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User
Posted 12 Aug 2022 at 12:07

The specialist report to our solicitor of our medical negligence case states that my husband's original urologist breached his care  on numerous occasions including missing the diagnosis causing an 8 month delay ( which then happened in the middle of lock down and meant we were treated at a distant hospital), not carrying out necessary diagnostic tests . The independent specialist states that the delay in treatment till his op 10 months later made no difference to  his outcome . Gleason score 4+5 and post op need for RT because the PSA had started to rise a year post surgery .On the basis of this report the legal firm are refusing to pursue our 'No win no fee "claim . I am doing my own research . Our treatment clearly goes against all best practice recommendations . I am trying to determine how you decide what is a critical time frame for treating prostate cancer . How can you determine that the delay has not affected the outcome when you don't know when it started growing nor the rate of progression? He was told it was a 'highly aggressive , nasty tumour' by three specialists and could not be left . One noted that pre pandemic he would have operated on "next week.'Why do the cancer treatment pathways recommend early diagnosis /treatment if it can be left for a year without having a negative impact on the outcome ? We incurred considerable distress knowing that the diagnosis had been missed and that it happened during lockdown and all the complications and delays that brought yet the solicitor informs us that mental pain is not considered important by the courts so is not worth pushing on those grounds . I know that the law is not fair but in my gut I feel that there is more to do . if anyone has any knowledge or experience in this area I would really appreciate some advice . Many thanks


 .

User
Posted 12 Aug 2022 at 22:50

A no win no fee solicitor, just writes a scary letter to the defendant, if the defendant doesn't rollover and settle out of court immediately they drop the case like a hot potato, and look for the next victim. Victims looking for a bit of compo are 10 a penny, so they aren't going to waste their time on your case which they have to prove.


Unless you enjoy the drama of the court room I think you should give up on this. It's nobodies fault that he got cancer, it's probably the Chinese governments fault we had a pandemic, but you ain't going to take them to court. So with a difficult cancer to diagnose (they all are) and a pandemic in the way, 10 months from first meeting to surgery is pretty good. I bet most people on this site who had RP waited at least three months from first inkling something was wrong to the surgeon sharpening his knife. With the expert saying it made no difference to the outcome, you are going to lose if you go to court.


Spend your time doing something more fun than reading medical journals and case law.

Dave

User
Posted 07 Mar 2024 at 03:22

Hi All



 


I would agree with those posters who have observed that medical negligence cases are difficult to prove in court even if the facts seem very clear. However I would advise anyone against going overseas for treatment as you will probably find it extremely difficult if not impossible to successfully litigate however clear the facts may be. In my case the facts were certainly clear enough.




I had proton therapy treatment in the Czech Republic. Without going into the details they made such a mess of my treatment that at it's conclusion , I barely made it on to the plane to get me home. When I arrived back, I was so ill that I was immediately transferred from the plane to hospital.




I ended up staying in hospital for 5 months. The doctors at the hospital discovered that I had large deep ulcers in my rectum consistent with severe radiation related colitis. I had to undergo a 5 hour surgery where it was discovered that I had a hole in my bowel caused by the very inaccurate proton therapy treatment I had received in Prague.   I had to have a colostomy with approximately 40cm of my bowel being removed due to the very inaccurate and extensive radiation my bowel and rectum had received. 





 I also got sepsis, pneumonia and lost 25 KG in weight. I very nearly died. Over three years after my treatment finished, I still have significant rectal bleeding 3or 4 times every day and am always tired and in pain. 


Although the Proton Centre has offices in The UK they state in their contract with patients that any litigation for any medical negligence has to be pursued through the Czech courts.  




 I later found out that the medical negligence laws in the Czech Republic have remained unchanged since the Soviet era and that the burden of proof on claimants is so great that it is effectively almost impossible to successfully sue. Further, compensation awards are also minimal even if successful. Medical negligence cases consequently have very little appeal to Czech lawyers and only a small number of smaller firms will consider representing plaintiffs in negligence cases and none on a no win no fee basis. I spoke to one lawyer who refused my case who stated that the owners of the Proton Centre are very rich and powerful bankers and businessmen who never settle out of court and do not lose medical negligence cases. They apparently chose the Czech Republic for the location of the Centre specifically because of it's medical negligence laws. The Centre was recently bought from the Erste banking group for CZK 2.5 billion by Démétér Property from the Raiffeisenbank group.


