East and North Hertfordshire NHS Trust

3. Mr A complains about complications he experienced after surgery on his testicle in June 2018. He says the Trust:

• discharged him when he was still experiencing swelling • did not check his wound before discharge.

4. Mr A says he experienced pain, a sensation of heat and a smell coming from the wound. A swab confirmed the presence of gangrene on 11 July 2018 and he was readmitted for three weeks. During that time, he spent a week on the intensive care unit (ICU), had two more operations and was given a large dose of antibiotics.

5. Mr A says he was unable to look after his wife and she had several falls in his absence and was also admitted to hospital. He says the events caused him and his wife distress and he had to arrange alternative care arrangements for her.

6. Mr A would like an acknowledgement of failings and service improvements.

7. Mr A had an operation in June 2018 to drain fluid from his left testicle. The Trust discharged him the next day. He then developed the severe but recognised complication of a rare type of gangrene.

8. On 6 July Mr A consulted his GP due to the level of pain he was in, the sensation of heat around the wound and a strong smell. His GP advised him to attend A&E the same day. On 11 July a swab confirmed gangrene in the wound.

9. Mr A discharged himself on 16 July due to care commitments and then returned to hospital the next day. Mr A was admitted to the ICU and had two more operations. He was in the ICU for a week and on a large dose of antibiotics, which continued throughout the admission. The Trust did a skin graft procedure and Mr A was discharged on 25 July.

13. The AAGBI and BADS published guidelines about discharge criteria for patients after short stay surgery. These guidelines say doctors should check patients for:

• stable vital signs (the body’s basic functions like breathing) • orientated to time, place and person • passed urine (if applicable) • able to dress and walk (where appropriate) • oral fluids tolerated (if applicable) • minimal pain • minimal bleeding • minimal nausea or vomiting.

14. The clinical records say Mr A was comfortable and independent after the operation. The records show he was eating and drinking. His observations were recorded as satisfactory and our adviser said there is nothing in the records to suggest Mr A did not meet the criteria for discharge.

15. The Trust discharged Mr A shortly after 1pm on 22 June 2018. Mr A says the Trust did not check his wound first. He said a nurse discharged him without anyone looking at his wound.

16. GMC guidance says doctors should, ‘where necessary, examine the patient’. While the Trust may not have checked his wound at the exact time of discharge, the clinical records say that at 10am on 22 June a doctor examined him as part of their ward round. The doctor noted Mr A’s ‘scrotal wound was clean and dry’. Our adviser said this suggests there were no signs of infection at the time of discharge. It seems the Trust acted in line with GMC guidance by examining Mr A before discharging him.

17. We have not seen any signs of failings. We realise Mr A unfortunately developed a serious but recognised complication of surgery and this must have been a challenging and distressing time for him and his wife.

1. We have carefully considered Mr A’s complaint about East and North Hertfordshire NHS Trust (the Trust). We have seen no sign that anything went wrong in the Trust’s decision to discharge him.

2. We understand that having gangrene (dead body tissue due to a lack of blood flow or a serious bacterial infection) was distressing for Mr A and we are sorry to hear about what happened to him.