I ask is it worth pursuing as after waiting for 18 months for an extremely slow 'no win, no fee' solicitor to get their act together and get a medical report from a 'specialist' sorted. The advice received is we wouldn't have above 50% chance of winning so advised to let it go. Now we only have until Oct this year left due to time limitation.

Firstly the report is not factual and many assumptions have wrongly been made.

The basics of what happened are as follows.

Oct 2014 my husband went into complete urine retention one evening. A call to 111 service at midnight got us a gp call back at 2am whereby he was advised to drink 2 litres of water and if no better contact either gp in morning or go to A & E. No attendance to him was offered only a phone consultation.

If he had been attended it would have been clear he had a lot of urine already 'stuck' and to put more pressure on his bladder by introducing a further 2 litres would cause further harm.

At 9.30am the following morning he went to A & E in excruciating pain and a bladder with 3.2 litres in it which was stretched so far it has been rendered useless ever since and he remains with a catheter in place.

Yes he had noticed as many older men do a decrease in urine output prior to this and yes his prostate is enlarged but up until that night had never given him cause for concern.

In his medical records for the visit to A & E it is stated he arrived with 3.2 litres of urine in his bladder but tge 'specialist urologist' who this solucitor got to review his notes says "whilst there is much mention of 3.2 litres in his bladder I would say it was more likely to have been around a litre after viewing A & E notes"....

Where he has arrived at this rubbish we know not. Unless he sprung a leak out of another orifice on the way to A & E.

We are both of the opinion the medical profession certainly stick together over negligence. This is a 65 year old man who now has had to give up his job because of this due to frequent infections caused by catheters and leaking embarrassing moments on train travelling to work everyday.

Even the out of hours 111 service admitted that in future they would send a gp out if a patient presented like this again. Also they conveniently lost recording of advice given to us the night we phoned for advice althougg they retained paper record...

Hello Sally. I'm sorry to hear about the problems you're having and can understand why you're frustrated.

This forum has regulars who visit, hopefully some of them will be along later or tomorrow with advice for you.

HB

From my experience with my elderly relative being discharged from hospital (having been there for some months) and who looked awful arriving back, be prepared for a struggle when up against the NHS. My relative was re-admitted to hospital just 8 days later with acute renal failure.

They did go on to survive another year or so and again I had battles with the NHS about the severity of the illness and CHC, it was still under review and I was still being told that they were not 'ill' enough to get it. Death eventually proved otherwise.

I did submit a formal complaint about the discharge and got fobbed off. Also the CHC assessments were completely full of errors, I used a SAR to get records, and also full medical records and found lots of inconsistencies.

I ask is it worth pursuing as after waiting for 18 months for an extremely slow 'no win, no fee' solicitor to get their act together and get a medical report from a 'specialist' sorted. The advice received is we wouldn't have above 50% chance of winning so advised to let it go. Now we only have until Oct this year left due to time limitation.

Firstly the report is not factual and many assumptions have wrongly been made.

The basics of what happened are as follows.

Oct 2014 my husband went into complete urine retention one evening. A call to 111 service at midnight got us a gp call back at 2am whereby he was advised to drink 2 litres of water and if no better contact either gp in morning or go to A & E. No attendance to him was offered only a phone consultation.

If he had been attended it would have been clear he had a lot of urine already 'stuck' and to put more pressure on his bladder by introducing a further 2 litres would cause further harm.

At 9.30am the following morning he went to A & E in excruciating pain and a bladder with 3.2 litres in it which was stretched so far it has been rendered useless ever since and he remains with a catheter in place.

Yes he had noticed as many older men do a decrease in urine output prior to this and yes his prostate is enlarged but up until that night had never given him cause for concern.

In his medical records for the visit to A & E it is stated he arrived with 3.2 litres of urine in his bladder but tge 'specialist urologist' who this solucitor got to review his notes says "whilst there is much mention of 3.2 litres in his bladder I would say it was more likely to have been around a litre after viewing A & E notes"....

Where he has arrived at this rubbish we know not. Unless he sprung a leak out of another orifice on the way to A & E.

We are both of the opinion the medical profession certainly stick together over negligence. This is a 65 year old man who now has had to give up his job because of this due to frequent infections caused by catheters and leaking embarrassing moments on train travelling to work everyday.