Whatever else you decide, get treatment in the UK and do not go overseas. In particular do not get Proton therapy in Prague. 


User
Posted 07 Mar 2024 at 05:25
There has been no follow up by the OP since August 2022 so we don't know how determinedly this was pursued if taken further.

Proton Beam Therapy requires great precision in delivery and it would seem this was not well done in Seven's case and he has shown that getting compensated in the Czech Republic is most difficult to secure compensation for a medical claim which one might consider a timely warning. However, there are are some excellent treatment centres abroad but as in other things you need to research that they have a very good reputation and that in need you can get compensation if you have a legitimate case. This is what I did before having my RT in Germany at one of the best hospitals in Europe. This included a boost to EBRT of 6 fractions of Carbon Ion each of 3 Gy which like Proton Beam is Hadron Treatment but packs a much greater punch.

I also had Dental Implants in Budapest but made sure they were done by a highly regarded Implantologist and this was mostly done in 2007. You do read of cases where people have dental treatment abroad and the NHS has to correct it. The same applies to people who have cosmetic surgery abroad, so research well beforehand. Sometimes mistakes happen in the UK though rarely.as standards are pretty high here. Unfortunately, due to Covid and the pressure many Hospitals were under, consultations and treatment waits were often delayed even when hospitals were doing tests at weekends, as happened to me.
Barry
User
Posted 07 Mar 2024 at 05:42

Originally Posted by: Online Community Member
We did have one clear case on this forum of biopsy results being mixed up and a healthy prostate being removed as proven by post op histology. That was settled after about five years for I believe a five or six digit sum. The evidence in that case was incontrovertible.


Dave, has summed up the chances of making a successful claim for clinical negligence well. 


You need to prove two things.


A) A breach of duty or care. 


B) Causation.  That the breach of care has had a detrimental effect on you.


Proving A is easy. Identifying misdiagnosis or clinical errors or omissions, isn't difficult.


Proving B, especially in prostate cancer cases, is almost impossible. The outcomes to our disease are so varied. You'd have enormous difficulty conclusively showing, on a legal balance of probabities, that any mistakes, delays or omissions in your treatment have made your outcomes worse.


I ended up buying a book for 30 quid by a leading barrister on clinical negligence in cases involving misdiagnosis of cancer.


It was worth every penny because it showed what a mountain you need to climb to just stand a chance of success.


I spent months trying to prove my case, but was eventually bludgeoned into submission. However, apart from the book, the process cost me nothing and gave me something to focus on whilst trying to recover. It put my mind at rest, although I failed, that I'd done my best  to fight my corner.


For others, the 'quest for justice' maybe  unbenefical and simply impede their recovery.


 

Edited by member 07 Mar 2024 at 08:13  | Reason: Typo

User
Posted 07 Mar 2024 at 12:06

Going back some years now, quite a number of people suffered severe radiation burns to breasts from the standard photons.. They formed a group called 'RAGE' following which major changes and safeguards were adopted in radiation. If you have a bit of time this makes interesting reading - quite a bit of it. https://www.macmillan.org.uk/assets/yesterdays-women-radiotherapy-action-group-exposure-rage.pdf


 So great care is necessary with RT


 


 

Edited by member 07 Mar 2024 at 12:08  | Reason: Not specified

Barry
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User
Posted 12 Aug 2022 at 12:42
The point of an independent expert opinion is to provide an unbiased view of the situation. Your husband will have had prostate cancer for many years before he saw the urologist and it is generally a slow moving cancer - as the expert has indicated, 12 months is unlikely to have made any difference to the outcome.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 12 Aug 2022 at 12:59

The data you're looking for doesn't exist as far as I know.


About 30% of prostatectomies require salvage treatment afterwards, but this is swayed by the disease risk. With a G4+5, he was a high risk, and some data suggests salvage treatment is required in nearer to 40% of high risk cases. So the treatment path your husband went down is not unexpected. The 10 month delay might have raised the chance of this, but as I said, there's no data so you won't be able to prove it.


Some patients were offered hormone therapy during COVID delays, to stop the cancer progressing.


I also can't actually picture his timeline from what you've written, so I might not be understanding what happened.

