After abdominal surgery, you kept returning with pain — and nobody investigated: what does NSW law say about post-surgical adhesions?
That experience — of being sent home repeatedly after abdominal surgery, with symptoms that were real and escalating — is not unusual for people who later discover they have developed post-surgical adhesions. The dismissal is not always deliberate. But the law does not require deliberate conduct to find a breach of the standard of care. What it requires is that a clinician’s response to a patient’s symptoms fell below what a reasonably competent clinician in that specialty would have done.
This article examines what post-surgical adhesions are, what the clinical standard requires of surgeons and GPs who manage patients after abdominal surgery, where care most commonly breaks down, and what the law in NSW says about the consequences of that breakdown.
What post-surgical adhesions are and how they should be managed
Post-surgical adhesions are bands of fibrous scar tissue that form between abdominal organs and the peritoneal wall — the membrane lining the abdominal cavity — following surgery. The body produces this tissue as part of its normal healing response to surgical trauma. In many patients, adhesions cause no symptoms at all. In a significant proportion, they cause chronic pelvic or abdominal pain, bowel obstruction, infertility in women, and in serious cases, strangulation of the bowel requiring emergency surgery.
Adhesions form after virtually any abdominal or pelvic procedure. Gynaecological surgery — including hysterectomy, myomectomy, and surgery for endometriosis — carries a particularly high adhesion risk. Colorectal surgery, appendicectomy, and caesarean section are also strongly associated with adhesion formation. According to a widely cited review published in The Lancet, adhesions develop in up to 93% of patients following open abdominal surgery and in a lower but still substantial proportion following laparoscopic procedures.1
In Australia, small bowel obstruction caused by adhesions accounts for a significant proportion of emergency surgical admissions. The Australian Institute of Health and Welfare has documented adhesiolysis — the surgical procedure to divide adhesions — as one of the more commonly performed abdominal procedures in the public hospital system.2
Standard clinical management of post-surgical adhesions depends on the severity of symptoms. For patients with chronic pain or intermittent obstruction, management typically involves imaging to confirm the diagnosis, specialist review, and a decision about whether conservative management or surgical intervention is appropriate. For patients presenting with signs of acute bowel obstruction — absolute constipation, abdominal distension, vomiting, and severe colicky pain — the standard of care requires urgent imaging, hospital admission, and surgical review without delay.
For general information about adhesions and their symptoms, see Healthdirect Australia.
What it requires: Surgeons performing abdominal procedures carry a continuing duty to their patients in the post-operative period. Where a patient presents with symptoms consistent with a post-operative complication — including adhesion-related obstruction — the treating clinician must conduct a thorough assessment, order appropriate imaging, and arrange specialist review where the clinical picture warrants it.
Why this matters: A failure to investigate recurrent post-operative abdominal symptoms, or to refer a patient to a surgeon when those symptoms are escalating, may constitute a departure from the standard that the RACS expects of its members and that the law uses as its benchmark.
The standard of care — what clinicians are required to do
The “standard of care” in law means the level of skill and care that a reasonably competent clinician in the same specialty, with the same information available, would have exercised in the same circumstances. It is an objective test. What this particular clinician intended, believed, or was under pressure to do that day is not the measure. The measure is what a competent peer would have done.
For post-surgical adhesions, the standard of care operates at three distinct points: at the time of the original surgery, during the post-operative period, and at any subsequent presentation with symptoms.
At the time of surgery: the consent obligation
A surgeon performing any abdominal or pelvic procedure must warn the patient of the material risks of that procedure. Adhesion formation is a well-documented, significant risk of abdominal surgery. The High Court of Australia in Rogers v Whitaker (1992) 175 CLR 479 established that a clinician must disclose any risk that a reasonable person in the patient’s position would want to know — and any risk that this particular patient would want to know, if the clinician is aware of that patient’s specific concerns.3 A surgeon who fails to warn a patient that adhesions may form, that they may cause chronic pain or bowel obstruction, and that further surgery may be required, has not met the informed consent standard the law requires.
What it requires: Patients have the right to receive information about their care in a way they can understand, including information about the risks of proposed treatment and the likely consequences of those risks materialising.
