IN THE MATTER OF
TERENCE HATFIELD Claimant
-v-
WALSALL HOSPITALS NHS TRUST Defendants
Background to Clinical Negligence Claim
The Claimant was the husband of Glenda Hatfield who aged 56 presented at the Accident & Emergency Department of the Defendant hospital on the 4 November 1999 at 18:17 hours. Her presenting complaint was noted as head pain, which she had suffered from 5pm that day. It was noted that she had developed neck and head pain whilst sitting down which had become increasingly worse. She had taken two Paracetamol but with no relief. She felt nauseous but had not vomited. She had no visual disturbance. She indicated that she had had similar episodes some two weeks ago which had spontaneously resolved. It was noted that she had no history of migraine, diabetes, cerebral or vascular accident, myocardial infarction or epilepsy. She was taking no drugs.
On examination, she was noted to be alert and her chest was clear. Neurological examination was normal and her cranial nerves were intact. There was no tenderness over the temporal arteries, her visual fields were satisfactory and she had no neck stiffness. A diagnosis of headache was noted and she was given an intramuscular injection of Ketroprofen (anti-inflammatory analgesic) at 18:30 hours. She was reviewed at 20:24 hours when she was noted to be better. It was noted that her headaches had gone but her blood pressure remained high. She was allowed home but advised to return if she had any problems.
On the 7 November 1999 Mrs Hatfield called her GP's out of hours service at 09:25 hours. She complained of a bad headache and that her back and legs were aching. She had pain up her spine. She was seen by Dr Khan at 09:55 hours who diagnosed back pain.
On the 8 November 1999 Mrs Hatfield attended her GP surgery. He noted that she had pain in the right posterior neck and occiput and no visual problems, vomiting or nausea. On examination he found that she was not anaemic, her pulse was 78 bpm and her blood pressure 190/112. She was found to have a full range of movement of the neck. She was prescribed an anti-hypertensive drug.
On the same day, 8 November 1999, Mrs Hatfield called the out of hours service again at 21:38 hours. She confirmed that she had had head pain since 4 November, her blood pressure was high and she had pain in her neck and temples. She confirmed that she had seen her GP that day but felt no better. She was invited to attend the out of hours centre but had not arrived by 23:51 hours.
On the 9 November 1999 Mrs Hatfield attended the A & E Department by emergency 999 ambulance. She arrived at 05:48 hours. The Triage nurse noted that she had had head pains since the previous Thursday and the pain was now worse.
At 06:25 hours Mrs Hatfield was reviewed by the SHO in Accident & Emergency who noted pain in the neck and back of the head. He noted that the pain had started on Thursday and it had become progressively worse. He noted she was suffering from nausea but no vomiting, visual disturbance or dizzy spells. He noted she had no history of migraine, diabetes, CVA, myocardial infarction or epilepsy. It was noted that she looked unwell but she was alert and orientated. She had a stiff neck but no photophobia. Neurological examination was satisfactory. CVS and fundi were both ticked as normal. Her blood pressure remained high at 180/85. The SHO diagnosed muscular neck pain and prescribed oral analgesics. Mrs Hatfield was discharged.
On the 10 November 1999 Mrs Hatfield was visited by her GP who recorded that the pain was easier, that she had a good range of neck movements, was passing urine frequently but had no thirst or dysuria. He prescribed an antibiotic but presumed she had a urinary infection.
On the 12 November 1999 Mrs Hatfield was again visited by her GP. She complained of noises in the head, which were very dependent on the position of the head. On examination she noted that her eardrums were normal and that there were no nystagmus. Her blood pressure remained high at 180/84. She was prescribed Bendrofluazide in addition to the other drugs she was taking.
On the 14 November 1999 Mrs Hatfield collapsed whilst in the company of her husband. She was brought into hospital by emergency 999 ambulance. The Triage nurse noted that she had a two week history of hypertension headache. On arrival she was completely unresponsive. Her pulse rate was between 50 – 80 bpm and her blood pressure 220/140. She had unequal and unreactive pupils and fundal changes. The clinical impression was of a massive CVA and an urgent CT scan was performed. The scan revealed a massive subarachnoid haemorrhage with intracranial bleeds. Mrs Hatfield died on the 15 November 1999 at 04:35 hours.
The Claimant's Allegations
The Claimant Mr Hatfield alleged negligence in the care afforded to his wife by the Defendant NHS Trust. He initially also sought to proceed against the General Practitioner and the out of hours GP service. He alleged that his wife had died as a result of the Defendant's collective failings.