User
Posted 12 Aug 2022 at 14:19

We also had a 12 month delay (due to Covid) being referred after my husbands PSA was 5.1, it jumped to 8.3 in those 12 months, and I too wonder if in that year that’s when the spread to the lymph node happened. From the start I knew I would never get an answer to this question so just had to deal with the situation we were now in. Fortunately things have been going really well for him up to this point but I can certainly understand your frustration and upset. Really hope your husband is ok x

User
Posted 12 Aug 2022 at 17:56

Konobie, as already said the data you are looking for probably doesn't exist. In hindsight I was having possible symptoms of prostate cancer when I was 50, that was terminal dribbling. At around 59, unknown to me I had a PSA test, the result was 6.9 and was not picked up by my GP as they were look at a gastric issue. At 62 almost by accident I had another PSA that came back at 7.7. and the previous test was discovered. The biopsy came back at 4+3. I waited another 4 months for the new robot at our hospital. My histology was not good and this week I started the fourth attempt at eradicating the cancer.


I did complain about the delay, but naively at the time I thought my cancer has been removed and there was not point pursuing the matter.


Thanks Chris 


 

User
Posted 12 Aug 2022 at 18:58

Thank you so much for all your helpful replies . I have moved on a little since this morning having studied numerous medical articles about the effects of delay on the outcomes of prostate Cancer patients . I have more to go through . I agree the independent specialist is just that but even within the different specialities doctors gain experience in specific areas . It depends on your area of expertise how much experience you will have with different medical conditions .I worked in the NHS with adults but would have limited experience with paediatrics . Andy 62 the timeline is October 2019 initial appointment with hospital specialist .April 2020 letter from hospital doctor warning of high PSA. Urgent Ca referral from GP back to hospital fortunately picked up by another local hospital who diagnosed Prostate Ca June 2020.  Due to be placed on waiting list at hospital 10 miles away with a 6 month waiting time ( December 2020 which would have coincided with 2nd lockdown) when we heard about Royal Marsden and got a referral just on the day they were refusing out of area patients . Due to our own actions  and hard work of staff at RMH the op was done in August 2020 so 10 months after the original missed diagnosis .

User
Posted 12 Aug 2022 at 22:50

A no win no fee solicitor, just writes a scary letter to the defendant, if the defendant doesn't rollover and settle out of court immediately they drop the case like a hot potato, and look for the next victim. Victims looking for a bit of compo are 10 a penny, so they aren't going to waste their time on your case which they have to prove.


Unless you enjoy the drama of the court room I think you should give up on this. It's nobodies fault that he got cancer, it's probably the Chinese governments fault we had a pandemic, but you ain't going to take them to court. So with a difficult cancer to diagnose (they all are) and a pandemic in the way, 10 months from first meeting to surgery is pretty good. I bet most people on this site who had RP waited at least three months from first inkling something was wrong to the surgeon sharpening his knife. With the expert saying it made no difference to the outcome, you are going to lose if you go to court.


Spend your time doing something more fun than reading medical journals and case law.

Dave

User
Posted 13 Aug 2022 at 11:10
Thanks Dave .I appreciate your plain speaking and you gave me plenty to think about . I agree with you about ‘no win no fee’ The legal team don’t lose out cos you have to take out an insurance policy to cover their expenses if they don’t proceed. The odds are stacked against you . You are probably also getting the junior less experienced staff . The letter sent from the legal firm to the NHS trust cited the wrong body part - enlarged bladder rather than prostate so we were immediately ‘on the back foot.’
I disagree that Prostate cancer is always difficult . In my husbands case it was huge and up to the margins . It was missed because the specialist omitted to check the PSA test that he ordered and it was filed away for 6 months til he did an audit. Not sure why he did the audit because my husband had been discharged . Missing that he failed to do appropriate scans and biopsy . The second team followed the diagnostic pathway and diagnosed it immediately.
It would have been 14 months delay if we hadn’t found out about the Royal Marsden Hospital and worked proactively to get my husband accepted there before the doors were closed . They were refusing out of area patients on the day we were accepted . So we appreciate how fortunate he was.
Most literature on the effects of delay come to the conclusion that a delay of 6 months is ok but the evidence for longer is lacking .The research was also done retrospectively on data of old cases so was skewed because the most aggressive would have been prioritised and the reasons for delay were not included . It would also have omitted patients who were diagnosed but not operated on . The age group was also limited . So there are many gaps . One lot of research cited 12 months as unsafe but I would imagine it is hard to be definitive since each persons cancer must develop at different rates .This is a subject that taxes me . If each cancer grows idiosyncratically how do you define the rate of growth . You only have markers at the time of diagnosis and post op pathological sample . ( unless you had multiple biopsies .)The biopsy and path. sample will tell the type of cancer whether it’s a slow type that you can live with or as the surgeon said ‘ a nasty one that will kill you.’ But as far as I can see each cancer grows at different rates so how does the independent specialist determine that 10 months is acceptable .This is just one of the questions I am looking into.
Life would be much easier to forget all about it and get on with something more enjoyable but I feel so strongly that there is an injustice here . There are many assumptions I made about the legal processes and the law that have been crushed . I might reach an insurmountable impasse but hopefully even if I can’t get a just resolution I can use my experience to help others following in my wake .
User
Posted 13 Aug 2022 at 13:45
I was a committee member at a sports club, we received a no-win no-fee letter about an alleged injury. I won't go in to the details, but that was when I realised the business model, for nowin nofee, is get an infinite number of monkeys to type an infinite number of letters and hope to cash in on a few.

