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"Post-poned Cardiac Ablation Manchester Infirmary"

About: Manchester Royal Infirmary / Cardiology Manchester Royal Infirmary / Endocrinology

(as the patient),

Dear Sirs/Madams

I write regarding the cardiac ablation that was due to be undertaken at Manchester Royal Infirmary, but was postponed at the last minute due to multiple failures from the cardiology department, namely:

1. On multiple occasions when I have contacted the cardiology department by phone, I have been told my pre-operative assessment took place in January 2021, I advised every time this was not the case. Ultimately the department failed to book in a pre-operative assessment in time for the operation today, despite being advised by me on multiple occasions this had never taken place. I also was not given any advice on what medications to discontinue before the surgery.

2. When I went for my bloods/covid test on Sunday, the nurse who took my bloods advised me to contact the Heart Centre on 0161 701 5044 to air my concerns about the procedure. I left an urgent message for them yesterday morning and have still not heard back! I also contacted the number on my operation letter (0161 701 0727) which resulted in a response, but it was too little too late and resulted in my procedure being postponed. This is because the department did not have everything in place, despite me trying for the last fortnight to provide all the information needed. I was only contacted by the relevant person at around 5.30pm the day before to let me know the procedure could not go ahead

3. I was contacted in January 2021 by the cardiac schedulers, they enquired if I would like to be put back on the waiting list, we agreed that I would contact them again once I had had both doses of the covid vaccine, and go on the wait list then. This is the phone call that I keep being told was a pre-operative assessment, when it simply was not. I have also had receptionists telling me that a pre-operative assessment I had in September 2019 was still valid for the procedure today! There have been changes to my medications and health since then. I was fully vaccinated by early April and contacted the cardiac schedulers at the time to make them aware.

4. The doctor failed to utilise the multidisciplinary team and consult an endocrinologist to check the cover required for my Addision’s disease during the procedure. They deferred to the same cover from my previous ablation in 2019, despite the fact I advised both during and after the procedure that it was quite traumatic and not handled well (I was not believed when I said I was in pain during the surgery and the trainee surgeon was reluctant to end the procedure until they realised it had gone on nearly 6 hours). The last surgery I had commenced at 2pm, I am supposed to take my steroids around 5pm, but I was not back in the ward until 7pmish and missed my tea time dose. All these factors could easily contribute to the onset of a crisis which can be fatal and are very preventable with adequate supervision, indeed I was taken very unwell toward the end of the procedure and advised the trainee surgeon of crushing, high pressure chest pains, similar to chest pains I have had to go to A&E for. I could feel myself entering a crisis and felt completely disregarded by the medical team.

Towards the end of surgery, the trainee surgeon asked the nurse to administer more painkillers so that they could continue (this was about 4 and half hour mark), but was advised I’d already had the maximum dose so only then did they decide to discontinue (even though I’d made it clear I was not coping anymore with the surgery).

5. I should mention the doctors used outdated guidance, as the guidance was updated January 2020 for Addision’s cover during surgeries (see ‘Guidelines for the management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency’). A cardiac nurse confirmed to me the cover for this procedure would be the same as the last, and that was sufficient. The guidance states the safest way to carry out a procedure is by steroid injection and then continuous infusion of steroids until an oral dose can be taken following the surgery.

6. I contacted my GP who wrote to my cardiologist requesting that they consult endocrinology department regarding my steroid cover for the surgery. This advice was flagrantly ignored, with endocrinology staff confirming to me that the cardiologist had made no such contact and that they were unaware I was going in for surgery. For previous ablations you have consulted an endocrinologist, so I am confused as to why on this occasion it was deemed to be unnecessary, despite the fact the procedure I was meant to have today carries more risk than those I have previously undergone as it is on the left side of my heart.

7. The ward failed to contact my husband when I was back on the ward, so that he could set off to come collect me from the hospital (they assured us they would contact him by 7pm that day and didn’t).

I have been seeking reassurances from this team for the past few weeks that this procedure would be done correctly and to the best standard for my specific condition, all of it was wasted effort as the cardio department had to cancel my procedure at the 11th hour due to the departments inadequate handling of the peri-operative period. I have been waiting for 5 years for this hospital to resolve these issues.

My daughter sent in a complaint on my behalf in April 2019 as the hospital had completely mixed up my medical history with another one of your patients, this was following my second ablation surgery. it does not appear as though your management of patient information has improved, despite assurances in PALS response that patient information would be handled more appropriately in the future.

I would appreciate your acknowledgement of the above events and trust that, in future, my concerns and the concerns of all those with Addison’s will no longer be ignored, so as to avoid your department such embarrassment as having to cancel a scheduled surgery at the last minute. I look forward to hearing from the cardiology team after they consult with endocrinology, as requested, regarding the appropriate management of my Addison’s during the peri-operative period.

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