time of taking on the case, it was clear that the Trust had a case to answer, and indeed, her treating surgeon was devastated by events and indicated she should be compensated. The initial offer put forward was paltry given the permanent nature of SB's injuries, and the ongoing effect on her everyday life. With the help of expert evidence, we were able to demonstrate this comprehensively. It has been a pleasure acting for SB, and I hope the damages go some way to helping her return to the person she was before she sustained her life changing injury."
The leading ENT surgeon in the case, 1 of only 2 recognised specialists in the country, provided the following endorsement of Arti's handling of the case when it concluded: "I write this letter simply to say how impressed I was with Ms Shah's commitment and tenacious attitude to this case - she is an asset to your firm and the legal profession as a whole. She combines professionalism with compassion, and has an excellent understanding of medicine and the law."
Photo © Marion Phillips (cc-by-sa/2.0)
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