Penningtons Manches’ clinical negligence specialists have concluded a claim for a woman in her fifties who suffered permanent disability as a result of delays in the diagnosis and management of cauda equina syndrome (CES) between two hospitals.

The team was instructed following a personal recommendation to the claimant who was suffering from various problems as a result of her CES including bladder, bowel and sexual dysfunction, impaired mobility and depression - all of which were having a significant impact on her day to day life and left her unable to work. She initially developed severe low back pain and, after seeking advice from her GP, underwent X-rays which showed no underlying cause. Over the next few weeks the pain began to radiate into her left leg down to her foot causing a sensation of pins and needles. She was then referred to North Hampshire Hospital to see a consultant but did not receive an appointment and her condition deteriorated further. She contacted her GP again who expressed frustration at the lack of contact from the hospital and chased the matter up. However an appointment was still not forthcoming.

While still awaiting her appointment from the orthopaedic team, the claimant woke one morning to find that she was not able to urinate. She was given an urgent appointment by her GP as soon as the surgery opened and advised to go straight to A&E with a referral letter. Her GP also called the orthopaedic department and advised of her concerns in relation to CES but was told to send the claimant to A&E.

The claimant arrived at the A&E department of North Hampshire Hospital at 9.15am but was not seen until 12 noon and was subsequently sent for an MRI scan at 3.00pm. Early that evening, she was told that the MRI showed that a disc in her lower spine had prolapsed into her spinal cord and surgery would need to be carried out at Southampton University Hospital. This took place at 8.00am the following day and it became apparent afterwards that the claimant had been left with significant disabilities.

The hospitals involved and the GP surgery were informed of a potential claim. Expert evidence was obtained that was supportive of a breach of duty; although the claimant attended A&E showing ‘red flag’ signs of CES and with a note from her GP requesting urgent assessment by the orthopaedic team, there was a negligent delay in seeing her. There were also delays on the part of the neurosurgical team at Southampton. Letters of claim were drawn up and submitted to both defendants, setting out the allegations against them. It was alleged that they had failed to appreciate the severity of the claimant’s symptoms and failed to act with the required urgency CES requires.

The NHSLA indicated that it would be representing both defendants and provided a formal reply denying liability and maintaining that there had been no undue delay. Even if surgery had been carried out sooner, the claimant’s outcome would have remained the same. In light of their stance, court proceedings were issued by the Penningtons Manches team against both defendants. The matter proceeded through a court timetable with both parties obtaining and serving witness and expert evidence on various aspects of the case.

Following exchange of the key reports on liability and causation, the defendants admitted that there had been some unacceptable delay by the A&E team, although not to the extent alleged by the claimant. No admission was made on causation and the defendants invited the claimant to discontinue her case.

Once the steps in the court timetable had been completed, including expert meetings, the defendants canvassed the possibility of a joint settlement meeting. After a long day of negotiations, the defendants agreed to pay the claimant a substantial six figure sum in settlement of her claim.

Philippa Luscombe, partner in the clinical negligence team at Penningtons Manches LLP, commented: “While cauda equina syndrome (where a disc in the spine prolapses into the spinal cord causing progressive permanent damage to the sensitive ‘cauda equina’ nerve) is a relatively rare condition, it is a surgical emergency because of its progressive nature and the permanent, debilitating damage it can cause if untreated. Medical practitioners should be alert to the ‘red flag’ signs of this condition and act with appropriate urgency. Sadly, only too often, they fail to either listen to the patient and/or sufficiently consider their history, focusing only on back pain. The consequences of these failings are usually very serious with most patients being left with significant issues with bladder, bowel and sexual function.

“It is frustrating to see the same errors occur in many cases. In this claim, the two hospitals denied liability until almost the last stage in the case and then paid out a substantial settlement. One can’t help but wonder whether the huge sums involved in defending the case would have been better spent apologising to the claimant and offering an early settlement as well as investing in training to prevent similar failures.”