The Penningtons Manches clinical negligence team has won damages of £35,000 from Ashford and St Peter's Hospitals NHS Foundation Trust following a surgical error on a client’s shoulder. 

The client was 18 years old when she first saw her GP in 2009 with problems with her right arm circulation and pain in her right shoulder. She was diagnosed with Raynaud’s phenomenon, a common condition that affects the blood supply to some parts of the body. She was referred for an X-ray that confirmed the presence of a cervical rib together with thoracic outlet syndrome, a condition caused by nerves and blood vessels becoming compressed by a lack of space between the base of the neck and the armpit.

Our client required surgery, which was performed at St Peter’s Hospital, Chertsey on 1 July 2010. The cervical rib was removed but our client developed a swelling in her neck and a new case of white finger following surgery. Over the next couple of months, our client’s circulation continued to get worse. She was started on thrombolytic therapy and put on Warfarin, an anticoagulant used to thin the blood. Our client’s condition did not improve and she developed aching pain in her right arm. She was referred to the Royal Devon and Exeter Hospital, where a revision operation was performed. This involved taking a vein graft from her left leg. During the procedure, the surgeon noticed a 15mm subclavian aneurysm and a sling of muscle tissue encircling the artery, which he released. Our client recovered well following the second operation. 

The clinical negligence team obtained supportive evidence from a consultant vascular surgeon to investigate whether the original operation had been performed to an acceptable standard. He was critical that the sling of muscle tissue encircling the subclavian artery, which was thought to be the cause of our client’s problems, had not been released during the initial surgery. Our expert said that the sling of muscle would have been very close to the cervical rib at the time it was removed. It would have been identifiable by the surgeon and should have been released. 

Penningtons Manches submitted a letter of claim to the defendant trust which admitted that the subclavian artery should have been released during the initial surgery and that our client’s complications had been caused because it had not. 

Our expert examined our client and noted that the complications she experienced after the initial surgery had caused her to experience problems with repetitive movements. This affected her social life and studies. She had to give up swimming and suffered a loss of confidence. 

Based on our expert’s evidence, we made an offer to settle our client’s claim which was not accepted by the defendant trust. Court proceedings to protect our client’s position were then issued towards the end of 2014. This did not encourage settlement with the defendant trust and, in early 2015, we served court proceedings on the trust. Another offer to settle was submitted and, after some further negotiation, the NHSLA accepted a well-placed offer of £35,000. 

Elise Bevan, senior associate in the Penningtons Manches clinical negligence team, who ran the case, said: “This was a very technically complex clinical negligence case in terms of the nature of the surgery performed and mechanism of injury sustained by our client who had suffered considerably since the surgery. While the trust was open and sensible in making an early admission of liability, it was frustrating that, despite providing them with considerable evidence as to the basis of our client’s case and our valuation, we had to incur all the costs of initiating litigation before it would enter negotiations based on that evidence. This not only delayed recovery of damages for our client but also significantly increased the legal costs payable by the NHS on both sides. This case is an example where an early sensible approach to litigation and cost-saving was not maintained by the trust and its respresentatives.”