Bristol hospital bosses have tightened up how patients’ consent is obtained and new medical procedures approved after more than 200 people were harmed from unnecessary bowel surgery. A report to North Bristol NHS Trust (NBT), which runs Southmead Hospital, last week revealed dozens of people were left in severe pain after consultant colorectal surgeon Tony Dixon gave them pelvic floor surgery using artificial mesh.
The review concluded there were 203 cases from the 387 investigated where the patient should have been offered alternative, less invasive treatment and so were deemed to have come to harm, although the operation had been carried out satisfactorily. Lives had been “ruined”, a trust board meeting heard.
Mr Dixon, who was suspended when concerns were first raised in 2017 and sacked by NBT two years later, pioneered the use of artificial mesh to lift prolapsed bowels, a technique known as laparoscopic ventral mesh rectopexy (LVMR), which can result from childbirth. He performed the operations between 2007 and 2017 at Southmead and also the Spire Hospital, a private facility where NHS patients overseen by NBT were regularly referred.
Read more: More than 200 Bristol patients 'harmed' by bowel surgery, hospital trust admits
Trust medical director Tim Whittlestone told the board on Thursday, May 26, that the patients who first raised concerns were “very brave”. He said: “We acted immediately on those concerns and launched a number of investigations, some of them about an individual surgeon, but more importantly about a review of patients who had undergone this procedure.
“On behalf of the trust I’m extremely sorry to patients who have subsequently discovered were harmed as a result of undergoing an operation under our care.” Mr Whittlestone apologised that the “very complex and thorough” review and recall of patients had taken so long but that it had been “one of the largest ever” clinical reassessments undertaken in the UK.
He said a large number of patients had accepted the trust’s offer of psychological support but that many required further corrective treatment in other hospitals because NBT lacked the expertise. "We have learned a lot of lessons. We have taken some very important steps in terms of governance within this organisation,” Mr Whittlestone said.
“Clinical governance, the question of consent and the approval of new procedures are the core, fundamental principles of good medical practice and we have really pioneered a different way of consenting patients in a process called shared decision making. So we set up a group, which also includes university representatives as we want to collect as much data as possible, to look at a completely different way of consenting patients and ensuring they are fully informed before surgery.
“We also took steps to improve our multidisciplinary team meetings to ensure that they are quality appraised and are of extremely high calibre, that no one individual or no one procedure or no one perceived wisdom can influence the recommended outcome for patients, and I am confident we have made great strides. We have increased the speed between realising that we have a recall and communicating with patients.
“It’s regrettable that some patients were waiting many months and indeed up to several years to hear the outcome of their recall and review process. We have ensured there are processes to provide ongoing narrative to patients in the future, should such events ever need to be repeated.
“On behalf of the board we would all want to express our regret and deep sorrow to these patients.” He said it was a “very frightening time” for those who had undergone the surgery.
“Some have had significant complications from surgery despite the procedure being carried out correctly,” Mr Whittlestone said. "Rectal prolapse is a debilitating and awful condition to start with, and some of the surgery is extremely complex and the potential complications of some of these operations are absolutely awful.
“Clearly some patients have had their lives ruined by complications from this surgery. Unfortunately we don't yet have the expertise to fully remove mesh and provide full reconstruction, and for those patients we are having to support them in their ongoing NHS care in London and on the south coast.”
Trust chairwoman Michele Romaine said: “It’s really, really important that we learn, but if you’re one of these patients, that is only of limited comfort. If you’ve had your life turned upside down you want to know if the organisation has learned the lessons, but also you were on the receiving end of this.
“What’s really important is that we are brave enough when we get things wrong to put our hands up and say we got things wrong. On behalf of the board I want to say we are sorry, we didn’t get it right, we have learned from that and we hope we have provided the support that is necessary to the people we did harm to.”
Patients who have spoken out include customer services manager Mandy Giltrow, 49, from Bristol, who still suffers frequent stomach and bowel pain, recurrent urinary infections and a hernia near her surgery scars.
