NHS Op difficulty

[Foxyflugel]

Hi all

Unsure if this is in the correct forum - if not, could mods please move it for me.

So..apologies for the long post but here goes....

I suffered Periductal Mastitis (PM) in 2010. After numerous courses of antibiotics and aspirations via ultrasound (whereby each visit was akin to a smoking cessation clinic - NHS) I realised that I had private healthcare via my present employer.

I went private and had my first op in Sept 2010 - then another op in Sept 2011 and my final op in Sept 2012.

My consultant said that I would need to let everything settle and ensure there were no more 'flare ups' before looking at breast asymmetry as a final op.

I then left my employer and lost my healthcare benefit.

In 2013 (after everything had settle down) I consulted my GP and they made an application for an IFR - this was refused but I was never informed of this (I never received the letter from my doctors). In 2014 I chased this matter and my docs gave me a copy of the refusal letter - which said that I needed an consultants report.

I went back to my consultant at the private clinic (he was not overly impressed and seemed to 'know' the 'usual' procedures of this committee) - I then received a letter saying that my IFR has been approved.

I was devastated to discover that my surgeon had moved on (I chose the NHS hospital where he was a honorary surgeon!!) and my GP said that he had chosen a very good surgeon at the same hospital.

I went for my consultation in April 2014 and was placed on the waiting list. After 6 months and still having heard nothing (being fobbed off by the consultants PA - you're nearly at the top of the list etc etc!) I escalated it to the complaints dept. They gave me a date around 1 week before xmas (and I discovered at the 11th hour (by pure accident) that this was not even going to be my consultant!!) - I rearranged this to the end of Jan (surgeon was away until then).

I had my op at the end of Jan this year and signed the usual documents - op plan etc.

I was glad it was over and looking forward to enjoying being able to wear my clothing and not being self conscious about my breast difference - all the pain and inconvenience would be worth it.

I then had to chase the hospital for my 12 week review appointment - and it was not with my consultant - but one of his 'team' - who thought my breasts looked good.

I then went back in August and I had demanded that I wanted to see my consultant as I needed to discuss issues with him.

Here's the problem.

My consultant had said that he was going to do a fat transfer into my right breast - as agreed in my paperwork - he never did this!
I now have areola tissue at the top of my scars (going down the underneath centre of my breast) and they are still differing sizes - probably more noticeable than before!!


The consultant drew up another op plan to reduce one of my breasts - but he also suggested 'tattoing' my areolas on and using cream to eradicate the pigmentation of the areola tissue underneath my areola. Both I refused as I feel absolutely devastated that I have been through more surgery to find myself in a worst position than before! (and I am petrified of needles - one of the reasons I do not have any tattoos through choice!)

To add insult to injury - the consultant was running late (1.5hrs) on my last appointment so the photographer had left for the day - he said he needed my photos back within 7 days to take to a meeting to discuss - I put myself out and returned to the hospital on Tuesday 30th August (had time off work) so the pics would be ready for this meeting.

I then chased it again and his PA said the photos weren't back in time for the meeting on 12 Sept??

I have then received a letter today (from the meeting on 12.10.16) saying that they refuse to do more surgery as I still smoke.

My original consultant said that there is no medical proof that smoking causes this condition (I believe it was stress that triggered it)
and he made no bones in telling me this.

The letter says that basically they will review it when I have been stopped smoking 6-12 months.

I will be pursuing this further - with legal assistance if necessary .

The facts are:-

My consultant (top class) told me that there is no proof that smoking causes this condition.
I had my first 3 ops private - so this cost the NHS nothing.
They knew I was smoking and still carried out the corrective op.
The surgeon DID NOT carry out all the procedure that was agreed on the op plan (no fat transfer etc)

Where do I go from here?? I have worked from being 18 years old and paid my taxes - why should I be discriminated against for my lifestyle? I could have lied and claimed that I had stopped smoking - but why should I? They claim it affects healing - which I appreciate - but I have healed well - other than the discharge sheet - which said I have dissolving stitches and luckily I realised that some weren't - and the nurses at my docs took them out.

Can anyone please advise or point me in the right direction for help?

Again, apologies for the long post but I wanted to include all the facts.

Thanks

Foxy

[PAWS]

Re: NHS Op difficulty

Hello Foxy!
What a blinking nightmare.


