Philippa Luscombe, partner in the clinical negligence team at Penningtons Manches, has secured an admission of liability from North Middlesex Hospital that it failed to properly assess a patient on two occasions. This led to a delay in diagnosis of cauda equina syndrome, a condition involving spinal discs compressing sensitive nerves that can cause permanent damage if not swiftly treated by surgery.

Our client had a past history of low back pain which recurred in December 2012. Over a few days, his back pain spread down the back of his legs, he had difficulty in fully emptying his bladder, developed numbness in the genital area and suffered abdominal discomfort.

He called the out of hours service which correctly suspected and documented the suspicion of cauda equina and told him that he urgently needed to attend A&E. He was subsequently triaged at the North Middlesex University Hospital A&E where it was noted that he had sciatica, difficulty urinating, pain in the back of his legs and numbness in his buttocks and groin.

The A&E doctor who reviewed him four hours later carried out an abdominal and rectal examination and made a diagnosis of constipation. He noted only 'tightness of the perianal region' but did note that it was 'difficult to pass urine'. The doctor did not carry out any sensory testing, neurological testing, power or reflex testing.

The A&E team referred our client to the surgical team where he repeated his history and symptoms and the surgical doctor carried out an abdominal and rectal examination but did not carry out any testing of our client’s lower limbs, although he noted bilateral limb pain. He was advised that the bowel and bladder problems were likely to be as a result of the painkillers that he was taking and he was later discharged.

On Christmas Day our client was in so much pain that he re-attended A&E reporting the same symptoms. A repeated diagnosis of constipation secondary to opiates was given and he was discharged. Two days later, our client has his planned appointment with his spinal surgeon who arranged an urgent MRI scan which confirmed the presence of cauda equina compression. Our client later underwent surgery.

Our client has been left with problems with his bladder and bowel function and sensation and function in his lower limbs. Having investigated our client’s case, we presented a claim to the hospital that it had failed to recognise the symptoms of potential cauda equina syndrome and to consider this diagnosis and investigate by way of MRI scan and referral to orthopaedic / neurosurgical teams. It also repeatedly failed to carry out a full and proper assessment.

The trust has responded in a timely fashion to admit the allegations of negligence made against it in full and both parties are now proceeding to assess the impact of the delay upon our client and the value of his claim.

Philippa Luscombe commented: “Cauda equina syndrome is a rare but very serious condition which needs urgent diagnosis and surgery to avoid permanent damage. The outcome for those who do not get timely surgery is a range of very disabling and distressing problems.

“Despite there being clear guidance as to the ‘red flag’ symptoms of cauda equina syndrome, we see doctors completely failing to consider it at all or erroneously ruling it out without proper assessment far too often. We currently have nearly 20 cases of clinical negligence involving a delay in diagnosis of cauda equina syndrome.

“For this client, mistakes were made at a number of levels and over a period of time. Although he is appreciative that the trust has made an early admission of negligence in his care, it confirms his concern that his current limitations would have been avoided if people had listened to his description of his symptoms and acted appropriately.”