Why this matters: A patient who was not told that adhesions were a material risk of their surgery, and who later developed serious adhesion-related complications, may have a claim in negligence grounded in the failure to obtain properly informed consent — separate from any claim about the management of the adhesions themselves.
During the post-operative period: the duty to investigate
A GP or treating surgeon who sees a post-operative patient presenting with recurrent abdominal pain, bloating, nausea, or altered bowel function must consider adhesion formation as a differential diagnosis — that is, one of the possible explanations for the symptoms that must be actively considered and either confirmed or excluded. Attributing those symptoms to “normal recovery” without conducting any investigation is not a clinical conclusion. It is an assumption. The standard of care requires more than an assumption.
Specifically, a clinician in this situation should take a thorough history of the symptom pattern, order abdominal imaging — at minimum a plain abdominal X-ray, and in many cases a CT scan — and refer the patient to a surgeon if the imaging is inconclusive or if symptoms persist. A clinician who sends a patient home four times with the same symptoms and no investigation has not met that standard.
At the point of acute obstruction: the duty to act urgently
When a patient presents with signs of acute small bowel obstruction — absolute constipation, abdominal distension, vomiting, and severe colicky pain, particularly in the context of prior abdominal surgery — the standard of care requires urgent action. That means immediate imaging, hospital admission, and surgical review. Delay at this point is not a matter of clinical judgment. It is a departure from a well-established protocol. The consequences of delay — bowel ischaemia, perforation, sepsis, and death — are well documented and foreseeable.
-
1Abdominal or pelvic surgery performed
Standard of care requires: informed consent discussion including adhesion risk, documentation of that discussion in the surgical record. -
2Weeks to months post-surgery: onset of symptoms
Patient experiences recurrent abdominal pain, bloating, nausea, altered bowel function. Standard of care requires: treating clinician considers adhesions as a differential diagnosis at first presentation with these symptoms. -
3First GP or specialist presentation
Standard of care requires: thorough history, abdominal examination, imaging ordered (X-ray or CT), and surgical referral if symptoms are consistent with adhesion-related pathology. ⚠ Common failure point: symptoms attributed to “normal recovery” without investigation. -
4Repeated presentations with same or worsening symptoms
Standard of care requires: escalation of investigation. Repeated presentations with the same unresolved symptoms are a clinical red flag. A clinician who sees the same patient three or four times with the same post-operative abdominal symptoms and takes no further action has not met the standard. ⚠ Common failure point: each presentation treated in isolation, no cumulative clinical reasoning. -
5Acute obstruction presentation
Patient presents to emergency or GP with signs of bowel obstruction. Standard of care requires: immediate imaging, hospital admission, surgical review without delay. ⚠ Critical failure point: delay at this stage risks bowel ischaemia, perforation, and sepsis. -
✓Correct diagnosis and management
Imaging confirms adhesion-related obstruction. Surgical team manages conservatively or operatively depending on severity. Patient informed of findings and ongoing risk.
This timeline reflects the general standard of care. Each patient’s clinical circumstances differ.
Where care breaks down — specific failure patterns
Post-surgical adhesion cases do not typically involve a single dramatic error. They involve a sequence of smaller failures — each one defensible in isolation, but collectively representing a pattern of care that fell below the standard. Understanding each failure pattern is essential to understanding where a legal claim may arise.
Failure to warn at the time of surgery
A surgeon who performs an abdominal procedure without discussing adhesion risk with the patient has not obtained properly informed consent. The risk is not rare or theoretical. Adhesions form in the majority of patients following open abdominal surgery. A patient who was not told this — and who later developed serious adhesion-related complications — was denied the opportunity to make an informed decision about whether to proceed, to seek a second opinion, or to ask about adhesion-reduction techniques.
The mechanism here is not malice. Surgeons often omit adhesion risk from consent discussions because the risk feels routine to them — a known consequence of surgery that they manage regularly. That familiarity does not reduce the patient’s legal right to be told. She went into theatre not knowing that the surgery might leave her with chronic pain or a future bowel obstruction. Nobody told her. That omission has legal consequences.