As a fully paid up and card carrying smoker I know how you feel re the ‘stop smoking or we won’t do it’ HOWEVER….despite the fact that we practically keep the bloody country going with the amount of duty we pay and feel we should have our own ‘wing’ with a plaque saying‘PAWS AND FOXY SACRIFICED THEIR HEALTH SO WE HAD THE REVENUE TO BUILD THIS’ smokers are increasingly being refused treatment. If you have any other smoking related issues or often if you are a heavy smoker it could be more to do with the anaesthetics side of things but that does not seem to be the case here.
What does your GP think? what sort of a relationship do you have with your GP?
If you still need treatment, you still need treatment. It is as simple as that and they should be the ones referring you to the correct experts and fighting your corner. Ask to book a double appointment and give them the whole story if you have not already done so. BTW if the receptionist asks what you want ‘double’ appointment for, tell them it is a complicated issue. Even if they know the full story it is their responsibility as a primary carer to make sure you are healthy AND HAPPY! Ask if it is possible to get a referral to a different team-although it is a long shot.
This may be causing you to feel depressed and denying treatment may make your overall situation much worse! (hint hint)
Specialists' opinions do differ so although one specialist might say this has nothing to do with the fags another may think differently. My father in law developed lung cancer and although one specialist said it was caused by working with asbestos another said it was smoking years ago. PM showed no excessive traces of asbestos so…..
My mother was told she could not have an op due to a heart condition but another team had no hesitation.
I rant constantly about the NHS and I do agree it is disgraceful that you had to wait so long for your appointments but that is what it is like and despite my rants it is not going to change in the near future so try not to let the general stuff like that get you down. You will rarely be sure of seeing the same consultant twice it is enough to drive you around the bend but it is what it is. You need to get your treatment sorted and that is the main issue.
I would say go back and badger your GP but I have to say you might have to ….well….maybe ...cut down at least on the smokes. Now I am not inclined to tell people to be dishonest but say you tried to abstain for ‘a little while’before you attended.
Anyway, if I was you I would go back to the GP and discuss the conflicting arguments.

[Foxyflugel]

Re: NHS Op difficulty

Hi PAWS and thanks for your reply.

My GP is a lady so she will sympathise I should imagine. When I went back to my consultant I told him I had cut down on smoking (which I have!!) I got the distinct impression that because I expressed my disappointment in the op results he didn't like this - but again, why should I lie - I have never lied and am not prepared to start to appease these professionals or get what I am entitled to.

My GP is off for 2 weeks btw. The thing is PAWS, I signed the agreed op procedure form - and he failed to do all what he was supposed to do! I was smoking when they agreed to do this corrective op - so what's the difference? If he had done an acceptable job of it then I wouldn't be in this position - I am really annoyed about it all tbh. I hate hospitals and injections.

My doctor recommended this surgeon - I think I will go for a second opinion and to another surgeon as I feel our relationship is now untenable after this - and the last thing I want is to fight to get this op done, be forced to have the same surgeon and then be in the same position again afterwards.

I think it is an infringement of my human rights that they are trying to force me to stop smoking!! - this view seems to work for certain others!!!

I will go and see me GP and take it from there. It does affect me btw - as I am struggling to get underwear to fit correctly/comfortably and if I wear certain tops then they pull lopsided - it's depressing!!.

Foxy

[PAWS]

Re: NHS Op difficulty

I do agree -my friend is just recovering from breast cancer and needs re-constructive surgery. I absolutely appreciate how this can affect a woman’s confidence and believe me I am totally with you when you say you are being discriminated against! If smoking has made surgery risky then giving up for a few months would not change your health significantly. One anaesthetist I know actually told me that giving up smoking just before surgery can really make you more susceptible to getting a serious chest infection. I also get your point that you were a smoker when they agreed to do the surgery in the first place-it is just so blinking hard to sue the NHS or any part of the medical profession. It is a very ‘closed shop’. I know you are not a dishonest person but I just thought….well...you know being a little ‘economical with details’ might help you get the job done but I totally admire your principles and agree with them.
If a specialist has said that smoking did not cause this condition and you are healthy enough to have an anaesthetic then why can you not have the op. This is the simple issue. Pressing for a second referral is a good option.
I wish I could give you some sound legal advice and hopefully some one on here can help. You can also take a look at this site and find your local branch http://www.healthwatch.co.uk


You can try your local MP. That is what they are for. You have an issue and you pay the MP to sort out this sort of thing. You gave them a job by voting and you pay their salary with your taxes so find out where and when they have a surgery and go tell them your story. Their colleges run this shambles.
I get really angry when I see people who are over weight, heavy drinkers or otherwise abusing their own health ‘tut-tutting’ at people who smoke so totally with you on this point! How would they feel if I was standing by their table ‘tut-tuting’ as they shoved a sodium laden fatty burger down their gullet or counted the number of bottles being slipped into their bin. Actually I like a glass of ‘falling down water’ myself and have been known to guzzle a bit of junk food so in medical terms I am proper f***** !:tung:

[PAWS]

Re: NHS Op difficulty

I forgot to say-smokers in the UK contribute approximately £12 billion per year to the government coffers. People who play sports such as Rugby or enjoy hobbies such as rally driving are not discriminated against but do not line the treasury quite so well.
This kind of blows the argument that we cost the NHS money.

[Foxyflugel]

Re: NHS Op difficulty

I knew what you meant PAWS - about being dishonest etc - but it's just the principal of the matter - as you understand.
I am vegetarian and have been for years and I would like to think I am healthy - yes I like a drink too. Surely, that is my risk too though - the anaesthetic - which I am prepared to take.

