A woman has been awarded significant compensation from the NHS after suffering pain and damage to her leg following a vaginal mesh implant.
Vaginal mesh has scarcely been out of the headlines recently as more and more women take legal action over problems caused by the implants, which have left many in severe pain and some permanently disabled.
The most common form of implant is called tension-free vaginal tape or TVT. It was once routinely used by the NHS as a surgical treatment for stress incontinence, a condition that can cause leakage from their bladder when running, sneezing or coughing.
The plastic tape works like a hammock to support the vaginal wall and nearby organs such as the bladder or bowel. TVT surgery generally takes less than an hour to perform and patients often go home the same day.
However, while clinical trials suggested excellent efficacy, women have been coming forward with a range of complications following the surgery.
One of those women is Sarah Green who recently agreed a five-figure out-of-court settlement with the NHS following negligent TVT surgery. The surgery left her in debilitating pain and with ongoing incontinence issues.
Doctor recommends TVT as the best treatment option
In 2015, Sarah visited her GP complaining of urinary leaking when she laughed or coughed. Her GP referred her to a urogynaecological specialist at Eastbourne District General Hospital and advised her to do pelvic floor exercises in the meantime.
The urogynaecologist thought that Sarah was suffering from mixed urge and stress incontinence. Urge incontinence is when urine leaks as you feel a sudden, intense urge to pee, and stress incontinence is when urine leaks out when your bladder comes under pressure, for example, when you cough. He ordered various tests to confirm the diagnosis.
Crucially, the tests didn’t show any stress incontinence. However, they did reveal an overactive bladder, which Green was given medication for.
Sadly, the medication didn’t make things better. That’s when the urogynaecologist advised Sarah that she had two options for treating her incontinence: TVT surgery or an autologous fascial sling, a similar surgery that takes tissue from your own body to create a sling that holds the organs in place.
Sarah’s urogynaecologist recommended TVT as the best option and said it had a very high success rate.
Patient can’t move her leg
After waking from the surgery, Sarah found that she could not move her left leg. Physiotherapy helped her gain a little power, but after several days she still couldn’t bend her knee or hip.
Six days after the first surgery, the TVT tape was removed.
However, Sarah still had horrendous pain radiating down her left leg. She underwent several investigations with a neurologist who noted her tingling and numbness. An MRI scan showed degenerative changes to the discs in her spine.
Sarah attended pain management sessions for six months, including physiotherapy and hydrotherapy, but they did nothing to relieve her symptoms. She still suffered constant severe pain down her left leg with the sensation of sandpaper rubbing her skin below the left knee.
The pain became so bad that she could not work for one week or drive. Her incontinence hadn’t gone away either. She suffered leaks and urgency daily, as well as incidents where urine would gush down her leg. She couldn’t sleep properly because of the pain.
Naturally, her chronic tiredness, together with her incontinence, took their toll on her mood and mental health.
Expert evidence is key to unlocking the case
Sarah’s medical negligence claim against East Sussex Healthcare NHS Trust included expert evidence from a consultant urogynaecologist and a leading neurologist. These opinions were necessary to show two things that are critical to proving a medical negligence case:
- Breach of duty care, which occurs when the patient does not receive an acceptable level of medical care
- Causation, which is proving the substandard treatment led to the claimant’s injuries. The standard test is the “but for” test – but for the negligent treatment, the injury would not have occurred.
Here, the experts believed that Sarah’s symptoms were incorrectly diagnosed as stress urinary incontinence rather than an overactive bladder. The correct treatment should have been medication, weight loss and/or Botox, not TVT surgery. If she had received the correct treatment, it was likely that her overactive bladder would have been controlled, alleviating her incontinence.
The experts also thought that the initial surgery was substandard – though of course, the surgery would not have happened at all if doctors had made the correct diagnosis..
At first, the NHS denied the claim. They said the diagnosis was correct, the surgery was appropriate, and the patient had simply experienced a recognised complication of the surgery.
But after a period of negotiation, the NHS agreed to pay a five-figure sum to settle the case.
What next for TVT claimants?
This was a difficult claim involving complex issues. It shows how important quality expert evidence is in establishing the negligence and causation needed to win a case. While no amount of money can fully compensate for the pain Sarah continues to suffer, she will be able to get the specialist care she needs to manage her leg pain and treat her urinary urgency and urge incontinence.
As for TVT surgery itself, the NHS paused the use of vaginal mesh and tape for stress urinary incontinence in July 2018. However, some complications have been known to manifest years after the implant surgery. If you have had this surgery in the past and think it may have harmed you, it’s important to seek legal advice as soon as possible. You have three years to make a vaginal mesh claim, and the clock starts ticking on the day you discover your injury is a result of the implant.