[2025] EWHC 2025 (KB)

This is a trial of liability and causation in respect of a clinical negligence claim brought by the claimant Julia Tosh (“the claimant”) against the defendant Vivek Gupta (“the defendant”). The claimant is currently 58 years old and works as a Clinical Coding Manager. The defendant is a Consultant General, Colorectal and Laparoscopic Surgeon, working within the NHS and in private practice.

On 6 March 2019, the claimant (then aged 52 years), was referred by a private General Practitioner (“GP”) to the defendant in his private practice, for investigation of her rectal symptoms. She attended an initial consultation with the defendant on 15 March 2019 and on 21 March 2019, the claimant underwent a flexible sigmoidoscopy (an investigative procedure), performed by the defendant. On 20 April 2019, the claimant attended a further appointment with the defendant by which time he had diagnosed the claimant with haemorrhoids which he graded as Grade 2 / 3. She agreed on the defendant’s advice to undergo a ligasure haemorrhoidectomy (surgical removal of her haemorrhoids) (“the operation”, “surgery” or “haemorrhoidectomy”) which was scheduled for 13 June 2019.

On that date, the defendant performed this operation on the claimant. Sadly, this ordinarily routine surgery resulted in the claimant developing anal stenosis (also known as “anal stricture”) which is a rare but serious complication of this surgery. This has, unusually, left her with life changing consequences namely ongoing severe bowel symptoms which have significantly affected, and will continue to affect, her health and her quality of life. I mean no discourtesy to the claimant by not describing these consequences, but they are not relevant to the issues that I must decide in this trial. Although the claim originally contained allegations of negligence in respect of the defendant’s conduct of the surgery, these allegations were discontinued following the Joint Statement prepared by the experts on 17 April 2025 (“Joint Statement”).

The remaining allegations of negligence that the claimant makes in this trial are that the defendant was negligent in respect of his (i) grading of her haemorrhoids; (ii) failure to discuss and offer non-surgical treatment options as an alternative to surgery; and (iii) failure to adequately explain the risks and benefits of the surgical haemorrhoidectomy. The claimant alleges that but for these negligent failures she would have chosen non-surgical treatment options rather than surgery and would therefore have avoided the complications that she suffered as a result.

The defendant denies that he was negligent in respect of any of the matters alleged. His case is that he assessed and graded the claimant’s haemorrhoids correctly, that he appropriately discussed non-surgical treatment options and the risks of surgery with the claimant and that he consented the claimant appropriately for the haemorrhoidectomy. The defendant asserts that in any event, the claim fails for lack of causation.