Failure to investigate recurrent post-operative symptoms
A GP who sees a patient four times in three months with the same post-operative abdominal pain and sends her home each time with reassurance has not met the standard of care. The standard requires that a clinician who sees the same unresolved symptom pattern across multiple presentations escalates their investigation. Repeated presentation is itself a clinical signal. It tells the clinician that the initial explanation — “normal recovery” — was wrong, or at least insufficient.
Cognitive anchoring drives this failure. The clinician forms an initial impression — “this is post-operative discomfort” — and subsequent presentations are filtered through that impression rather than assessed afresh. Each visit is treated as a continuation of the same benign story, rather than as new evidence that the story needs revision. The patient, meanwhile, is living inside a body that is telling her something is wrong. She keeps going back. She keeps being told to wait.
What happened: A patient presented repeatedly with symptoms that a GP attributed to a benign cause. The GP failed to investigate further or refer to a specialist despite the persistence of symptoms over multiple consultations.
What the court found: The NSW Court of Appeal held that a GP’s failure to refer a patient for specialist investigation, in circumstances where the symptom pattern warranted it, constituted a breach of the standard of care. The court applied the principle that a reasonably competent GP would have recognised the limits of their own assessment and escalated.
Why this matters: The principle established in this case applies directly to GPs who repeatedly see post-operative patients with unresolved abdominal symptoms and fail to refer for imaging or surgical review.
Failure to recognise and act on acute bowel obstruction
When a patient with a history of abdominal surgery presents with the classic triad of bowel obstruction — colicky abdominal pain, vomiting, and absolute constipation — the diagnosis is not obscure. It is one of the first things a clinician should consider. A GP or emergency physician who fails to order an abdominal X-ray in this clinical context, or who discharges the patient without surgical review, has departed from a standard that is clear and well-established.
The harm that flows from this failure is severe and time-dependent. Bowel ischaemia — where the blood supply to a section of bowel is cut off — can develop within hours of complete obstruction. Perforation follows ischaemia. Sepsis follows perforation. A patient who was discharged from an emergency department with a missed bowel obstruction and returned two days later in septic shock did not experience a bad outcome. She experienced a preventable one.
For information on how systemic failures in post-operative care are tracked and addressed in the Australian health system, see the Australian Commission on Safety and Quality in Health Care.
| Failure mode | What should have happened | What went wrong | Harm that resulted |
|---|---|---|---|
| 1. Consent failure at surgery | Surgeon discusses adhesion formation as a material risk before the procedure, documents the discussion, and gives the patient the opportunity to ask questions. | Adhesion risk not mentioned in the consent discussion. Patient signs a generic consent form. No record of a specific adhesion risk warning in the surgical notes. | Patient develops chronic adhesion-related pain or bowel obstruction without having been given the opportunity to make an informed decision about the procedure. |
| 2. Failure to investigate recurrent symptoms | GP or treating clinician orders imaging at the second or third presentation with unresolved post-operative abdominal symptoms and refers to a surgeon if the clinical picture warrants it. | Patient seen multiple times with the same symptoms. Each presentation reassured and discharged. No imaging ordered. No surgical referral made. Symptoms attributed to “normal recovery” without investigation. | Adhesion-related obstruction develops and progresses without detection. Patient’s condition deteriorates over weeks or months before a correct diagnosis is made. |
| 3. Failure to recognise acute obstruction | Emergency or treating clinician orders urgent abdominal imaging, admits the patient, and arranges surgical review when a patient with prior abdominal surgery presents with signs of bowel obstruction. | Patient discharged from emergency without imaging or surgical review. Obstruction not diagnosed. Patient returns days later with bowel ischaemia, perforation, or sepsis. | Bowel resection required. Permanent stoma formed. Sepsis requiring ICU admission. In the most serious cases, death. |
This table describes failure patterns in general terms. Each case depends on its individual clinical facts.
The legal framework in NSW
Medical negligence claims in NSW are governed primarily by the Civil Liability Act 2002 (NSW) — a statute that sets out the legal tests for negligence, the defences available to clinicians, and the rules for calculating damages. Understanding how this statute applies to post-surgical adhesion cases is essential to understanding whether a particular failure gives rise to a legal claim.
