QB-2022-000824 - [2025] EWHC 1610 (KB)

The Claimant seeks £82,456.50 being £9,500 for adhesiolysis to treat chronic pain, £8,000 for a pelvic clearance and associated medical care aged 51 and £66,795.00 for IVF treatment plus associated costs to complete her family.

I have considered all the evidence relating to adhesiolysis very carefully, and in particular the evidence that the benefit of adhesiolysis to reduce pelvic pain is uncertain, that the evidence that it is safe even in patients without the Claimant’s complexity is also uncertain, and although there is some evidence it may improve emotional wellbeing falling short of psychological benefit, the evidence base of that is also low-certainty. I do note Mr Raine-Fenning’s evidence that he would not carry out so many adhesiolysis operations if it did not provide benefit to his patients. However, it seems to me that the very much higher risk profile of the Claimant compared to his own patients (which I feel safe in inferring, as Mr Raine-Fenning says he would not operate on a patient with the Claimant’s complex issues) means that the risk/reward analysis tips decisively away from adhesiolysis, in my judgment.

Of course, it will be for the Claimant to obtain further advice from treating specialists, and it will be a matter for her to decide whether, if she is offered adhesiolysis, the potential benefits are such that she considers those risks worth taking, but I do note that she did not accept a laparoscopy when she was offered it in June 2019, and also resisted a caesarean section because she was concerned about adhesions when her son was born. The First Defendant correctly notes in its counter-schedule that Dr Raine-Fenning acknowledges in his updated condition and prognosis report that “Miss Hodgson can just rely on analgesia. Her pains typically settle fairly quickly and she seems to cope without any treatment. However, she needed to take codeine during the recent flare in July – September 2023”. I consider that it is very unlikely that she will have adhesiolysis treatment, and that in any event if she does, that it will be reasonable to have such treatment privately. She has been referred to, and will in my judgment be best served in, the NHS at a tertiary endometriosis centre where she will be under the care of a specialist multidisciplinary team as described by Mr Raine-Fenning. I make no award for adhesiolysis.

In relation to infertility treatment, I accept that the Claimant is sub-fertile, not infertile, and her fertility has been successfully tested by two natural conceptions. I also accept the Claimant’s revised evidence at trial that she wishes to find a partner before undertaking IVF. Of course that is not certain, and if she does find a partner, it is not certain that he will want to have children. But life is not certain and both these things are entirely possible and I would go so far as to say probable. I also hope that if she does find a partner and decide together to add children to the family, that conception will occur naturally. However I do accept Mr Raine-Fenning’s evidence, and I prefer it to that of Mr Magos and Mr Slack as he is the fertility expert and they are not, that as a result of the breach of duty it is more likely that not that she will not conceive naturally in the first year of trying, and so she will be advised to try IVF and it would be reasonable for her to do so.

The Claimant’s written evidence is that she would like four children in total. She currently has one son. She estimates that each cycle of IVF will cost her £7,000 and that three cycles will be needed for each live birth. She claims 3 x £21,000 plus additional costs of £1265 for each birth.

I do not think that the timescales are in her favour to have four children with assisted conception. She needs to find a partner and agree to start a family with him, which may take several years. Three cycles of IVF per live birth will also take considerable time, if that is what is needed. Both the First and Second Defendants submit that there is too much uncertainty for any award to be made. I disagree. I think it is reasonable and realistic to assume on the balance of probabilities that she will be able to undergo one full treatment of three cycles of IVF. The First Defendant in his counter-schedule agrees that if I am to find that she will undertake private IVF at all, this is the most likely scenario. However he submits that I should further discount it by a 67% to reflect the possibilities that she may not find a new partner who wishes to have children, that she conceives naturally, etc. I consider that I have reflected these possibilities in my assessment of the likely timescales available to her, by awarding for one full treatment not three, and if I were to further discount as suggested this would, in effect, be double-counting. Accordingly, in my judgment the award which is fair to both parties is the cost of three cycles of IVF to achieve a single live birth, plus associated costs. If the Claimant conceives more quickly, using only a single cycle for example, the remaining award could fund one or two more cycles to achieve a third child, if she remains of the age where this remains open to her. I award the sum of £22,265.00 for future IVF to which a multiplier of 0.9851 must be applied (the appropriate multiplier for advance receipt given the likely timescale which in my judgment is for such treatment to start in 3 years’ time). Accordingly the sum awarded is £21,933.25.

In relation to pelvic clearance, I am satisfied that the Claimant is likely to undertake this surgery once she has completed her family in order to treat the chronic PID, although it may not give entire relief from pain because of remaining adhesions. I award the sum of £8,000for pelvic clearance, to which the agreed multiplier of 0.91 must be applied.