Chec Blackpool

3. Mrs A complains Chec Blackpool in March 2023:

• performed cataract surgery unnecessarily • did not actively explain risks of cataract surgery • poorly performed surgery, cutting her cornea.

4. Mrs A says she had to undergo an unnecessary surgery, without appropriate information of the risks. Mrs A says the cut to her cornea led to an eye abscess, and she has been left in extreme pain, constant discomfort and her eyesight has deteriorated.

5. Mrs A seeks financial remedy and service improvements to make sure it does not happen again.

6. This background is only intended to place the key events related to this complaint in context, not to provide a full, chronological account of everything that happened.

7. On 18 January 2023, Mrs A was referred to Chec after presenting to her optician with floaters.

8. On 16 February, Mrs A attended a consultation at Chec and was diagnosed with bilateral cataracts.

9. On 15 March, Chec performed cataract surgery on Mrs A. Following surgery, she began to experience pain and discomfort.

10. On 17 March, A attended a follow-up consultation at Chec. The pressure in her eye was very high and she was diagnosed with corneal oedema (swelling). She was prescribed drops.

11. On 21 April, Mrs A attended a further consultation at Chec. She underwent a further procedure to remove lens matter.

Unnecessary surgery

15. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications anything went seriously wrong.

16. Mrs A says she was put forward for and had unnecessary cataract surgery by Chec Blackpool between February to March 2023. We have turned to consider whether the evidence indicates it was an appropriate decision to refer Mrs A for cataract surgery.

17. From Mrs A’s medical records, we can see she first presented to Chec with '’floaters’ and reduced vision on 16 February 2023. During this consultation, Mrs A was examined and diagnosed with cataracts.

18. The NHS webpage on cataracts say they are cloudy patches on the lens of the eye, which get worse over time and surgery is the only proven effective treatment.

19. NICE guidance NG77 ‘Cataracts in adults: management’ is the standard used to manage and treat cataracts. Section 1.2.1 sets out what should happen when referring a patient for cataract surgery.

20. Section 1.2.1 says to base the decision to refer a person with a cataract for surgery on a discussion with them which includes how cataracts affects the person's vision and quality of life, whether one or both eyes are affected, what cataract surgery including risks and benefits, how the person’s quality of life may be affected if they choose not to have cataract surgery, and whether the person wants cataract surgery.

21. From Mrs A’s medical records, we can see she was diagnosed with grade four cataracts in both eyes. Our adviser said this was an appropriate diagnosis based on her examination as noted in her medical records. Our adviser noted this the most advanced stage of cataracts.

22. From Mrs A’s consultation records on 16 February, we can see cataracts had affected her vision and some daily tasks had become a struggle. We can see it was explained to Mrs A cataracts get worse over time. Our adviser said as cataracts were present in both eyes, Mrs A’s vision had reduced, and it would get worse over time, it was reasonable a decision to refer her for cataract surgery. This in line with section 1.2.1 of NG77.

23. From Mrs A’s consultation record on 16 February, we can see the risks of cataract surgery were discussed and she was told retinal detachment was a possible complication of cataract surgery.

24. We also have a copy of a consent form which listed the potential side effects of cataract surgery, what the surgery involves and the risks and benefits. We can see Mrs A signed the consent form on 17 February 2023. This indicates Mrs A agreed to proceed with the surgery, was aware of the risks and benefits and what the surgery involved. This is in line with section 1.2.1 of NG77.

25. Having carefully considered all the available evidence, we are persuaded it was a reasonable decision to refer and to perform cataract surgery on Mrs A. We have seen no indications Chec did not follow national guidelines.

Risk and benefits

26. Mrs A says the risks and benefits of cataract surgery were not actively explained to her. We have turned to consider whether evidence indicates the risks and benefits of cataract surgery were not actively explained to Mrs A.

27. The GMC’s ‘Decision making and consent’ is national guidance which sets out what should happen to gain consent before surgery.

28. Sections 21 to 23 says you must give patients clear, accurate and up-to-date information, based on the best available evidence, about the potential benefits and risks of harm of each option, including the option to take no action. It says it would not be reasonable to share every possible risk of harm, potential complication, or side effect.