The peer professional opinion defence — and its limits
Section 5O of the Civil Liability Act 2002 (NSW) provides that a clinician is not negligent if their conduct was consistent with a practice widely accepted by peer professional opinion as competent professional practice. This is the defence most commonly raised by clinicians in medical negligence proceedings. In plain terms: if a body of competent surgeons or GPs would have done the same thing, the clinician may not be liable.
But section 5O has a critical limitation. The defence does not apply if the court considers that the peer professional opinion was itself unreasonable. A practice that is widespread is not automatically a practice that is legally defensible. Where a body of clinical opinion fails to account for a known and foreseeable risk — such as the risk of adhesion-related obstruction in a patient with prior abdominal surgery — a court may decline to accept that opinion as a complete answer to a negligence claim.
Causation — the “but for” test
Section 5D of the Civil Liability Act 2002 (NSW) requires a plaintiff to establish causation — that is, that the clinician’s breach of duty caused the harm suffered. The primary test is the “but for” test: but for the clinician’s failure, would the harm have occurred? In adhesion cases, this question is often the most contested element of the claim. A plaintiff must establish not only that the clinician failed to investigate or act, but that earlier investigation or action would have produced a different outcome.
In many adhesion cases, that causal link is demonstrable. A patient whose bowel obstruction was missed at an emergency presentation, and who returned two days later requiring emergency bowel resection, can point to a clear causal chain: the failure to diagnose led to the delay, the delay led to ischaemia, and the ischaemia led to the resection. The question of what earlier intervention would have prevented is answered by the clinical evidence.
For a full explanation of how medical negligence claims are structured and assessed in NSW, see Reframe Legal — Medical Negligence.
What happened: A patient presented with symptoms that, if properly investigated, would have revealed a serious condition. The treating clinicians failed to conduct the appropriate investigation, and the patient suffered serious harm as a result of the delayed diagnosis.
What the court found: The High Court held that causation in medical negligence cases does not require certainty that earlier intervention would have prevented all harm — it requires proof on the balance of probabilities that the breach materially contributed to the harm. The court also affirmed that the standard of care is measured objectively, not by reference to what the individual clinician believed was appropriate.
Why this matters: In post-surgical adhesion cases where a delayed diagnosis led to a worse outcome, a plaintiff does not need to prove that earlier action would have guaranteed a perfect result — only that it would have made a material difference to the outcome on the balance of probabilities.
Who holds the duty of care
In post-surgical adhesion cases, the duty of care may rest with multiple clinicians across the care pathway. The operating surgeon holds a duty in relation to the consent process and the post-operative management plan. The GP holds a duty in relation to the investigation and referral of post-operative symptoms. The emergency physician holds a duty in relation to the recognition and management of acute obstruction. A hospital holds a non-delegable duty of care to patients treated within its facilities — meaning that even if an individual clinician’s conduct is found to be within the standard, the hospital may still be liable for systemic failures in the care pathway.
The critical distinction in all of these cases is between a bad outcome and a breach. Adhesions form in the majority of patients following abdominal surgery. Not every patient who develops adhesion-related complications has a legal claim. The question is not whether the outcome was bad. The question is whether a clinician, at a specific decision point, failed to do what a competent clinician in that position would have done — and whether that failure caused or materially contributed to the harm.
When post-surgical adhesion care may amount to medical negligence
The following scenarios describe factual situations that may engage the legal elements of negligence. Each is grounded in the clinical standard and the legal framework described above.
The surgeon who did not mention adhesions before the operation
A patient undergoes a hysterectomy or colorectal resection. The surgeon discusses the risks of bleeding, infection, and anaesthetic complications. Adhesion formation — a well-documented, significant risk of the procedure — is not mentioned. The patient later develops chronic pelvic pain and requires a second operation to divide adhesions. She was never told this was possible.
Under Rogers v Whitaker, the surgeon was required to disclose any risk that a reasonable person in the patient’s position would want to know. Adhesion formation, with its potential for chronic pain, bowel obstruction, and further surgery, is precisely that kind of risk. The failure to disclose it engages the consent element of negligence. If the patient can establish that, had she been properly warned, she would have made a different decision — sought a second opinion, chosen a different surgical approach, or declined the procedure — causation is engaged.