I run a small company and occasionally I have to chase debts and deal with employment law. So I do find myself dealing with the legal system. Like you I do some of this out of principal, and to teach myself sufficient so when the next bad debt comes along I am more informed on the process.

I would say over the last ten years I have spent about three months studying law, and as a result successfully recovered £800. BTW I can earn £800 in a day if I just stick to my day job. So the only people who benefit from the courts are lawyers.

We did have one clear case on this forum of biopsy results being mixed up and a healthy prostate being removed as proven by post op histology. That was settled after about five years for I believe a five or six digit sum. The evidence in that case was incontrovertible.

I would like to think, if you win your case the medic would never make this mistake again, but the system will close ranks and protect him.

My experience of this is renting an office in a building next to a firm of solicitors:

One of the partners was embezzling client money. The night before the Solicitors Regulator Authority raided, a fire in a light fitting in a communal area nearly burnt the whole building down, which would have destroyed lots of evidence (along with my business).

Months later I looked up the details on the SRA website, and read about the embezzlement, there was no mention of arson (how could it have been proved, other than circumstances). The solicitor was struck off. Personally I think he should have had prison for five years and all his ill gotten gains confiscated.

So if you pursue your case I hope you are young enough to live to the end. You almost certainly won't win, if you do any award will be lost to legal fees, the medic involved will be retired and claiming a nice pension by the time it is over.

I know you are trying to do the right thing. I'm just telling you what I as a layman have discovered about the legal system.

None of this post constitutes legal advice. You should seek independent legal advice about your specific case.⚖️💰

Dave

User
Posted 13 Aug 2022 at 14:23

Hi Newbie1konobie. Chapeau for doing all the research independently of the NWNF lawyers. Your instinct about the level of expertise they’ll employ at these opening stages is accurate.


Can you just confirm what it is you are seeking to demonstrate through the lawyers? Is it that the salvage radiotherapy would?/could have been unnecessary had the surgery happened earlier ? Or is it just that he should/could have been treated more promptly? It makes a big difference to where the NWNF lawyers set the bar.


Whatever, I hope you get the answers and satisfaction you need. Good luck.

User
Posted 07 Mar 2024 at 03:22

Hi All



 


I would agree with those posters who have observed that medical negligence cases are difficult to prove in court even if the facts seem very clear. However I would advise anyone against going overseas for treatment as you will probably find it extremely difficult if not impossible to successfully litigate however clear the facts may be. In my case the facts were certainly clear enough.




I had proton therapy treatment in the Czech Republic. Without going into the details they made such a mess of my treatment that at it's conclusion , I barely made it on to the plane to get me home. When I arrived back, I was so ill that I was immediately transferred from the plane to hospital.




I ended up staying in hospital for 5 months. The doctors at the hospital discovered that I had large deep ulcers in my rectum consistent with severe radiation related colitis. I had to undergo a 5 hour surgery where it was discovered that I had a hole in my bowel caused by the very inaccurate proton therapy treatment I had received in Prague.   I had to have a colostomy with approximately 40cm of my bowel being removed due to the very inaccurate and extensive radiation my bowel and rectum had received. 