29. It says you should include the following information when discussing benefits and harms. Recognised risks of harm that you believe anyone in the patient’s position would want to know. Risks of harm and potential benefits that the patient would consider significant for any reason. Any risk of serious harm, however unlikely it is to occur. Expected harms, including common side effects and what to do if they occur.

30. From Mrs A’s consultation record on 16 February, we can see the risks and complications of cataract surgery were discussed. We also have a copy of a signed consent form. The consent form contained information on the risks and benefits of cataract surgery, the aims of the surgery, and potential side effects.

31. We can see Mrs A signed the consent form on 17 February 2023. This indicates Mrs A agreed to proceed with the surgery, was aware of the risks and benefits, side effects and what the surgery involved.

32. Having considered all the evidence, we are persuaded Mrs A was adequately informed about the risks of cataract surgery. We have seen no indications Chec did not follow national guidelines around consent.

Cataract surgery

33. Mrs A says her cataract surgery was poorly performed on 15 March. She specifically says her cornea was cut during the surgery. We have turned to consider whether the evidence indicates Mrs A’s surgery was poorly performed and whether her cornea was cut during the surgery.

34. The GMC’s ‘Good Medical Practice’ is the standard all doctors must adhere to. Section 69 says what should be recorded in a patient’s medical records. Section 69 says medical records should contain relevant clinical findings, drugs prescribed, investigations, treatments, information shared with patients, decisions made, actions agreed, and who is creating the record and when.

35. In line with section 69 of the GMC’s ‘Good Medical Practice’ if anything went seriously wrong during the surgery, this should have been noted in the medical records. Our adviser has reviewed Mrs A’s medical records from 15 March and said the surgery was described as unremarkable. Our adviser said there was no evidence in Mrs A’s notes to suggest the surgery was poorly performed.

36. Our adviser also said there was no evidence in Mrs A’s notes to indicate she suffered a cut to her cornea except for normal surgical incisions expected during cataract surgery.

37. However, we also note Mrs A said following surgery she began to experience extreme pain and discomfort in her right eye. She says her vision has since deteriorated. We note her records show swelling to the cornea which led to an infection and a scar.

38. The NHS webpage on cataracts says the risk of complications developing because of cataract surgery is estimated at around one in 50 cases. Our adviser reviewed Mrs A’s medical records and agreed she suffered post-operative complications in her right eye. Our adviser said Mrs A suffered corneal decompensation (swelling of the cornea) which is a known complication of cataract surgery.

39. We would expect risks to be shared with patients in line with the GMC’s ‘Decision making and consent’. Section 21 to 23 says patients should be given clear, accurate and up-to-date information, based on the best available evidence, about the potential benefits and risks of harm of each option, including the option to take no action. It specifies that recognised risks should be shared, specifically any risk of serious harm.

40. From Mrs A’s signed consent form we can see corneal decompensation is listed as a potential complication of cataract. This indicates Mrs A was aware of corneal decompensation as a potential complication and agreed to proceed with the surgery.

41. Our adviser said the swelling of the cornea resulted in the epithelium (surface lining of the cornea) becoming denuded (ulcer) which allowed the cornea to become infected. Mrs A received treatment for this at Blackpool Victoria.

42. Our adviser explained the infection resulted in a corneal scar, which has affected Mrs A’s long-term vision. Whilst we sympathise with Mrs A, corneal decompensation is a known complication of cataract surgery.

43. Having carefully considered all the available evidence, there is no evidence to suggest Mrs A suffered injury due to a poorly performed surgery.

44. We recognise Mrs A has had a difficult experience and we do not underestimate how challenging it has been to raise her complaint with us. We thank Mrs A for bringing her complaint to our attention and for giving us the opportunity to investigate this for her. We hope our explanations show how we have carefully considered his complaint.

1. We have carefully considered Mrs A’s complaint about Chec Blackpool (Chec). We were saddened to hear about Mrs A’s post cataract surgery complications.

2. We have decided we will take no further action. This is because we have seen no indications anything went seriously wrong. We will go on to explain the reasons for our decision in this statement.