The GP who attributed everything to recovery
A patient presents to her GP six weeks after an appendicectomy with recurrent abdominal pain and bloating. She returns three more times over the following two months with the same symptoms. Each time, the GP reassures her that post-operative discomfort is normal and that she needs more time to heal. No imaging is ordered. No referral is made. At her fifth presentation, she is in acute pain and vomiting. An abdominal X-ray in the emergency department shows a small bowel obstruction. She requires emergency surgery and a bowel resection.
The GP’s failure to investigate at the second or third presentation — when the persistence of symptoms should have prompted a differential diagnosis that included adhesion-related pathology — is a departure from the standard of care. The repeated presentation was a clinical signal. Ignoring it was not a judgment call. It was a failure to apply basic clinical reasoning to an escalating symptom pattern.
The emergency physician who discharged a patient with obstruction
A patient with a history of prior abdominal surgery presents to an emergency department with colicky abdominal pain, vomiting, and inability to pass wind or stool. The emergency physician examines her, attributes the symptoms to constipation, and discharges her with laxatives. No abdominal X-ray is ordered. Forty-eight hours later, she returns by ambulance in septic shock. Imaging reveals a perforated bowel. She spends three weeks in intensive care and requires a permanent stoma.
The clinical picture at the first emergency presentation was consistent with bowel obstruction. In a patient with prior abdominal surgery, adhesion-related obstruction is the leading differential diagnosis. An abdominal X-ray is a basic, low-risk investigation that would have confirmed or excluded the diagnosis within minutes. The failure to order it — and the decision to discharge without surgical review — departed from the standard of care in a way that directly caused the patient’s catastrophic outcome.
The three elements of negligence applied to post-surgical adhesions
For a post-surgical adhesion claim to succeed in NSW, three legal elements must all be established. A bad outcome alone is not sufficient. The clinical failure must be connected to the harm through each element of the legal test.
Adhesions forming after a technically well-performed abdominal procedure, where the patient was properly warned of the risk and received appropriate post-operative follow-up — adhesion formation is a known biological response to surgical trauma, not a surgical error.
A patient with prior abdominal surgery presents to an emergency department with classic signs of bowel obstruction. The treating physician discharges her without imaging or surgical review. She returns two days later requiring emergency bowel resection for a perforated, ischaemic bowel.
This is a general educational framework only. Each case depends on its individual facts and circumstances.
Long-term and permanent harm when adhesion care fails
The harm that results from missed or mismanaged post-surgical adhesions is not always immediately visible. It accumulates. Understanding the full harm trajectory is essential to understanding what a compensation claim must account for.
Physical consequences
Chronic adhesion-related pain is the most common long-term consequence of unmanaged adhesions. For many patients, this means daily abdominal pain that limits physical activity, disrupts sleep, and prevents normal function. Recurrent partial bowel obstruction — episodes of severe pain, vomiting, and distension that resolve without surgery but recur unpredictably — is a recognised pattern that significantly impairs quality of life.
At the severe end of the spectrum, complete bowel obstruction requiring emergency surgery may result in bowel resection — the removal of a section of bowel — and in some cases the formation of a stoma, where the bowel is brought to the surface of the abdomen and waste is collected in an external bag. A stoma may be temporary or permanent. For patients who were not warned of this possibility before their original surgery, the psychological impact of a permanent stoma is profound and was entirely foreseeable.
Women who develop pelvic adhesions following gynaecological surgery may experience infertility as a direct consequence. Adhesions can distort the fallopian tubes, prevent ovulation, or create an environment hostile to implantation. For women who had not completed their families at the time of surgery, this consequence — if it was not disclosed as a risk — represents a harm that the law recognises and compensates.
Psychological consequences
The psychological burden of chronic post-surgical pain is well documented. Patients who live with undiagnosed or undertreated adhesion-related pain frequently report anxiety, depression, and a loss of trust in the medical system — particularly when they presented repeatedly and were dismissed. The experience of being told that their pain was normal, or that they were recovering well, when in fact they were developing a serious complication, produces a specific kind of harm: the harm of not being believed.