 I also got sepsis, pneumonia and lost 25 KG in weight. I very nearly died. Over three years after my treatment finished, I still have significant rectal bleeding 3or 4 times every day and am always tired and in pain. 


Although the Proton Centre has offices in The UK they state in their contract with patients that any litigation for any medical negligence has to be pursued through the Czech courts.  




 I later found out that the medical negligence laws in the Czech Republic have remained unchanged since the Soviet era and that the burden of proof on claimants is so great that it is effectively almost impossible to successfully sue. Further, compensation awards are also minimal even if successful. Medical negligence cases consequently have very little appeal to Czech lawyers and only a small number of smaller firms will consider representing plaintiffs in negligence cases and none on a no win no fee basis. I spoke to one lawyer who refused my case who stated that the owners of the Proton Centre are very rich and powerful bankers and businessmen who never settle out of court and do not lose medical negligence cases. They apparently chose the Czech Republic for the location of the Centre specifically because of it's medical negligence laws. The Centre was recently bought from the Erste banking group for CZK 2.5 billion by Démétér Property from the Raiffeisenbank group.


Whatever else you decide, get treatment in the UK and do not go overseas. In particular do not get Proton therapy in Prague. 


User
Posted 07 Mar 2024 at 05:25
There has been no follow up by the OP since August 2022 so we don't know how determinedly this was pursued if taken further.

Proton Beam Therapy requires great precision in delivery and it would seem this was not well done in Seven's case and he has shown that getting compensated in the Czech Republic is most difficult to secure compensation for a medical claim which one might consider a timely warning. However, there are are some excellent treatment centres abroad but as in other things you need to research that they have a very good reputation and that in need you can get compensation if you have a legitimate case. This is what I did before having my RT in Germany at one of the best hospitals in Europe. This included a boost to EBRT of 6 fractions of Carbon Ion each of 3 Gy which like Proton Beam is Hadron Treatment but packs a much greater punch.

I also had Dental Implants in Budapest but made sure they were done by a highly regarded Implantologist and this was mostly done in 2007. You do read of cases where people have dental treatment abroad and the NHS has to correct it. The same applies to people who have cosmetic surgery abroad, so research well beforehand. Sometimes mistakes happen in the UK though rarely.as standards are pretty high here. Unfortunately, due to Covid and the pressure many Hospitals were under, consultations and treatment waits were often delayed even when hospitals were doing tests at weekends, as happened to me.
Barry
User
Posted 07 Mar 2024 at 05:42

Originally Posted by: Online Community Member
We did have one clear case on this forum of biopsy results being mixed up and a healthy prostate being removed as proven by post op histology. That was settled after about five years for I believe a five or six digit sum. The evidence in that case was incontrovertible.


Dave, has summed up the chances of making a successful claim for clinical negligence well. 


You need to prove two things.


A) A breach of duty or care. 


B) Causation.  That the breach of care has had a detrimental effect on you.


Proving A is easy. Identifying misdiagnosis or clinical errors or omissions, isn't difficult.


Proving B, especially in prostate cancer cases, is almost impossible. The outcomes to our disease are so varied. You'd have enormous difficulty conclusively showing, on a legal balance of probabities, that any mistakes, delays or omissions in your treatment have made your outcomes worse.


I ended up buying a book for 30 quid by a leading barrister on clinical negligence in cases involving misdiagnosis of cancer.


It was worth every penny because it showed what a mountain you need to climb to just stand a chance of success.


I spent months trying to prove my case, but was eventually bludgeoned into submission. However, apart from the book, the process cost me nothing and gave me something to focus on whilst trying to recover. It put my mind at rest, although I failed, that I'd done my best  to fight my corner.


For others, the 'quest for justice' maybe  unbenefical and simply impede their recovery.


 

Edited by member 07 Mar 2024 at 08:13  | Reason: Typo

User
Posted 07 Mar 2024 at 12:06

Going back some years now, quite a number of people suffered severe radiation burns to breasts from the standard photons.. They formed a group called 'RAGE' following which major changes and safeguards were adopted in radiation. If you have a bit of time this makes interesting reading - quite a bit of it. https://www.macmillan.org.uk/assets/yesterdays-women-radiotherapy-action-group-exposure-rage.pdf


 So great care is necessary with RT


 


 

Edited by member 07 Mar 2024 at 12:08  | Reason: Not specified

Barry
 
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