So, I've emailed the PALS at Lewisham Hospital and asked about how I take the complaint I've placed against the hospital to the next level, having exhausted the local resolution stage. Here's the letter I got from the Chief Executive, with names changed to protect the (presumably) innocent and comments in sarcastic asides from me.
Ugh. Tell me I'm not being a crazy person and complaining about nothing, yes? I'm really quite disheartened about all of this and, to add to the general joy of it all, I appear to be getting a bit depressed by it all, as I'm sure is only appropriate.
Dear Mr ZombieCoterie
I was concerned to hear of your experiences related to the planning of your surgery and post operative care after shoulder surgery. We aim to provide a high standard of service to the community we serve and I am genuinely disappointed when a patient indicates that we have failed to achieve this.
It wasn't shoulder surgery, it was ulnar decompression in my elbow...
Ms Marvel, Service Manager for Orthopaedics has carried out an investigation on my behalf which I trust will address the issues you have raised. Ms Marvel has also asked Spiderman, Orthopaedic Registrar, for his input.
You sat that the operation was delayed by a month until 15th May 2009. Ms Marvel has reviewed your records which show your initial care was under Doctor Octopus who worked as a Locum Consultant in Orthopaedics for 6 months. Unfortunately, Doctor Octopus left the Trust at the end of March as he had taken up a consultant post elsewherte. Captain America, Consultant Orthopaedic Surgeon, kindly agreed to take over Doctor Octopus's patients and perform the surgery until the appointment of a new upper limb orthopaedic consultant. Your surgical pre-assessment date was linked to the initial operation date under the care of Doctor Octopus. I am so sorry that the reason for cancellation was not made clear to you.
You say that when you attended the Pre-assessment Clinic you did not see the surgeon or anaesthetist. On the day of your pre-assessment unfortunately Captain America and his Registrar were unavailable due to study leavel. Our normal practice is that all our patients are seen in the Pre-assessment Clinic and have a detailed discussion regarding the proposed surgery and postoperative period with a member of the surgical team. On that particular occasion neither Spiderman nor Captain America were available to have this discussion with you. Spiderman apologises that he did not realise on the day of the surgery that you had not had this discussion. He was under the impression that you had had an extensive discussion with the surgeon. Regarding not seeing the anaesthetist, Ms Marvel has discussed this with the Pre-assessment Department staff who have explained that when you brought up your 'Added to Waiting List" form you were asked to fill in a pre-screening questionnaire on which you would have given information about any previous medical history. The Nurse Practitioner at pre-assessment screens this information and, if necessary, a separate anaesthetic appointment would have been arranged for you.
We have recently reviewed the consenting process and all patients listed for upper limb orthopaedic surgery are now consented in Outpatient Clinic at the time of listing for surgery. This should minimise the risk of patients feeling uninformed regarding their planned surgery.
You say that postoperatively you did not see an orthopaedic surgeon or physiotherapist and were sent home with the message that an appointment would be sent in the post. Surgeons do not routinely see the patients postoperatively. Recovery has clear guidelines regarding discharge and work to the postoperative instructions described on the discharge summary by the doctor. The discharge summary stated that you were to be seen 6 weeks post surgery, and that your sutures were to be removed at the GP practice after 2 weeks. Spiderman would like to apologise for not making this clear on the day of surgery.
Ms Marvel spoke to Dr Susan Storm, Head of Physiotherapy, regarding postoperative physiotherapy and she has advised that is not routine practice to provide postoperative physiotherapy. If physiotherapy is necessary this is usually requested after the first follow-up appointment. The Invisible Woman has informed Ms Marvel that a physiotherapy appointment was organised for you which you attended on 2nd July 2009. Spiderman has agreed to write rehabilitation guidelines for upper limb surgery to ensure patients are aware what exercises can be started after surgery.
The issue here is more that the physiotherapist has, in two months, been able to remedy the very same problem as was operated on in the other arm. My left arm is pretty much healed without surgery as a result, so my issue is that if I'd had this physiotherapy intervention when the nerve compression was first diagnosed by the nerve conduction test I had at King's, I could have been healed by last Christmas and been back at work at the beginning of this year rather than being on benefits and unable to return to interpreting. I could also have avoided having my arm chopped up.
Your appointment was rescheduled to 12th August 2009. Ms Marvel has investigated this and has been unable to find a specific reason for the postponement as Spiderman and Captain America were both in clinic on 1st July. I understand from Ms Marvel that your appointment was brought forward to 15th July, which you attended. I do hope that with the physiotherapy you are now making a good recovery.
You say that on discharge you were given tiny plasters that were smaller than the incision. Ms Marvel discussed this with Professor Xavier, Matron for Riverside Theatres, and he would like to apologise for providing the wrong size plasters. The wound is packed in theatres and the nurses in Recovery are not aware of how large the incision is unless informed in the postoperative notes. Providing plasters smaller than the incision was not intentional and Matron X is sorry this happened.
I sincerely hope our explanations and apologies ahave addressed your concerns and that you are reassured that we have taken steps to minimise the recurrence of such a breakdown in communication. However, if you feel there are further issues arising from this matter, then please do not hesitate to contact the PALS Unit on 020 8333 3355 and they will be happy to discuss the matter further and, if necessary, set up a meeting with the relevant members of staff.
If, alternatively, you feel that the Local Resolution stage of the complaints procedure has been exhausted, you may wish to consult the complaints leaflet sent to you with the acknowledgement letter as it gives full details of what other courses of action are available to you.
What are your thoughts on this? I'm not sure if by admitting they've not done things that are essential to ensuring I've given informed consent they are admitting negligence or quite what format the complaint takes from here. I think the Local Resolution has been exhausted, so I've asked PALS to let me know what I should do next. If it looks like I have a case for trying to claim back lost earnings or damages for the extra year I've been out of work then I will do so. I take particular issue with the discussion I had with Doctor Octopus when we got the results of the nerve conduction test and I asked specifically if I would stand any chance of healing without surgery and whether physiotherapy would help and he told me that I was being silly and that only surgery would help at that point. Turns out he was wrong, if the other side had the same problem (the nerve conduction test showed the same trouble both sides) and has been fixed without surgery. According to the physio it's really clear from the notes and from a quick inspection that the problem was to do with something in my neck and that I needed a lot of specific exercises to straighten my neck and improve my posture.