Delayed retinal detachment diagnosis after cataract surgery leads to vision loss

Written on 12th September 2024 | 9 minute read

Background to the case

The case concerns Mr Stephen Hutchinson aged 66 from Wisbech, a patient who underwent cataract surgery at Anglia Community Eye Service (ACES) in Wisbech in 2019.

Unfortunately, the procedure did not go as planned and complications arose during surgery. Mr Hutchinson was not told about these complications and post-operatively he reported concerns about his vision. Mr Hutchinson also complained of delays in appropriate triage, assessment and treatment, which ultimately resulted in a total loss of vision in the right eye from a retinal detachment.

The Initial Procedure: Cataract Surgery

On 14 October 2019, Mr Hutchinson underwent cataract surgery at ACES. During the surgery, a small tear occurred in Mr Hutchinson’s posterior capsule, which was documented in the operation notes but not communicated to Mr Hutchinson at the time or upon discharge.

The tear in the posterior capsule was a complication that required careful post-operative monitoring and prompt medical intervention if symptoms of retinal detachment developed. However, Mr Hutchinson was not informed about this and was discharged from ACES clinic without any specific advice or safety netting being provided.

Post-Operative Complications and Clinical Negligence

Following the surgery, Mr Hutchinson started to experience blurry vision. He made multiple calls to ACES expressing concerns between 16 and 24 October. Whilst blurry vision can be a common symptom following cataract surgery, given the complication during Mr Hutchinson's surgery, any changes in vision warranted further clinical review.

However, reassuring responses from ACES made without the benefit of a thorough eye examination delayed the necessary medical intervention and staff failed to escalate Mr Hutchinson’s concerns to the operating surgeon.

Mr Hutchinson had to insist on being seen by the operating surgeon, on 25 October. During this first post-operative review, it was noted in Mr Hutchinson's medical records that his vision had not cleared and was in fact getting worse. Mr Hutchinson was seen again by the operating surgeon the following day and whilst the medical records documented that a retinal detachment was suspected, Mr Hutchinson was not informed. Instead, he was asked to return for a further appointment two days later.

Mr Hutchinson duly returned on 28 October for a washout of the eye. Once again, he was asked to return two days later. Mr Hutchinson returned to be assessed again by the operating surgeon for the fourth time on 30 October and on this occasion a referral was finally made to Addenbrooke’s Hospital for specialist vitreoretinal review and treatment.

Mr Hutchinson was seen by Addenbrooke’s Hospital on 31 October and was booked for emergency surgery the same day to try to save his sight. Whilst Addenbrooke’s was able to reattach Mr Hutchinson’s retina, his sight could not be saved due to the delays in referral.

Retinal Detachment: A Serious Medical Condition

Retinal detachment is a serious sight-threatening medical condition that requires urgent intervention to prevent permanent vision loss. In Mr Hutchinson's case, the symptoms of retinal detachment were present and reported to ACES in the days following his surgery. However, these symptoms were not acted upon in a timely manner.

Between 16 and 24 October 2019, Mr Hutchinson made five telephone calls to ACES and attended an appointment, expressing concerns about his deteriorating vision. Reassurances were given, and opportunities for urgent review and intervention were missed. By the time the retinal detachment was suspected, and a referral was made for further management on 30 October, significant damage had already occurred to Mr Hutchinson's retina, resulting in substantial loss of vision.

Complaints Process

Prior to seeking legal advice, Mr Hutchinson made a formal complaint to ACES raising his concerns about the complications that arose during his surgery, the fact that he wasn’t told that his surgery was complicated and thereafter the issues with his post-operative care.

In response to Mr Hutchinson’s complaint, ACES advised that, with the benefit of hindsight, his care and outcome may have been better had he been seen by the operating surgeon sooner and that there should have been a full explanation of what happened during surgery.

However, the complaint did not acknowledge that any of Mr Hutchinson’s care fell below a reasonable standard and Mr Hutchinson felt that no lessons had been learned from his experience. He therefore proceeded to make a complaint about ACES to the local Clinical Commissioning Group (CCG).

The Importance of Serious Incident Reports for Patient Safety

Following Mr Hutchinson’s complaint to the CCG, the group contacted ACES asking them to raise his case as a Serious Incident under the NHS Serious Incident Framework. Serious Incidents are events in healthcare where the potential for learning is so significant that they warrant using additional resources to mount a comprehensive investigation.