Post-traumatic stress disorder following emergency surgery for bowel obstruction — particularly where the patient was critically unwell and required intensive care — is a recognised clinical consequence. A patient who underwent emergency bowel resection following a missed obstruction, and who was not warned that this was a possible outcome of their original surgery, carries a psychological injury that is directly traceable to the clinical failures in their care.
Financial and economic consequences
The financial impact of adhesion-related complications is substantial. Repeated hospital admissions, specialist consultations, imaging, and surgical procedures generate direct medical costs. Lost income — from time off work during acute episodes, from chronic pain that limits capacity to work, or from permanent disability following bowel resection — compounds over years. Unpaid carer burden, where a family member reduces their own working hours to provide care, is a recognised head of damage in NSW negligence claims. Home modification costs, where physical limitations require changes to the living environment, are also recoverable.
What compensation covers in NSW
Compensation in a successful medical negligence claim in NSW covers two broad categories of loss: general damages and special damages.
General damages compensate for pain and suffering, loss of enjoyment of life, and loss of amenities — the things the plaintiff can no longer do because of the harm they suffered. Under section 16 of the Civil Liability Act 2002 (NSW), non-economic loss is only compensable if the severity of the harm reaches a statutory threshold — currently assessed as a proportion of a “most extreme case.” This threshold is designed to exclude minor or transient injuries from compensation. Serious adhesion-related harm — permanent stoma formation, chronic debilitating pain, infertility, or catastrophic bowel injury — will typically satisfy this threshold.
Special damages compensate for quantifiable financial losses: past and future medical expenses, past and future lost income, the cost of ongoing care, and any other out-of-pocket losses caused by the negligence.
| Severity of harm | Indicative range (NSW) | Key factors |
|---|---|---|
| Moderate injury with recovery | $50,000–$150,000 | Duration of pain, treatment required, time off work |
| Serious injury with lasting effects | $150,000–$500,000 | Permanent impairment, ongoing treatment, care needs |
| Severe or life-changing injury | $500,000–$2,000,000+ | Catastrophic loss of function, lifetime care, lost earnings |
These figures are general reference ranges only. Each case turns on its own evidence — medical records, expert clinical opinion, and economic reports that quantify the actual loss.
The limitation period for medical negligence claims in NSW is three years under the Limitation Act 1969 (NSW). For post-surgical adhesion cases, this period may run from the date the patient discovered — or ought reasonably to have discovered — that they had suffered harm as a result of a clinician’s failure, rather than from the date of the original surgery. This is a critical point for patients whose adhesion-related harm emerged gradually over months or years after the procedure.
How to think about your own situation
The questions below are not a legal test. They are prompts to help you think clearly about whether your experience may warrant further examination.
These questions are not a legal test. But the pattern they reveal — when several of them point in the same direction — is often the starting point for a proper examination of whether the standard of care was met. The medical records will show what was documented at each presentation. Expert clinical opinion will assess whether that documentation reflects a standard of care that was adequate. The law then applies to the gap between what happened and what should have happened.
For a detailed explanation of how this process works in NSW, see Reframe Legal — How Medical Negligence Claims Work in NSW.
Uncertainty is normal — and it does not mean the law has nothing to say
Most people who experienced what is described in this article feel uncertain about whether what happened to them was negligent. That uncertainty is rational. The clinical picture is genuinely complex. Adhesions are a known risk of surgery. Not every bad outcome is a legal wrong. The line between an acceptable complication and a preventable one is not always obvious from inside the experience.
But uncertainty about whether negligence occurred is not the same as evidence that it did not. Legal analysis does not work from the patient’s level of certainty. It works from objective evidence: the medical records, the clinical guidelines, the expert opinion of a clinician in the same specialty, and the established legal standard. What this particular clinician intended or believed is not the measure. The measure is what a competent peer would have done with the same information.
Many people in this situation waited a long time before seeking any examination of the facts. Some were discouraged by clinicians who told them that complications happen. Others doubted their own memory of events. Still others assumed that because no one had acknowledged a failure, no failure had occurred. None of those things are evidence that the standard of care was met. They are evidence of how difficult it is to navigate a system that rarely volunteers accountability.
