Cauda Equina Syndrome - clinical negligence

PL

 

v

 

Dr C

 

Background to the Claim

 

PL had a long history of lower back pain and in 1991, when he was 35 years old, he underwent a laminectomy for removal of a prolapsed intervertebral disc. This was only partially successful and he continued to suffer episodic lower back pain.

 

In December 2005 PL consulted his GP (Dr C) with a particularly severe recurrence of the back pain  associated with right sided sciatica. Dr C referred him for an MRI scan, which was performed on 13 January 2006. Her referral letter stated -

"Right sided sciatica with pain/signs in L5/S1 distribution. 3 weeks acute pain and immobility. Diagnosis - nerve root compression"

 

Both the back pain and the sciatica got steadily worse and on 18 January 2006 PL consulted Dr C by telephone as he felt unable to attend the surgery. He was reassured.

 

Six days later (24 January) PL noticed a worrying alteration in his symptoms. The sciatica was now also on the left side associated with a degree of numbness in the leg. He again telephoned Dr C who made the following note -

"Has numbness down left leg now and says he is passing urine/moving bowels. However says he feels he cannot pass urine sometimes. Not incontinent. Pain on right side diminished a bit. Resting at home. Methocarbamol made him feel terrible so only took 2 doses. Says taking slightly less Buprenorpphine now. Waiting for scan - to find out how long it will be. SOS. If worse may need urgent referral to exclude cauda equina."

 

PL's condition continued to deteriorate and by 2 February 2006 he was finding it difficult to control his bladder and to open his bowels. He claims that he contacted Dr C by telephone on the same day and again 4 days later (6 February 2006) and on both occasions informed her of these

developments.

 

On 8 February 2006 PL found he could not pass urine at all. He contacted the out of hours deputising service and an ambulance was arranged to take him straight to the local hospital.

 

On admission he was immediately transferred to the regional neurosurgical unit where cauda equina compression was diagnosed. He underwent spinal surgery the following day where a large sequestered intervertebral disc was removed.

 

Following surgery the back pain improved but PL was left with permanent neurological damage. He was unable to pass urine normally and had to regularly self catheterise to empty his bladder. He also had difficulty opening his bowels and had no control over passing flatus. He had very little penile sensation and also complained of numbness in both legs and feet, although his mobility was not impaired.

 

Case for the Claimant

 

PL alleged that the care he received from Dr C was negligent in failing to suspect as early as 24 January 2006 that he was suffering from cauda equina syndrome and arranging an immediate admission to hospital. It is also alleged that further opportunities for an urgent referral were missed on 2 and 6 February 2006 when he telephoned Dr C describing his symptoms. It is PL's claim that had he been referred to hospital on any of these 3 dates, or in fact any time prior to 8 February 2006 he would have had his prolapsed disc removed before it caused permanent nerological damage and, on the balance of probabilities, would have made a full recovery.

 

Case for the Defendant

 

Dr C denied liability and asserted that in respect of the 24 January 2006 telephone consultation the symptoms described by the claimant did not mandate hospital referral, and that the treatment and advice provided by her was in accordance with a responsible body of GP opinion. There was a dispute of fact as to whether the telephone conversations that allegedly occurred on 2 and 6 February 2006 actually happened as there is no recorded evidence of either call.

 

Court Proceedings

 

Proceedings were issued, expert medical evidence obtained and a settlement meeting arranged. No settlement could be arrived at during this meeting but thereafter the defendant improved its offer and the case concluded with PL recovering damages of £355,000. This included damages for pain and suffering and loss of amenity, past and future loss of earnings, limited past care and an element of care of the claimant in older age.

 

Legal Representatives

 

For the Claimant

 

Eddie Jones

JMW Solicitors LLP

 1,Byrom Place

Spinningfields

Manchester

M3 3HG

 

For the Defendant

Halliwells LLP

Manchester