Despite several requests from the CCG, ACES declined to conduct an investigation. The refusal by ACES to report the case as a Serious Incident meant that a comprehensive investigation into the failings in Mr Hutchinson's care was not initiated. Therefore, opportunities for learning and improving patient safety were missed.

At the time, ACES told CCG that the Serious Incident process required both sides to agree that an incident met the threshold. Since ACES decided that Mr Hutchinson’s case did not constitute a Serious Incident, they argued that it therefore did not warrant an investigation. Internal CCG emails disclosed under a subject access request (SAR) for Mr Hutchinson noted that the refusal by ACES to declare a Serious Incident was not a surprise and indicated a pattern of failing to investigate and learn from adverse patient outcomes.

Mr Hutchinson’s case highlighted a potential loophole in the NHS Serious Incident Framework, where one care provider can disagree with the classification of an incident as a Serious Incident, preventing a thorough investigation from taking place and therefore preventing lessons from being learned and preventing harm to future patients.

At the conclusion of the legal claim, Mr Hutchinson received a letter of apology from ACES stating that there has now been a complete overhaul of the triage process, meaning that if a patient telephoned post-operatively with any concerns, the triage form is now reviewed by a member of the senior clinical team. ACES also advised that since investigations have taken place, there is now different management and shareholders of ACES, meaning that processes have been reviewed and changed to minimise risk.

Mr Hutchinson was assured by ACES at the conclusion of his claim that they would promptly retrospectively notify the CQC of the Serious Incident. Mr Hutchinson has subsequently learned that such a notification was not made until May 2024, some four and a half years after he lost his sight and as a result, he remains concerned that patient safety lessons have not been acted upon in a timely manner.

Legal Proceedings and the Role of Specialist Clinical Negligence Lawyers

The complex medical and legal issues in Mr Hutchinson's case highlight the importance of engaging specialist clinical negligence lawyers who have the necessary expertise to thoroughly investigate claims and can ensure that all necessary medical expert evidence is gathered, and appropriate legal arguments are put forward.

In Mr Hutchinson's case, Tees were able to secure admissions of liability from ACES for the failings in care, specifically that:

There was a failure to advise Mr Hutchinson of the complicated surgery and provide appropriate safety netting advice.
There was a failure to put in place appropriate care and diligence following surgery, including regular follow-up every 1-3 days for up to six weeks after surgery to actively exclude a retinal detachment and/or tear.
Mr Hutchinson should have been seen by a clinician when he first called on 16 October 2019.
That if Mr Hutchinson had been reviewed on 16 October, he would have been investigated and should have been referred to the vitreoretinal specialists at Addenbrooke’s with suspected retinal detachment.
That on 25 and 26 October the operating surgeon failed to refer Mr Hutchinson to the vitreoretinal specialists at Addenbrooke’s with suspected retinal detachment.
It was admitted that with earlier diagnosis and treatment of his retinal detachment Mr Hutchinson would have retained his vision.

Mr Hutchinson was unable to get these answers through the complaints process and sadly learnt through his clinical negligence claim with Tees that his sight loss was entirely avoidable and arose as a result of many instances of negligence by ACES.

In this case, Mr Hutchinson was awarded damages in excess of six figures at mediation, reflecting the significant impact the retinal detachment and the subsequent loss of vision had on his life. While no amount of money can truly compensate for such a loss, this award goes some way to acknowledging the harm suffered and the failures in care provided by ACES, as well as compensating Mr Hutchinson for the financial losses that he suffered and will, in the future suffer, as a result of his sight loss. This case serves as a stark reminder of the potential consequences of clinical negligence and the critical importance of transparency, timely intervention, and thorough investigation by medical negligence lawyers in healthcare.

Conclusion

The case of Mr Hutchinson highlights the complexities of navigating the complaints procedure following a clinical negligence incident in order for a patient to try to obtain answers as to what happened to them and seek assurances that lessons have been learned to prevent future avoidable instances of patient harm.

Mr Hutchinson engaged specialist clinical negligence lawyers at Tees who were able to conduct a thorough investigation and secure admissions of liability.

Mr Hutchinson’s case also brought to light potential issues with the NHS Serious Incident Framework where a care provider was able to avoid carrying out important Serious Incident investigations and the CCG were unable to compel them to do so, highlighting potential failures with patient safety and preventing future incidents of clinical negligence.