 

Even the out of hours 111 service admitted that in future they would send a gp out if a patient presented like this again. Also they conveniently lost recording of advice given to us the night we phoned for advice althougg they retained paper record...

I had a 5 year battle and won a 6 figure sum and without a solicitor in sight.

I contacted NHSLA directly and they were actually helpful.

The trick is to keep it simple. Get your own report done. Ignore talk of it costing 1,000's it shouldnt be more than 3 or 4 hundred. Get a list of approved experts from NHSLA and go directly to the expert yourself with your story and med records, submit the report to NHSLA and they are obliged to counter it by getting one done themselves. It's plain sailing after that and the 3 year rule shouldnt apply or count if NHSLA are aware of your claim.

NHS Litigation Authority link: http://www.nhsla.com/Pages/Home.aspx

I had a 5 year battle and won a 6 figure sum and without a solicitor in sight.

I contacted NHSLA directly and they were actually helpful.

The trick is to keep it simple. Get your own report done. Ignore talk of it costing 1,000's it shouldnt be more than 3 or 4 hundred. Get a list of approved experts from NHSLA and go directly to the expert yourself with your story and med records, submit the report to NHSLA and they are obliged to counter it by getting one done themselves. It's plain sailing after that and the 3 year rule shouldnt apply or count if NHSLA are aware of your claim.

Thankyou for that advice we will look into doing that.

As regards the medical consequences of what occurred, I leave that to those more knowledgeable. But as regards the legal process:

1. It may well be the case that as a complaint to the NHS there is no reason to think that just because the process extends over more than 3 years, it is no longer somehow valid. But as regards litigation, proceedings involving personal injury will usually be 'time-barred' if they haven't been formally commenced (i.e by service of a Writ) within 3 years from the date of injury.

And it's not unduly cynical, in my view, to predict that a complaint that is no longer backed by the possibility of litigation will be treated even more dismissively than before.

2. It is the case that one's own 'expert' medic can turn out quite shamelessly to conjecture 'facts' which are not supported by the written evidence. This is indeed a form of outrageous, mutual back-scratching amongst the medical profession: I have seen it happen to a member of my own family right under my legal nose.

This should be addressed by the solicitors acting for the claimant (e.g. by questioning the expert on his\ her report, or by getting a new one.) If I wasn't confident that this was being sorted out properly, I would change solicitors - keeping a very vigilant eye on the 3 year limitation period.

Nolegion's thoughts mirror my own.

If approaching the 3 year deadline : issue proceedings and then stay them to allow negotiation, so it doesn't become statute barred.

Have you dispensed with the services of the NWNF lawyer, because if you haven't and you take this on yourself, they will have their grubby paws out in the event that you obtain a settlement.

It should be very easy to find out how much urine was actually in the bladder. At first they would have done a bladder scan which gives an estimate, any machine I have ever used for this the maximum reading they give is +999 it does not have the ability to estimate any higher than that so would have been impossible to get a figure of 3.2 litres that way so the question is where did that figure come from? did he have an ultrasound? and what was the actual residual volume when he was catheterised? The residual volume is all that really matters because that is the actual amount that was there. If the 3.2 litres was the residual volume then I don't see how the person doing the medical report could say it was less than that. If however the 3.2 litres was the estimate, but the residual was only one litre then what the urologist said would make sense at least on paper. I guess what I am saying is that you need to see what he seen, what is actually on the medical notes because that's the only way I think you can get to the bottom of it.

It should be very easy to find out how much urine was actually in the bladder. At first they would have done a bladder scan which gives an estimate, any machine I have ever used for this the maximum reading they give is +999 it does not have the ability to estimate any higher than that so would have been impossible to get a figure of 3.2 litres that way so the question is where did that figure come from? did he have an ultrasound? and what was the actual residual volume when he was catheterised? The residual volume is all that really matters because that is the actual amount that was there. If the 3.2 litres was the residual volume then I don't see how the person doing the medical report could say it was less than that. If however the 3.2 litres was the estimate, but the residual was only one litre then what the urologist said would make sense at least on paper. I guess what I am saying is that you need to see what he seen, what is actually on the medical notes because that's the only way I think you can get to the bottom of it.

A&E wouldn't necessarily have done an ultrasound.