The question of whether a clinician’s conduct met the standard is answered by examining the records — not by how certain the patient feels, and not by what the clinician said at the time. For information about the regulatory framework that governs clinician conduct in Australia, see AHPRA — Australian Health Practitioner Regulation Agency.
Where consent is part of the picture — where you were not told about adhesion risk before your surgery — the legal framework for that specific failure is explained at Reframe Legal — Informed Consent and Medical Negligence.
Dr Rosemary Listing is a lawyer with a PhD in law, specialising in medical negligence. Her legal practice concentrates on cases where clinical care in NSW failed to meet the standard the law and the profession require. Her doctoral research and legal practice have given her a rigorous command of the clinical standards against which negligent conduct is measured, and of the evidentiary requirements those claims must satisfy in NSW courts.
Post-surgical adhesion cases present a particular intersection of legal and clinical complexity. The condition is common, the harm is often serious, and the failures that produce it — a consent discussion that omitted a material risk, a GP who attributed escalating symptoms to normal recovery, an emergency physician who discharged a patient with an undiagnosed obstruction — are rarely dramatic. They are quiet failures, spread across multiple clinicians and multiple consultations, which makes them harder to identify and harder to articulate. Understanding where the clinical standard required a different response, and how that departure connects to the harm that followed, requires fluency in both disciplines.
The cases that have reached NSW courts, and the complaints recorded by the Health Care Complaints Commission, reveal a consistent pattern in how post-surgical adhesion failures occur and how they are assessed. That pattern involves a clinician — most often a GP or emergency physician — who encountered a patient with a prior surgical history and escalating abdominal symptoms, and who failed to treat that combination as a clinical red flag requiring investigation. The legal assessment of that failure turns on what a competent peer would have done with the same information at the same decision point.
The people who seek a legal examination of their records after a post-surgical adhesion complication are not looking to blame anyone. They want to understand what happened and whether it could have been different. Many waited a long time before seeking any kind of examination of the facts — often because they were told that complications are a normal part of surgery, or because they doubted their own experience when clinicians offered reassurance that nothing had gone wrong.
Dr Listing examines medical records alongside expert clinical opinion and applies the legal standard — not to assign blame, but to give people an honest answer about whether what happened to them met the benchmark the profession sets for itself. That answer, whatever it is, is what most people are actually seeking.
- Menzies D, Ellis H. Intestinal obstruction from adhesions — how big is the problem? Annals of the Royal College of Surgeons of England. 1990;72(1):60–63. (Widely cited data on adhesion formation rates following abdominal surgery.)
- Australian Institute of Health and Welfare. Admitted Patient Care 2021–22: Australian Hospital Statistics. AIHW, Canberra, 2023. Available at: https://www.aihw.gov.au/
- Rogers v Whitaker (1992) 175 CLR 479 (High Court of Australia). The foundational Australian authority on informed consent in medical negligence.
- Civil Liability Act 2002 (NSW), ss 5B, 5D, 5O, 16. Available at: https://legislation.nsw.gov.au/
- Limitation Act 1969 (NSW), s 50C (latent injury provisions). Available at: https://legislation.nsw.gov.au/
- Dobler v Halverson [2007] NSWCA 335 (NSW Court of Appeal). Authority on GP duty to refer and investigate persistent symptoms.
- Naxakis v Western General Hospital (1999) 197 CLR 269 (High Court of Australia). Authority on causation in medical negligence — material contribution test.
- Royal Australasian College of Surgeons. Surgical Care Standards. RACS, Melbourne. Available at: https://www.surgeons.org/
- Australian Commission on Safety and Quality in Health Care. Australian Charter of Healthcare Rights, 2nd edition. ACSQHC, Sydney, 2019. Available at: https://www.safetyandquality.gov.au/
- Ten Broek RPG, Issa Y, van Santbrink EJP, et al. Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis. BMJ. 2013;347:f5588. (Data on adhesion-related hospital admissions and surgical burden.)
This article contains general legal information only. It does not constitute legal advice, and reading it does not create a lawyer–client relationship. The law discussed applies to New South Wales, Australia. Each person’s circumstances differ. Time limits apply to legal claims in NSW, and these limits may affect your position. You should seek independent legal advice about your specific situation.