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A Surgeon’s Discretion
8 August 2023
Caitlin Sykes, a clinical negligence based trainee solicitor considers a Surgeon’s Discretion: by reviewing the case of McCaul v Lancashire Teaching Hospitals NHS Foundation Trust (2022) EWHC 1963 (QB)
Background of the case
The Claimant in this case was set to undergo a procedure to increase the restricted blood flow of their right leg. A consultant vascular surgeon carried out the surgery on 28th June 2017. The results of the procedure were not favorable. On 4th July the Claimant underwent a below the knee amputation.
The Claimant signed a consent form prior to the procedure for a ‘right iliac angiogram and a right common iliac artery angioplasty, plus a right common femoral artery thrombo-endarterectomy plus patch.’ The surgery, however, was limited to the endarterectomy and patch and did not include the rest of the planned procedure.
The Claimant’s case, as supported by expert evidence, was that it was negligent of the surgeon to not proceed with the angioplasty, and as a result her condition worsened and a below the knee amputation became necessary, but which would have been avoided had the correct surgery been performed?
The Defendant’s case was that pre-operation plans are no substitute for a surgeon’s clinical assessment and opinion on how to proceed during surgery with the surgeon being satisfied that the blood flow passing down through the artery in question was good, and the planned procedure was not necessary.
The issue remained as to whether a surgeon’s discretion outweighed a pre-operative management plan.
The Court decided in favour of the Defendant as it was found that the Defendant was not negligent in choosing to abandon the pre-operative plan, and the decision to do so was found to be reasonable. The Defendant had the benefit of intra-operative findings which supported the decision on an alternative management plan. It was therefore concluded that a surgeon’s discretion should not be dictated by a pre-surgical management plan.
This case highlights that a surgeon’s discretion to deviate from a pre-operative plan will be favored, if the deviation can be supported with good reason and medical logic.
It will not always be the case that a surgeon’s decision to deviate from a treatment plan, will be considered the correct decision and would need to be considered on a case by case basis.
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