Portsmouth Hospitals NHS Trust has settled a claim for compensation for Derek Crowe, 70, of Liss, arising from negligent management of a urethral catheterisation. This led to unnecessary pain and suffering for a period of at least two years for Mr Crowe, as well as the need for multiple procedures and operations which has resulted in extensive scarring.
On 17 January 2012 Mr Crowe went into urinary retention and was admitted to A&E at the Queen Alexandra Hospital. He underwent traumatic urethral catheterisation which was unsuccessful and resulted in the need for a suprapubic catheter. The suprapubic catheter was eventually removed four months later. In November 2012, Mr Crowe developed a swelling in the suprapubic area at the site of the previous catheter. He was referred to a consultant general surgeon who recommended exploration and repair.
Mr Crowe underwent exploration on 20 December 2012 and an abscess was found during surgery. On removing this, a small channel of pus was discovered. The wound continued to discharge pus and serous fluid. Further investigations showed a retropubic collection, which was thought to be the leftover from his suprapubic catheter, and an infected hernia mesh. Mr Crowe underwent washout and flushing of the wound on 14 March 2013 and further surgical exploration on 18 April 2013. The abdominal sinus was found to lead through to the previous suprapubic catheter tract into a retropubic abscess containing the medial portion of his old hernia mesh. The infected mesh was excised.
These events have had a significant detrimental effect on Mr Crowe’s quality of life and functioning over the period in question. Various holidays and social events were ruined. Although the wound has now healed and there are no signs of recurrent abscess formation, Mr Crowe continues to experience intermittent suprapubic discomfort, which is aggravated when doing anything strenuous, stretching or standing from a seated position. As a result of the surgeries, Mr Crowe has extensive scarring on his lower abdomen. This creates an irregular contour deformity of which he is deeply self-conscious.
Mr Crowe initially made a complaint to Portsmouth Hospitals NHS Trust and, having investigated the situation, it was admitted by the NHS Litigation Authority (NHSLA), on behalf of the Trust, that the urethral catheterisation had been performed negligently by the nurse in A&E. Mr Crowe was offered £5,000 by way of compensation.
Although grateful for the recognition, Mr Crowe was concerned that the NHSLA had not taken into consideration the problems that he had encountered afterwards and the full extent of the injuries resulting from the admitted negligence. He broached this issue with the NHSLA which advised him to seek advice from a specialist firm of solicitors.
Mr Crowe approached the clinical negligence team at Penningtons Manches LLP which, on review of the papers, advised him that they considered the claim to be worth more than £5,000. The team obtained independent expert evidence on the extent of the injuries from a consultant urologist. His evidence was that the suprapubic catheter had only been needed because the urethral catheterisation had been botched. The suprapubic catheter was colonised with bacteria and, given the proximity, the hernia mesh became exposed to these bacteria which then multiplied, leading to infection of the mesh and development of an abscess.
As a result, Mr Crowe had to undergo multiple operative procedures, including drainage of abscesses, partial removal of the mesh and then a complete removal of the mesh in a series of operations, as well as prolonged wound care and antibiotic treatment.
This evidence was presented to the NHSLA and, at the same time, Mr Crowe made an offer to settle his claim for £75,000. The NHSLA responded saying that it was not in a position to accept the offer until it had obtained its own evidence. Matters were delayed by the NHSLA which then failed to provide a formal response within the Pre-Action Protocol period or at all. It was unwilling to engage in negotiations and attempt to resolve the claim.
It became necessary to issue court proceedings against the trust, following which the NHSLA delayed things further and requested an extension of time to provide the defence. In the defence it was confirmed that the catheterisation had been performed negligently but it was silent on the injuries caused as a result. Mr Crowe was therefore no further forward than 12 months before.
Penningtons Manches made an application to the court that the NHSLA and the trust set out their case so that there could be meaningful discussions to bring the claim to a conclusion. There were further delays while the NHSLA obtained independent expert evidence which should have been requested at the start of the claim. It finally admitted the extent of the injury as set out in the initial letter to the trust and settlement negotiations were entered into. These were protracted as the trust’s solicitors delayed in responding to offers made on behalf of Mr Crowe. Settlement was eventually agreed at £64,850.
Elise Bevan, the Penningtons Manches lawyer handling the case, said: “This was a relatively straightforward claim made unnecessarily complicated by the Portsmouth Hospitals NHS Trust and the NHSLA. Mr Crowe rightly explored the complaints procedure initially and attempted to resolve things that way. However, he found that the NHSLA failed to appreciate what had happened and were reluctant to consider what he had to say.
“As it was clear at the outset that the case was worth more than £5,000 and that Mr Crowe had hit a brick wall with the NHSLA, we agreed to act for him. We managed to investigate the claim relatively quickly, presented the case to the trust and made a sensible offer at the same time. There was then a period of frustrating delays caused by the trust and the NHSLA as they failed to get to grips with this case. As they did not respond to the Pre-action Protocol Letter of Claim, we had to issue court proceedings.
“The solicitors acting on behalf of the trust were no better. They created further delays by obtaining additional expert evidence that was neither required nor necessary. They made an opening offer to settle the claim for £45,000 which, given the evidence that we had provided in support of Mr Crowe’s losses, was completely off the mark. After painfully slow negotiations, we finally managed to achieve a good outcome for Mr Crowe.
“The way this claim was dealt with by and on behalf of the trust is disheartening. The conduct caused unnecessary frustration and expenditure, ultimately to the NHSLA. As claimant solicitors we make real efforts to keep costs to a minimum and it is often due to the defendants and their representatives that the costs escalate and these claims take so long to resolve.”