The number of patients taking legal action after paying for weight loss surgery has risen sharply over the past two years, according to medical negligence figures seen by The Times.
Cases of post-operative infection and gastric bands slipping or leaking after being fitted to shrink the size of a patient’s stomach are identified as common problems in analysis by the Medical Defence Union (MDU).
Of 35 medical negligence claims involving bariatric surgery in private hospitals notified to the MDU since 2003, 21 have been in the past two years. At least one patient has died and another was left in intensive care after the surgery.
Bariatric surgery has become increasingly popular in recent years as a means of tackling Britain’s most serious obesity cases. Patients are able to cut their weight drastically by having a band fitted to shrink the size of their stomach, reducing the amount they can eat.
According to the Royal College of Surgeons, about one million Britons have a body mass index of more than 40 — the criteria for an initial assessment for gastric surgery on the NHS. About 25 per cent of these people want an operation, but only 4,300 NHS weight-loss operations were carried out last year. Official figures for the number of private-sector operations carried out do not exist, but it is estimated to be about 5,000.
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In the private sector, medical insurance companies do not cover bariatric procedures because obesity is considered a chronic disease. As a result patients wanting surgery — at a cost of about £5,000 — normally have to fund it themselves.
A gastric band is an inflatable silicone device that is placed around the top portion of the stomach using keyhole surgery.
It is adjustable, allowing doctors to alter the circumference and control how much a patient is able to eat. As well as being recommended for people with very high body mass indexes, it also used for other conditions which improve with weight loss, including sleep apnoea, diabetes, osteoarthritis and high blood pressure.
Reasons for the increasing number of claims include patients’ unrealistic expectations and doctors’ failure to explain the risks of the operation.
Christine Tomkins, chief executive of the MDU, said that while most of the problems emerging from this sector were not life-threatening — and not all claims led to compensation — the outcomes in a handful of cases were severe for the patients concerned. She said that there had only been two or three claims a year until 2008, when the number had risen ten-fold. Most of the claims are continuing, and the estimated value of active cases ranges from £2,500 to £500,000.
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Dr Tomkins said that in at least one case the patient died, after an infection allegedly caused by perforation of the gut. Another patient had to be put on a ventilator because of an infection after a leak during a gastric bypass.
“We are starting to see the emergence of medical negligence claims,” she said. “Given that this type of surgery is likely to increase in popularity, we want to try to help our members to avoid some of the common problems our analysis has highlighted.”
These include post-operative complications such as infections; bands slipping or leaking and delays in diagnosing these problems; difficulties and complications in adjusting bands; and alleged failure to obtain consent from patients, for example about the risks involved or the post-operative diet required.
Active claims include six cases in which it is alleged that gastric bands slipped, three perforations of the gut, a case where a swab used during the operation was left inside the patient and had to be removed during further surgery, and technical problems in the inflation of a gastric band. Guidelines produced by the National Institute for Health and Clinical Excellence (Nice) recommend bariatric surgery on the NHS as a treatment option for adults with obesity if they meet set criteria.
These include having a body mass index of 40 or more, or between 35 and 40 if the patient has a significant disease or ailment — such as type 2 diabetes or high blood pressure — that could be improved if they lost weight.
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Additionally, all appropriate non-surgical measures need to have been tried to achieve or maintain weight loss for at least six months.
The MDU analysis found that many cases involved problems adhering to the dietary regime, and complaints of insufficient information on this prior to treatment. After a gastric band operation, the patient may be prescribed a liquid-only diet, followed by mushy foods and then solids — with time periods dictated by the surgeon.
Many doctors start adjusting the band about two months after surgery to allow the stomach time to heal.