Blake Lapthorn secures settlement for client in clinical
negligence claim against Queen Elizabeth King's Lynn Hospitals NHS
Trust
Blake Lapthorn's Clinical Negligence team has agreed settlement
of a claim on behalf of Mr H, who sustained significantly
debilitating injuries following spinal surgery in 2007, in the sum
of £400,000.
Mr H had initially contacted Blake Lapthorn, who has
considerable experience in bringing cases of cauda equina syndrome,
in March 2008. The case was complex both in terms of liability and
quantum.
Mr H, who is a roofer and builder by trade, had suffered
intermittent back pain and sciatica since the age of 15. In 2004
due to continuing back pain and numbness over the two outer toes of
his left foot he attended a physiotherapist who referred him to a
consultant orthopaedic surgeon at the Queen Elizabeth hospital in
Kings Lynn. An MRI scan revealed a prolapsed disc, which had
completely obliterated the spinal canal. A microdiscectomy was
performed in June 2005, but was unsuccessful in improving Mr H's
symptoms. Mr H then began to suffer from pins and needles, had
reduced sensation in his penis and he experienced difficulty in
urinating with slow stream. Physiotherapy produced no improvement
and a further MRI scan showed a recurrence of the disc prolapse. He
was listed for a repeat discectomy, which the orthopaedic surgeon
performed on 4 January 2007.
In the days following this operation, whilst Mr H's mobility and
sciatic pain had greatly improved, it was clear that he had
suffered a significant deterioration in his bladder and bowel
function. He required catheterisation, parasthesia over the
perineum, was unable to open his bowels and required an enema. A
further MRI scan revealed a compromise of the cauda equina however
no action was taken by the orthopaedic staff at the hospital to
address the cause of these new symptoms and Mr H was
discharged.
Mr H's symptoms worsened and his GP referred him for further
treatment. Another MRI scan showed further disc problems and his
surgeon recommended further decompressive surgery but due to
concern over failure of the previous surgery Mr H sought a second
opinion. This further opinion advised against additional surgery as
there was no prospect of the residual cauda equina dysfunction
being reversed and a significant risk of it being worsened. Mr H
accepted this advice and having made a formal complaint, sought
legal advice.
Mr H tried a number of treatments to improve his bladder and
bowel symptoms. He had a sacral nerve stimulator and subsequently a
pudendal nerve stimulator fitted to try and deal with his
incontinence. This proved moderately successful in the short term,
but then ceased to be effective. Mr H continues to self-catheterise
with the attendant problems with UTI, and has been placed on the
waiting list for a clam cystoplasty, a major surgical procedure. Mr
H alleged that as a consequence of the failure to recognise and
treat his post-operative complications, he has been left with both
bladder and bowel incontinence, erectile dysfunction and some
residual numbness and weakness in his left leg.
Having obtained and reviewed the medical records, Blake Lapthorn
sought independent expert opinion from a consultant orthopaedic
surgeon, who in turn sought input from a consultant radiologist.
The experts concluded that there had been clear signs of cauda
equina compression caused by an evolving haematoma during the
post-operative period and that these had been missed by Mr H's
treating clinicians. A further supportive report was subsequently
obtained form a consultant neurosurgeon. On the basis of these
reports, Blake Lapthorn sent a letter of claim to the defendant
hospital NHS Trust.
Protective proceedings had to be issued before the letter of
response was received. This denied both breach of duty and
causation. The defendant alleged that the injuries had been caused
during the surgery, which was a recognised and non-negligent
complication of the procedure. It further denied that the
post-operative MRI scan showed a haematoma compressing the thecal
sac.
Accordingly a condition and prognosis report was obtained and
Court proceedings were served. The defendant then filed a formal
defence but also made an early Part 36 offer, which was rejected as
being unrealistically low. In its defence, it was conceded that Mr
H's symptoms of cauda equine syndrome should have been recognised
by 8.00 pm on 7 January 2007 (but no earlier), but the defendant
contended that the cauda equine lesion was already complete by this
time and therefore surgical intervention would have made no
difference in any event.
The medical experts advised that Mr H was not fit to continue
with roofing and building and would most likely not be insurable
due to his condition. Mr H had tried his utmost to continue working
in spite of his injuries, to support his family. However, urinary
incontinence caused practical difficulties when attending private
jobs and in reality, Mr H was not able to carry out anywhere near
as much roofing work as he had prior to his surgery, despite the
improvement in back pain. Mr H was also involved in another
business with family members and put his efforts into this,
although the long-term market for such a business was really
unclear. Mr H's injuries caused him to be easily fatigued and
during Blake Lapthorn's dealings with Mr H and his family, it
became clear that he was suffering symptoms of depression. These
factors in combination meant that Mr H was unable to help around
the home as much as he had done previously and at times required
additional care himself.
Blake Lapthorn sought further reports on condition, prognosis
and quantum from experts in psychiatry, forensic accounting, care
and rehabilitation, colorectal surgery and urology. Mr H's full
schedule of financial loss was calculated to be in the region of
£390,000 plus general damages of a further £70,000 - £80,000.
The case was due to be set down for a seven day trial. However,
in April 2011, shortly before exchange of expert evidence, the
defendant admitted breach of duty in relation to the failure to act
sooner on the signs of cauda equina syndrome and conceded that Mr H
would not have gone on to develop bowel and bladder problems and
erectile dysfunction. A Part 36 offer of £360,000 was made. After a
brief period of further negotiation, settlement was agreed in the
sum of £400,000 plus reasonable costs.
Kym Provan, an associatein the Clinical Negligence team at Blake
Lapthorn who represented Mr H, said: "Mr H was delighted with the
settlement, which will allow him to work within his physical
capabilities, most likely for significantly fewer hours. He is also
now able to plan to undergo surgery for the bladder operation
without the financial worry over a long recovery period. The family
will be able to pay for help around the home where needed so that
they can begin to enjoy their family life together again."
