GP Failure to act on Ultrasound Scan Diagnosing a large Cervical Fibroid

Rachel Bowen was instructed to act on behalf of Mrs X in a claim against her GP for failing to take action following receipt of an ultrasound scan report that reported the presence of a large cervical fibroid.

Mrs X had attended her GP complaining of increased urinary frequency, pain when urinating, tenderness over the left ovary and inter-menstrual bleeding. Mrs X was referred for a pelvic and transvaginal ultrasound scan which revealed the presence of a large cervical fibroid. The ultrasound scan report was wrongly annotated by a trainee GP at the surgery as being normal with no further action required. When Mrs X contacted her surgery for the results of the scan she was told the scan was normal and no follow up was required.

Some 18 months later the Claimant was taken by ambulance to hospital with significant suprapubic pain, blood in her urine and vaginal blood loss. On arrival at hospital, examination demonstrated the cervical fibroid pushing through the cervix. Mrs X developed urinary retention and was catheterised. A further ultrasound scan showed that the fibroid had enlarged considerably since first reported and Mrs X required a hysterectomy. Due to the size of the fibroid, the anatomy was grossly distorted and during the performance of the hysterectomy, damage was caused to the ureters. The left ureter had to be surgically repaired and ureteric stents were inserted into both ureters. Mrs X required a blood transfusion and spent the night in HDU.

Due to the ureteric injury, Mrs X suffered suprapubic pain and urinary incontinence. A fistula developed between the urinary tract and the cervix causing leakage of urine. A further stent was inserted together with a free-draining urethral catheter. Over the next few months, Mrs X had a number of examinations under anaesthesia and the ureteric stents had to be replaced on several occasions. It took approximately 12 months for the ureteric injury to resolve and for the stents to be removed and the urinary incontinence to cease. Mrs X was left with symptoms of an overactive bladder and a tendency to recurrent cystitis, in addition, she developed psychological injury in the form of an Adjustment Disorder.

It was alleged that the trainee GP had wrongly recorded the ultrasound report as normal and had failed to organise a follow-up consultation with Mrs X to discuss the findings of the report and failed to organise a gynaecological referral. Causatively had Mrs X been reviewed by a Gynaecologist at the time of the scan, she would have been advised of the various options for treating a large fibroid and on the balance of probabilities, she would have opted to undergo fibroid embolisation. Mrs X would therefore have avoided the need to undergo a hysterectomy and the injury to her ureters caused due to the distortion of the anatomy due to the large size of the fibroid, would have been avoided.

The Defendant admitted that there was a breach of duty in that the trainee GP failed to recognise that the ultrasound scan report was not normal but denied that a reasonable GP would have referred Mrs X to see a Gynaecologist unless she was symptomatic and put Mrs X to strict proof that a referral to a Gynaecologist was mandatory. The Defendant admitted that the breach of duty had led to a delay in treatment but put Mrs X to strict proof as to the alleged consequences of the delay and in particular the type of treatment that she would have undergone and her subsequent recovery had earlier investigations been carried out with a referral to a Gynaecologist.

Following exchange of both parties expert evidence on breach of duty and causation and service of the Claimant’s quantum expert reports, the Defendant made an offer to settle Mrs X’s claim. This offer was rejected and following further negotiations Rachel successfully settled the claim in the sum of £120,000.00.

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