Cauda Equina Syndrome - negligent treatment
EG
And
THE UNIVERSITY HOSPITALS OF COVENTRY & WARWICKSHIRE
Background to the Claim
62 year old EG had a long history of lower back pain and right sided sciatica. In 1999 she underwent fenestration of L5-S1 and sub-articular decompression of the S1 root, which initially appeared to be successful. However, in 2002 her pain returned and, despite a number of facet joint injections, things did not improve.
In October 2002 an MRI scan showed "marked diffuse degenerative changes and spinal stenosis particularly at L4/5 with related spondylolisthesis".Another facet joint injection was tried, but with limited success.
By the spring of 2003 it was clear that further surgery would be needed to control the pain and EG was keen to proceed as she was becoming significantly disabled and depressed by her condition. She was placed on the non urgent waiting list by her surgeon (Mr S)
On 4 March 2004 EG was admitted to hospital and consented to "instrumented fusion L4 - S1 + L4/L5 nerve root decompression". Consent was obtained by Mr N, a locum spinal surgeon, who EG had not previously met. Mr N claims that he discussed the planned operation with EG in some detail and warned of possible risks and complications, but this is not documented. EG remembers nothing of the consenting procedure and it is unclear whether she signed the consent form before or after administration of the pre-medication (Temazepan)
Mr N performed the operation as planned but it lasted for almost 6 hours, several hours longer than would normally be expected for this type of surgery. There was also excessive blood loss of 1,800 mls, and EG was admitted to ICU until her condition stabilised.
Immediately post operatively EG appeared to be doing quite well and Mr N was satisfied with her progress. She was having some hesitancy passing urine, and required catheterisation at one point, but this was put down to a urinary tract infection. At no time did she have a neurological examination and she was discharged after 2 weeks.
At outpatient follow up in July 2004 a very satisfactory picture was painted by Mr N, but her GP reported frequent and increasing urinary tract infections ever since the operation as well as some right sided vulval numbness.
The urinary problems continued and in January 2005 her GP referred EG to a urologist. Tests revealed a severe degree of bladder dysfunction almost certainly due to cauda equina damage at the time of surgery. Perineal numbness was also increasing
Particulars of Injury
EG is now considerably worse off than before the surgery as she now suffers from bladder dysfunction as well as chronic back pain and she is under the care of a pain specialist. She is incontinent of urine at night and has to self catheterise 3 times a day in order to completely empty her bladder. She suffers from frequent urinary tract infections as well as chronic constipation and has no perineal sensation.
She has very little flexion in her lumbar spine which, together with the pain, considerably restricts her activities. No improvement is anticipated and her degree of her disability is likely to increase in later life.
Case for the Claimant
EG claimed that the consenting procedure was inadequate and had she been aware of the seriousness of the operation and the fact that it was intended to insert metalwork into her spine she would not have consented at that time. She would have taken further advice from her usual consultant and discussed the risks with her partner
She also claimed that the surgery was conducted incompetently by Mr N and that the compression of the sacral nerves and the resulting cauda equine syndrome were a direct result of this incompetence.
EG believed that the excessive length of the operation and the unusually large blood loss supported her view that the surgery was conducted incompetently, and also that Mr N was not sufficiently experienced to undertake an operation of this complexity.
Case for the Defendant
Mr N claimed that the nature and the risks of the operation were fully explained to EG during the consent procedure.
He denied any inexperience or incompetence during the surgical procedure although in a letter to the GP in January 2005 he states - "significant problem with initiating urination and some numbness around her perineum. Probably the result of some nerve root damage of the cauda equina with the decompression".
Court Proceedings
Following the issuing of proceedings in November 2007 the defence vigorously denied liability.
The court ordered an exchange of of witness statements by 27 February 2009 but the defendants requested that this be deferred until 13 May 2009. The parties agreed to jointly instruct experts in urology and pain management for condition and prognosis purposes.
The court ordered an exchange of expert evidence on the issues of breach of duty and causation by 28 April 2009 but this did not take place as witness statements had not yet been exchanged.
Rather unexpectedly, on 29 April 2009, the defendants made a part 36 offer of £150,000 which was accepted by the claimant. Benefits were £6,694 leaving a net balance of £143,306.
The case was funded under a Conditional Fee Arrangement.
Legal Representatives
For the claimant
Sue Taylor
JMW Solicitors
1, Byrom Place
Manchester
M3 3HG
For the defendant
Bevan Brittan
DX707297
BIRMINGHAM 65
