Failure to diagnose 4th degree tear during child birth

Rachel Bowen was instructed to act on behalf of Mrs X who suffered a 4th degree tear during delivery of her first child. Unfortunately, the Defendant failed to recognise this was a 4th degree tear and undertook a surgical repair surgery in the mistaken belief it was a 3rd degree tear.

For information purposes, the difference between a 3rd and 4th degree tear is that a 4th degree tear, extends beyond the internal and external sphincter muscles and breaches the epithelium of the anal canal. Therefore, surgery for a third-degree tear will repair tears to the sphincter muscles but not repair the rectal tearing.

After surgery, Mrs X complained of passing faeces and wind through her vagina. She was readmitted to hospital a week later for an examination under anaesthetic (EUA) where an obvious 4th degree tear was identified and repaired. However, Mrs X continued to pass faeces through the vagina and suffer from incontinence and uncontrollable flatulence.

Mrs X attended regular reviews with the colorectal, gynaecological and urogynaecology surgeons. She underwent 2 further EUA’s during the second of which a recto-vaginal fistula was identified. This was successfully repaired but she still continued to suffer ongoing faecal urgency, incontinence and leakage.

Mrs X’s bowel injuries had an impact on her mental health and she was diagnosed with Mixed Anxiety and Depressive Disorder. Mrs X required assistance caring for her new baby and with domestic chores. She was left unable to return to her pre injury employment and our medical experts advised she would only be able to work part time in the future in a home based job up until the time of menopause when her bowel symptoms were likely to deteriorate.

Rachel pursued the case on the basis that but for the Defendant’s negligence, the 4th degree tear would have been identified and repaired immediately following delivery and on the balance of probabilities she would have made a full recovery. Mrs X would have avoided the need for repeat surgeries, avoided developing a fistula and avoided faecal and flatal incontinence and avoided psychological injury. Mrs X would have returned to her job full-time and would have not required any childcare or domestic assistance.

The Defendant admitted the failure to identify Mrs X had a 4th degree tear but argued that the repair undertaken a week after delivery, was in effect, a primary repair and therefore Mrs X’s outcome would have been little different had the surgery been undertaken one week earlier. The Defendant eventually accepted that on the balance of probabilities the fistula would not have developed but continued to deny that the delay caused Mrs X’s bowel problems and argued that she would have suffered from these symptoms in any event.
The Defendant made an early initial low offer to settle the claim in the sum of £5,000, which was rejected. Following exchange of expert evidence Rachel arranged for a joint settlement meeting to take place during which the claim was successfully settled in the sum of £642,500.00.

 

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