Shoosmiths was approached by Ms X, who had suffered a late miscarriage of her pregnancy after she had previously, improperly, been diagnosed with an “inevitable miscarriage” and been administered misoprostol.
This case highlights the fact that ‘medical paternalism’ (a set of attitudes and practices in medicine in which a physician determines that a patient's wishes or choices should not be honoured) is still sometimes practised and hinders patient autonomy when making decisions about their medical care.
After successfully settling the case, which was conducted by Caroline Weir and Victoria Plesca, our client said:
“Thank you so much, I really appreciate all the work you have done. [Please include my case] on your website, especially if it helps other parents who experience the same events. I remember at the time I was searching for so many hours… trying to find similar cases.”
After experiencing some mild bleeding during the first trimester of her second pregnancy, our client decided to attend the Emergency Department at Northampton General Hospital NHS Trust. She was reviewed by the Senior House Officer (“SHO” with a maximum two years’ experience in Obstetrics & Gynaecology) at 23:45. Based on a speculum examination only, a diagnosis of “inevitable miscarriage” was made and the decision was to admit Ms X and administer misoprostol.
Misoprostol is a drug (technically called an abortifacient) which stimulates uterine contractions and is also associated with effects that halt the pregnancy. It has the side effect of possibly causing birth defects if administered in healthy pregnancies. This decision of the SHO was discussed with the registrar, who concurred with the plan without examining our client or arranging an ultrasound examination.
Ultrasound could have revealed that pregnancy was viable
Despite her request for an ultrasound examination to confirm whether there was a heartbeat, Ms X was told that it was too late in the night for a scan. Later during the night, Ms X requested to be re-examined, but her request was again refused with the argument that nothing would have changed since the last examination. Misoprostol was then administered at 03:00 hours.
At 10:10 hours, Ms X finally underwent an ultrasound which detected a heartbeat and evidence of a viable intrauterine pregnancy of around eight weeks gestation. The consultant obstetrician and gynaecologist examined Ms X and “explained findings of viable intrauterine pregnancy but” that he “could not predict the effect of the misoprostol.” The consultant did not apologise for the error. Naturally, Ms X was relieved but concerned.
At 17 weeks gestation, Ms X started to bleed heavily, and so she arranged a private scan which confirmed absence of a fetal heartbeat. She was admitted to hospital where a further scan confirmed the intra uterine death of the baby. The post-mortem examination later showed that the baby was otherwise healthy and had been developing well.
Oral misoprostol was prescribed again to assist with emptying the uterus and delivery of the baby. The mother requested a scan to ensure that no products of conceptions were retained. In response, she was reassured and told that the scan was unnecessary.
Unfortunately, on the day of her baby’s funeral, she experienced further heavy bleeding and had to attend the hospital where an examination and a scan confirmed that there were, in fact, retained products of conception. Ms X had to undergo a surgical evacuation.
Once Shoosmiths had investigated the case, a detailed letter of claim was prepared, in accordance with the pre-action protocol for the resolution of clinical negligence disputes, setting out how the Trust had breached their duty of care and what steps they should have taken in order to have avoided this sequence of events.
In their letter of response, the Trust admitted liability for all the allegations set out in the letter of claim and made an offer to compensate our client for her pain, loss, and suffering, followed by a letter of apology. The Trust accepted that our client should not have been prescribed misoprostol, without the appropriate steps being taken to ensure the correct diagnosis, and that it would ensure the quality of its service improved.
“Patient autonomy is a fundamental principle of professional medical ethics. The idea that individual patients should have the freedom to make choices about their lives, including medical matters, appears to be a basic right but sometimes this can be forgotten. It would have been appropriate, in this case, to delay administration of the misoprostol until a confirmation scan could have performed.”
This information is for educational purposes only and does not constitute legal advice. It is recommended that specific professional advice is sought before acting on any of the information given. © Shoosmiths LLP 2023