Loveday v Austin Hospital [1999] VSC 180

Loveday v Austin Hospital [1999] VSC 180 - VSC 1999 case summary — Zoe

[33]

"Following hysterectomy Mrs Loveday suffered a number of serious surgical conditions requiring numerous operations over a number of years. The initial causation of this appears to be complications following the hysterectomy and I think it is certain that none of this would have happened if the hysterectomy had not been carried out. Mrs Loveday had had an injury to the large bowel as a child but following recovery had no further trouble. In the ensuring years she had two children with no problems related to the previous bowel surgery. There is no reason, therefore, to suspect that she would have had further problems if the hysterectomy had not been carried out. The hysterectomy itself was difficult due to the previous bowel injury and surgery. This should have been anticipated and would be a major causative factor in the surgical complications that follows. The other matter raised in some of the reports is sexual function. From the physical point of view I would not expect Mrs Loveday to have difficulties with sexual function. However, on the emotional side I am sure she would and in her present state of mind I feel she would have great difficulty forming a relationship with a man. A psychiatrist could also address this question. ... I think it is certain that the various surgical complications and procedures that have followed the hysterectomy would not have occurred if that operation had not been carried out. How much would have been avoidable I cannot say and this is an opinion that should be sought from a surgeon. However, the previous bowel injury and surgery would greatly have increased the risks of a hysterectomy and, in fact, made the operation difficult... Thirteen years has now passed since the original operation and I think Mrs Loveday's condition is somewhat stablized. She is left with recurrent abdominal problems and serious emotional problems. I believe a psychiatric opinion would help on the latter... I believe Mrs Loveday's major disability is emotional and that the surgical misadventures have contributed considerably, if not totally, to this state. How much of it was the result of the treatment by the defendants and how much was inevitable I am unable to say... I believe Mrs Loveday is physically fit for work... From the emotional point of view I am not able to say for what type of work she would be fitted. However, physically I believe she could handle light work. From the physical point of view I think Mrs Loveday's life expectancy has not been altered as a result of these problems... The only further treatment I would suggest at this time is assistance with the emotional problems. I note that Mrs Loveday has also had considerable psychiatric treatment."

[35]

"Mrs Loveday has been a patient of mine for the past seven years. She has a past medical history of a perforating injury to her rectum at the age of nine. This was treated with primary repair and defunctioning colostomy. In February 1980 she tells me she had a hysterectomy performed by Dr McGoldrick. This operation was complicated by a bowel obstruction and she was transferred to PANCH where she had an emergency laparotomy which confirmed the bowel obstruction and adhesions. Shortly after that surgery she developed a recto vaginal fistula which required further surgery and a temporary colostomy which was closed several months later. In September 1990 Mr Harry Frydenberg operated on her for a subcute bowel obstruction. She had extensive adhesions and he spent 2-3 hours dividing them and untangling her bowel. In September 1991 she was admitted to Box Hill and then Austin Hospital again for subcute bowel obstruction which was treated conservatively each time. There was another admission in March 1992 for the same problem. In May 1992 Mr Frydenberg again operated on her for bowel obstruction and spent 3 hours dividing multiple adhesions. He felt there was no more that he could do for her. I then sent her to see another surgeon, Mr John Mackay in Box Hill who was very reluctant to operate on her again but because of worsening pain and further subcute small bowel obstruction he operated on her at St Vincents Hospital in August 1993. This was her last bowel operation. Since then her chronic abdominal pain and distension have persisted and resulted in her increasing dependency on narcotics and multiple other medications. This drug dependency has resulted from the complications that occurred following the hysterectomy in 1980. Her perforating rectal injury must also be partially responsible because this presumably resulted in the adhesion of her large bowel to the uterus, which made the hysterectomy a more difficult procedure. Her current medical problems are: 1. Ongoing abdominal pain and distension. Surgery would only ever be contemplated again if there were a dire need. 2. Drug dependency. In recent months Mrs Loveday has stopped using Pethidine injections, oral long acting narcotics (Kapanol), Promethazine injections, Cafergot Suppositories and Ergodryl for migraine and reduced her use of minor tranquillizors. There will always be the risk of her drug use escalating again but for the moment she has made a great improvement in that area. 3. Depression. Mrs Loveday has been seeing a psychiatrist, Dr John Pettiford for 1½ years. She remains on large doses of antidepressants. 4. Migraines. Has been having these for years. They seem to be related to her abdominal pain, so that when that is bad her migraines are also bad. Since stopping the Cafegot and Ergodryl the rebound effect of these medications has stopped. 5. Squint. She had an operation on her right eye in 1991 for problem of squint. Over the past year she has had further problems with her eye in that the squint has returned and she is currently having to use a special prism in her glasses. She is undergoing further investigation at the moment and may require further surgery on her eye. Mrs Loveday's prognosis is guarded. There is nothing further that surgeons can offer her to get rid of her chronic abdominal pain. She has finally come to accept this situation and hopefully in the future will be able to stop herself from going on the downward spiral of drug dependency. She has been emotionally damaged by all that has gone on in the past 18 years and any other setbacks (e.g. problem with her eyes) may be the catalyst for not coping with the abdominal pain again."

[40]

"The traumas which Ms Loveday experienced, including the diagnosis of cancer, her hysterectomy her discovery that her hysterectomy and resultant infertility had been unnecessary and subsequent operations and medical complications have had a major impact upon her life, and she has developed what is probably a Post-Traumatic Stress Disorder where she continues to ruminate about and relive these experiences, and experience repeated nightmares. She has also developed an Adjustment Disorder with mixed anxiety and depressed mood as a result of her continuing medical problems, chronic pain and sense of loss and grievance. She has felt demoralized by what she regards as the loss of the last 20 years of her life and the impact her continuing medical problems and resultant disabilities have had upon her life and the lives of her children. Ms Loveday's earlier childhood trauma at the age of 9 years has probably not contributed to her psychiatric condition. Her childhood experiences within her dysfunctional family have undoubtedly had an impact upon her personality development, and has probably contributed to her inability/unwillingness to develop a stable long-term relationship and has probably left her with a vulnerability expressed in the form of her compulsive gambling and her drug addiction. Although she has these vulnerabilities, it is the traumas that she has suffered over the past 20 years that have probably triggered and maintained her drug dependency and compulsive gambling. Her self-consciousness about the appearance of her abdominal scars has probably also contributed to her avoidance of intimate relationships. Given the nature of Mrs Loveday's psychiatric conditions, her prognosis is likely to be unfavourable and these conditions are likely to persist for the foreseeable future. She may benefit from a resumption of supportive psychotherapy with her treating psychiatrist. Although such treatment may help her cope more effectively with her problems, it is unlikely to substantially alter her condition."

At a glance

Court

Decision date

Before

Source

Judgment (81 paragraphs)

Parties

Cases Cited (1)