Surgery error left man in pain and needing second operation, Ombudsman finds

A man had to have the same operation twice after a surgical error meant a painful lump was not removed from his back, an investigation by the Parliamentary and Health Service Ombudsman has found. The routine operation to remove a lipoma, which is a benign tumour, was not carried out correctly meaning that Lukasz K had to have a second operation to remove it.

Mr K, a personal trainer from Greater Manchester brought a complaint about Manchester University NHS Foundation Trust to the Ombudsman in May 2018 after the Trust’s own investigation failed to recognise mistakes in his care.

In July 2016 he went to his GP with pain in his left leg and lower back and was told he had two lipomas which could be surgically removed. He was referred to the Trust and an operation was scheduled for December 2016. The lipoma in his leg was removed successfully but the one in his back was not, despite the Trust telling him that both had been removed.

The Ombudsman’s investigation found that although the Trust said the lipoma on his back had been removed, the incision was made in the wrong place and the lipoma remained in his back, causing him avoidable pain and stress. If the first operation had been carried out correctly this would have been avoided.

The lipoma in his back was eventually removed in September 2017 during a second operation, over a year after Mr K had been referred to the Trust. This left him with a second painful scar and prolonged his healing time which meant he had to take more time off work.

Rob Behrens, Parliamentary and Health Service Ombudsman, said:

‘Our NHS staff do a vital job caring for hundreds of thousands of patients under enormous pressure. But as this case shows, it is essential that lessons are learned when mistakes happen.

‘Undergoing surgery can be a stressful experience that often involves some discomfort or pain and Mr K should not have had to experience this twice.

‘The Trust has now acknowledged that it was at fault and apologised to Mr K.’

Mr K said:

‘You expect operations to be carried out properly, so I was surprised when my GP told me that the lipoma in my back hadn’t been removed, even though the Trust told me it had been.

‘I was in pain for several months because of the mistake and it affected my ability to drive and do my job.

‘I’ve lost confidence in the NHS and would feel apprehensive about having an operation in the future.’

Following the Ombudsman’s investigation the Trust wrote to Mr K to acknowledge and apologise for the failings in his care and treatment. At the Ombudsman’s recommendation, the Trust also paid £1,000 to Mr K in recognition of the unnecessary pain and stress caused as a result of its failings.




Notes to Editors:

  1. The Parliamentary and Health Service Ombudsman provides an independent and impartial complaint handling service for complaints that have not been resolved by the NHS in England and UK government departments. We look into complaints where someone believes there has been injustice or hardship because an organisation has not acted properly or has given a poor service and not put things right. We share findings from our casework to help Parliament scrutinise public service providers and to help drive improvements in public services and complaint handling.
  2. Part of the new corporate strategy for 2018-21 is to increase transparency and the impact of our casework. This case summary forms part of an interim measure to move towards publishing the majority of our casework on our website over the next three years. Sharing insight and learning from our casework will help to improve public services.

PHSO press office

Kate Minton, E:, T: 0300 061 4129

Out of office hours – E: , T: 0300 061 4444