Patient not passed urine?. Palpable bladder and pain on palpation?.

A&E don't have to do "definitive care" ; that would be enough to say "in urinary retention, needs a catheter to relieve it". Why would then spend time doing an ultrasound if they'd reached a diagnosis and a plan?.

I agree, though, that if the residual volume was noted when catheterised (or even "in excess of x amount"), an expert would have to say that it was measured wrongly to say that that wasn't the volume obtained .....

A&E wouldn't necessarily have done an ultrasound.

 

Patient not passed urine?. Palpable bladder and pain on palpation?.

A&E don't have to do "definitive care" ; that would be enough to say "in urinary retention, needs a catheter to relieve it". Why would then spend time doing an ultrasound if they'd reached a diagnosis and a plan?.

 

I agree, though, that if the residual volume was noted when catheterised (or even "in excess of x amount"), an expert would have to say that it was measured wrongly to say that that wasn't the volume obtained .....

I highly doubt they would have done an ultrasound, though they may have done a bladder scan which takes less than a minute to do if you have a machine available (although that is a big if). That's why i was wondering where the figures came from because it's interesting that there is a massive discrepancy in the nunbers and that seems to be what is important to the lawyer. It would be extremely bad practice for them not to note the residual volume in any circumstance when someone is catheterised but even more so when in acute retention

I highly doubt they would have done an ultrasound, though they may have done a bladder scan which takes less than a minute to do if you have a machine available

How does the 'bladder scan' work, if not ultrasound?.

It may be a portable ultrasound, rather than a 'departmental machine', but surely it is still ultrasound?

Yep, it's a Doppler/Ultrasound - personal experience of countless scans following spinal surgery.

It's a specific machine for bladder scanning, but its similar technology to an ultrasound - you literally point and click and it gives an estimate of urine volume takes less than a minute there is no need to interpret the results or anything the way there is with an actual ultrasound because it just tells you the number. The machines are not always easy to come by in a hospital though as they don't tend to have many of them and they get borrowed and not returned all the time so its not a 100% thing that they would have done one, but had the machine been available they would have.

It's a specific machine for bladder scanning, but its similar technology to an ultrasound -

Its not "similar technology", it is still ultrasound. It does the calculation for you, but it is ultrasound.

you literally point and click and it gives an estimate of urine volume takes less than a minute there is no need to interpret the results or anything the way there is with an actual ultrasound because it just tells you the number. The machines are not always easy to come by in a hospital though as they don't tend to have many of them and they get borrowed and not returned all the time so its not a 100% thing that they would have done one, but had the machine been available they would have.

If they have a diagnosis of urinary retention, it still isn't needed in A&E.

If the diagnosis was in doubt, then sure, scan.

But, if the diagnosis isn't in doubt, it is a waste (of time, in finding the machine and doing the scan, and of the resource of the machine).

If it isn't needed to establish the diagnosis, what is it adding?. It isn't adding a measurement of the residual, as that can be obtained by placing the catheter, which is what is needed for the management plan.

If it can only take time, isn't adding a diagnosis (if the diagnosis has been made), and isn't adding to the measurement of the residual, why waste time doing it?.

They should be thinking "with their A&E head on" in A&E.

Not "what do we have to do to definitively manage every problem" but "what do we need to do to get a diagnosis and a management plan, and do that without adding unnecessary bells and whistles", so they can get to the next A&E patient...... leaving the definitive management to them appropriate specialty (which includes GP as a specialty in its own right).

Returning to the OP's situation : was the residual recorded as part of the A&E notes for the catheterisation?

I emailed NHSLA never received a reply

A bladder scan was done to establish it was full. The 3.2 came from what immediately came out once he was cathertised. We know he drank the 2 litres as instructed so it never came out until it was released.

I dont honestly think he has the energy to take on anymore stress fighting this. We cannot afford to get an independent urologist report done as he's had to retire due to this and other health issues if they are just going to come up with the same old truck and noting the statute time bar and the fact that if by some miracle he got compensation the solicitor we have would demand some of that.

I hadnt replied before because he just had sepsis and pneumonia. Got over that and I've just dropped him at hospital for planned surgery (tongue biopsy). He's not well with severe copd/emphysema so i guess he has to live with it.