Oxford University Hospitals NHS Foundation Trust

3. Mrs R complains that while the Trust did laparoscopy surgery (surgery to see inside the abdomen and pelvis) on 21 August 2018, it failed to remove her copper coil when replacing it with the Mirena coil (types of contraception). Mrs R was left with two coils inside for five months.

4. Mrs R says she was left in a lot of pain after surgery. She explains she was anaemic, had water retention, low vitamin D levels, and had a hormonal imbalance. She also explains she has experienced mental health problems.

5. As an outcome, Mrs R would like financial compensation.

6. Mrs R was meant to have the copper coil removed and replaced with the Mirena coil.

7. Mrs R experienced pain after the surgery and says her health deteriorated. She experienced pelvic and abdomen pains meaning she was unable to walk, she felt tired and nauseous, and her vision was blurred.

8. On 6 January 2019, she had an ultrasound which she said was very painful. Mrs R asked for the Mirena coil to be removed.

9. On 21 January, Mrs R had the Mirena coil removed and during the appointment it became clear the copper coil was not removed by the Trust on 21 August 2018.

10. Mrs R said she continued to experienced health problems after this.

11. Mrs R complained to the Trust in March 2019 and got a response in July.

Failed to remove copper coil

14. The law says a person needs to make their complaint to us within a year of becoming aware of the problem (date of knowledge). We cannot investigate complaints brought to us after one year, unless we consider there is a good reason to do this. We discussed this with Mrs R to understand the reasons why she did not bring her complaint to us sooner. We have also considered the time the Trust took to respond to Mrs R. We have not found good reason to put the time limit aside.

15. Mrs R knew the copper coil was not removed when she had the Mirena coil removed on 21 January 2019. During this appointment, Mrs R had both coils removed. As this is the day Mrs R found out she had had two coils for five months, we will treat the 21 January 2019 as her date of knowledge.

16. The Health Service Commissioners Act 1993 section 9 (4) explains Mrs R needed to have complained to us within 12 months of her date of knowledge. This meant Mrs R should have complained to us by 21 January 2020.

17. Mrs R complained to the Trust in March 2019 and it replied in July 2019. This meets the six month time frame stated in the Complaints Regulations 2009.

18. Mrs R explained she struggled to find a solicitor to pursue a clinical negligence claim. In October/November 2019 she found a solicitor to take on her claim.

19. The solicitors first contacted Mrs R on 5 December 2019. Between 2019 and 2022, Mrs R pursued the claim with the solicitors. In January 2022, the solicitors told Mrs R they were not carrying on with her claim as, while there may have been a breach in duty, it would be difficult proving if it caused her injuries.

20. Mrs R then complained to us in March 2022.

21. We asked Mrs R what happened during the three year period when her claim was with the solicitors, as this was a long time for them to have her case and then decide not to pursue it. Mrs R explained she chased the solicitors many times but because of COVID-19 they did not make much progress the first year. She said she was aware of the time limit for making a clinical negligence claim and she said she was told she did not need to worry.

22. Mrs R explained that in 2021, the solicitors experienced problems with her medical records and there was a delay in the medical expert publishing the medical report. On 24 January 2022, the solicitors told Mrs R they were not carrying on with her case.

23. We asked Mrs R whether, at any time between January 2019 and January 2022, she brought her complaint to us and, if not, why not. Mrs R said no.

24. Mrs R could not say why she did not bring her complaint to the us during this time. Mrs R said she felt a lot of pain before and after she had the coils removed. She explained she had to look after her mother but did not tell us when this was. We are sorry to hear about the difficult time Mrs R had.

25. Mrs R said she wanted someone to represent her so she did not have to be involved, as she was explaining things over and over again. She explained how she wanted someone to help her but no one believed her. She was experiencing a lot of problems with her health and she wanted answers.

26. In the complaint form Mrs R explained she was very confused at the time ‘everything happened’ and she was not told about her options. She said a ‘no win no fee’ solicitor was the right choice at the right time.

We have considered Mrs R’s reasoning for not bringing her complaint to us sooner. We realise Mrs R said she was not told what options she had and we have seen the Trust’s final complaint response did not tell Mrs R about her right to complain to us.

28. Mrs R knew she wanted to pursue a clinical negligence claim and contacted several solicitors. She was aware of the three-year time limit and chased the solicitors because of this. We can also see Mrs R chased the solicitors who had taken on her claim.

29. From the information provided, we believe Mrs R did not plan to bring her complaint to us before March 2022. This is proven by Mrs R saying pursuing a clinical negligence claim was the right choice at the right time. She also said she wanted someone to represent her, so she did not have to get involved.

30. Had Mrs R contacted us after getting the Trust’s response, we would have been able to advise her of the time limit for bringing a complaint to us.

31. Mrs R only brought her complaint to us after she was told by the solicitors they would not take her claim further. As Mrs R was aware of our organisation, she could have looked on our website to find out the timeframe for complaining to us. She could also have approached an advocacy service, a family member or friend to help her if she did not feel well enough to complain herself and if she had caring responsibilities for her mother.

32. We can also see the Trust responded in good time to the complaint and Mrs R has not said the Trust caused delays which stopped her from coming to us sooner.

33. From the information available, we do not think it is reasonable to put the time limit aside. Mrs R has come to us as she was unsuccessful with her clinical negligence claim. Her complaint is two years and two months outside of our time limit and we have seen no good reason to put this aside.

34. Mrs R did not contact us during the time her case was with the solicitors to tell us she was pursuing a clinical negligence claim. We believe that had Mrs R had any intention of bringing her complaint to us sooner, she would have contacted us.

38. It should also be noted it is very difficult to investigate a complaint that is over a year old as it can be hard to get hold of evidence and people may remember less about what happened.

35. In conclusion, we believe Mrs R’s complaint is out of time. We are sorry to hear about what happened to her and how this continues to affect her life. We are sorry there is nothing further we can do but we must consider the law on our time limit.

1. We have carefully considered Mrs R’s complaint about the Oxford University Hospitals NHS Foundation Trust (the Trust).

2. We have decided Mrs R’s complaint falls outside of our time limit, and we do not have good reason to put this to one side and investigate the complaint. We understand Mrs R experienced a difficult time after her operation in August 2018 and we are sorry to hear this. We would like to thank Mrs R for bringing her complaint to our attention and we want to reassure her that our decision does not take away from her experience.