In relation to the care provided by the NHS Trust, it was alleged that:
1. The Defendant failed to consider a diagnosis of subarachnoid haemorrhage on 4 November 1999 and to refer her to the general physicians or neurologists for further assessment including a CT scan and, if necessary, lumbar puncture. 2. It was further alleged that the Defendant failed to confirm the diagnosis of subarachnoid haemorrhage when Mrs Hatfield re-attended the Accident & Emergency Department on the 9 November 1999 in the presence of a continuing headache and to refer her for further assessment and investigations.
Causation
It was alleged that had the correct diagnosis been made on the 4 or 9 November 1999 then Mrs Hatfield would have been referred to a local neurosurgical unit where neurosurgery could have been performed and she would have had a 90/95% prospect of a full or near full recovery.
Having taken further advice from a General Practitioner expert, it was decided not to proceed further against the GP nor the out of hours service.
The Trust Defendant's Response
The Trust admitted that although Mrs Hatfield did not have the classical features of subarachnoid haemorrhage on 4 November 1999, i.e. no neck stiffness, no cranial nerve deficit and no fundiscopic abnormalities, consideration should have been given to a diagnosis of subarachnoid haemorrhage given her age and the history of the onset of the headaches. The Trust admitted that Mrs Hatfield should have been further investigated to include CT scan and if necessary lumbar puncture.
It was further admitted by the Defendant Trust that when Mrs Hatfield re-attended on the 9 November 1999 again a diagnosis of subarachnoid haemorrhage should have been considered given the previous history and the fact that Mrs Hatfield had by then suffered severe head pain for five days. It was admitted that she should have been referred to the neurologist and had a CT scan and, if necessary, a lumbar puncture should have been performed.
On the issue of causation, the Defendant did not ultimately dispute the Claimant's contentions regarding causation.
The Claimant's Case
In addition to pursuing a claim under the Law Reform Miscellaneous Provisions Act 1934 and Fatal Accidents Act 1976, the Claimant additionally pursued a claim in his own right for damages. The Claimant witnessed the final and sudden collapse of his wife and developed shocking psychiatric injury with consequential loss and damage. He was present when an emergency ambulance arrived to take his wife to hospital and was present on her arrival at the hospital when her condition was critical and attempts were being made to investigate her condition. He had witnessed her rapid and grave decline since attempting to secure investigation and treatment at the hospital on the 4 and 9 November 1999. The shock of these events resulted in the Claimant developing a major depressive disorder and an abnormal bereavement reaction. He did not have symptoms of a post traumatic stress disorder.
The Claimant managed to return to his work as an HGV driver after his wife's death until July 2000 when the impact of his symptoms became intolerable.
The Defendant admitted that the Claimant had suffered an abnormal grief reaction and considered the same abnormal in terms of time rather than severity. No admissions were made regarding the Claimant's inability to return to work or his inability to perform any kind of remunerative employment or that he was handicapped on the labour market.
Negotiations
Following the service of a Defence, the parties entered into detailed negotiations which resulted in global settlement of £150,000 being paid to the Claimant in respect of his own claim and the claim brought by the estate and his loss of dependency. The damages for the Claimant's own pain, suffering and loss of amenity are estimated to be in the region of £15,000. In addition, he claimed damages under the following heads of claim:
Claimant's own action
Past loss of earnings
Interest on past losses
Future loss of earnings
Law Reform Act/Fatal Accidents Act Claim
Bereavement award
Funeral expenses
Claimant's loss of financial dependency
Claimant's loss of services dependency
Regan v Williamson claim
Interest
Expert's instructed
Mr J Wardrope, Consultant in Accident & Emergency Medicine Mr P J Kirkpatrick, Consultant Neurosurgeon Dr N Ineson, General Practitioner
Professor P Maguire, Consultant Psychiatrist
Expert's instructed by the Defendant
Dr D G Goodhead, Consultant Psychiatrist
Solicitor's comment
The Claimant's psychiatric presentation was somewhat unusual insofar as he did not develop symptoms of post traumatic stress disorder as a result of witnessing his wife's collapse. The Claimant was diagnosed as having a major depressive illness with anxiety and an abnormal grief reaction. The Claimant's nominated psychiatrist, Professor Maguire, was satisfied that the Claimant's presentation was attributable to him witnessing the traumatic sudden demise of his wife rather than the fact of her death alone. Professor Maguire expressed the opinion that with an abnormal grief reaction the final images preceding death are often very strong, additionally an abnormal grief reaction can present in the circumstances where the patient considers the death was preventable. The Defendant's nominated psychiatric expert in his report did not address specifically whether or not the Claimant's psychiatric injury was attributable to his witnessing his wife's sudden demise.
Case Report submitted by Eddie Jones, Solicitor for the Claimant, JMW Solicitors.
Counsel for the Claimant, Sally Hatfield, Peel Court Chambers, Manchester.
Solicitor for the Defendant Browne Jacobson, Solicitors, Nottingham.
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