Foxy

[PAWS]

Re: NHS Op difficulty

Surgeons and their support teams can refuse to preform surgery on a patient who smokes if they feel the operation might actually harm the patient. Smoking increases the risk of infection, strokes and other health issues that can make surgery more dangerous. It is often the decision of the individuals preforming the surgery rather than a blanket policy of your local hospital. It might be this rather than whether or not the original condition was caused by smoking that has led to the refusal. Might be worth investigating that point before deciding what to do next. It is annoying because many non smokers may be more likely to have health problems that would make an operation dangerous but the medical teams /NHS can use this argument to defend themselves against any action. Consultants working in the private sector are inclined to be more flexible -dare I say it is because they get better paid for the work !
I just think you are likely to be on a sticky wicket if you try and fight them on this much as I agree with you but as I said I am no legal expert!

[Foxyflugel]

Re: NHS Op difficulty

But the fact that they did it in the first place?? - and now refuse to correct what they have missed/messed up??

[PAWS]

Re: NHS Op difficulty

But the fact that they did it in the first place?? - and now refuse to correct what they have missed/messed up??

Oh I totally agree with you -it is off it’s head:sad: but they have a blanket defence that I am afraid might make them ‘bullet proof’. It is very irritating and I hope one of the clever beagles might know of a way around it.

[Foxyflugel]

Re: NHS Op difficulty

Anyone???

I did go back to my doctor but she said I had to take the matter up with my surgeon.

Who can I escalate it to? This is affecting my daily life.


I certainly feel like seeking legal recompense - I am worse off now than I was previous to my op - and they now want to leave me in this state!!

Thanks

Foxy

[Peridot]

Re: NHS Op difficulty

Hi Foxyflugel,
It is a really horrible and difficult situation. I am not saying that there is a claim that you would be successful with, you would need specialist advice on that. Clinical negligence claims are difficult, there are differing opinions in the medical community on how things are treated or should be treated, none of which are necessarily incorrect.

It does seem that suggestions have been made regarding treatment in the past, but you don't want the treatment they have offered, for example tattooing of the aureola.

Once allocated to a consultant in the NHS it is his 'team' effectively that will treat you. They are under the consultant's wing so to speak so any procedures would be carried out according to how he would deal with the issue. One of the differences between private and NHS care but understandable when you consider how many ops/treatments are carried out on the NHS.

If you believe there is a claim in negligence against the hospital, for not completing the procedure correctly, such a claim would have to be brought within 3 years of your knowledge of the problem. I doubt you would find a lawyer willing to take on a claim that the hospital is breaching your human rights in refusing to operate, while you continue to smoke I'm afraid. It would be seen as a justifiable reason not to operate, irrelevant of whether your previous consultant was happy to, while you continued to smoke. I'm not having a go, I know how hard it is to give up, but also as an ex nurse I can see the other side too. It is becoming more frequent that surgeons/anaesthetists are refusing to operate on smokers. Not fair, but there is research to support the arguments that back up their refusals, not only with regard to the anaesthetic risk but also with the effect on the body's ability to heal following the operation.

Looking at the time lines, if you genuinely believe that you have a potential claim in negligence against the hospital you may be within time if it is with regard to the most recent op that you have the issue. Before any solicitor would consider whether there is a claim to be pursued, however, you would have had to follow the relevant health authorities complaints procedure. I would obtain a copy of there complaints procedure in the first instance. Start the ball rolling with regard to an official complaint then see what response you get, before seeking some specialist advice from a solicitor specialising in clinical/medical negligence.

In the meantime, I would look at getting some support and advice on dealing with the issues you are now experiencing. You have confirmed that this treatment (or lack of treatment) and the aesthetic of your breast, are causing you some genuine concerns and obviously significant anxiety. Would any other assistance help you? Have you spoken to your GP about your anxieties and has she suggested anything else to try and support you through this?
It may be worth looking for available support networks out there, either in your locality or in cyberworld.

I am sure there are people out there who have experienced similar and who may have some pointers for you. You need some support, and if I may say sooner rather than later, particularly if you are intending on bringing a claim against the hospital. Unfortunately potential litigation will only increase stress levels I am afraid. It is the nature of these things. Get some support for yourself, then try and take up the battle, if you believe it is necessary.

[MIKE770]

Re: NHS Op difficulty

The contact details of AvMA are:
Action against Medical Accidents (AvMA)
44 High Street
Croydon
CR0 1YB
Helpline: 0845 123 2352
Tel: 020 8688 9555 (admin only)
Fax: 020 8667 9065
E-mail: advice@avma.org.uk
Website: www.avma.org.uk


Might be worth investigating issue:- know it cost us £750+ to have specialist to investigate operation and death of young daughter by a Bath medical negligence company in late 80s, but the report was balanced only to find years later an investigation was being taken place into the surgeon regarding a lot of complaints, when contacted them the people said sorry hospital destroy patients records after 3 years so would not be any help to them , I offered to send copy of original report they declined!