May 24, 2025 from Medscape
A 61-year-old man underwent elective left endoscopic plantar fascia release under general anaesthesia. Though generally fit, he developed a bilateral pulmonary embolism one month after the procedure. The patient pursued a clinical negligence claim, alleging inadequate thromboprophylaxis led to avoidable harm, including heart strain and delayed physiotherapy.
Misclassification of Risk
The patient was incorrectly categorized as “very high risk” for venous thromboembolism (VTE) due to an inaccurate risk assessment by a healthcare assistant. In reality, his score should have classified him as “high risk” due to age and BMI. The surgery itself was considered low risk for VTE, and he received appropriate mechanical prophylaxis and safety netting information on discharge.
Expert Reviews Support Surgeon’s Care
The Medical Protection Society obtained expert reports from a consultant orthopaedic surgeon and a haematologist. Both agreed that:
- Delegating the risk assessment to a nurse was reasonable.
- Even with a corrected score, chemical prophylaxis would not typically be used for this type of surgery.
- The management complied with NICE guidelines and national audit findings for similar procedures.
They also found no clear causation between the surgery and the embolism. Hospital records described the event as “unprovoked.”
A formal letter denying liability was sent to the patient’s legal team, leading them to confirm they were no longer pursuing the matter. The case was considered successfully defended.
Important Takeaways
- Verify delegated assessments: Surgeons should personally review and agree with VTE risk scores.
- Document informed consent and safety netting: Clear records can be crucial in defending against negligence claims.
- Rely on guidelines: National recommendations and audits can help justify clinical decisions.
- Causation matters: Even with adverse outcomes, proving negligence requires a direct link between action and harm.
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