GRAHAM GREENFIELD
(Executor of the Estate of CAROLE GREENFIELD)
Claimant
-v-
BROMLEY HOSPITALS NHS TRUST
Defendant
CASE REPORT – SETTLEMENT
Background to the claim
The deceased was born on 19th September 1944. She was married to Brian Greenfield who died in July 2002. She had two children, Graham Greenfield who was born on 2nd January 1965 and Maria Rogers who was born on 12th July 1972. Neither Graham Greenfield nor Maria Rogers were dependent on their mother at the time of her death.
The deceased had a history of Crohn's disease. In January 1986 she had undergone a right colectomy. In August 1987 she had a recurrence of her Crohn's disease in the distal small bowel which was managed by medication. However by June 2000 it was noted that there was a recurrent Crohn's mass in the right iliac fossa and it was decided to proceed to resection of the bowel.
On 27th July 2000 the deceased underwent excision of recurrent Crohn's mass with anastomosis between the ileum and descending colon at Bromley Hospital performed by Mr El Hasani. The findings at operation were unremarkable. Minor adhesions were noted from the previous operation. No difficulties were described in the performance of the procedure by Mr El Hasani.
On the first post operative day the deceased's observations were stable with good urine output. She remained nil by mouth.
On 30th July 2000 the deceased was transferred to St Thomas's Hospital as an emergency with an acutely ischaemic upper limb. The same day she underwent an embolectomy.
On 7th August 2000 the deceased underwent a CT scan which indicated a massive abdominal collection. On 8th August 2000 the deceased underwent a laparotomy. The operation note recorded the presence of "faecal peritonitis +++" which was secondary to a perforation of the terminal ileum 20cm proximal to the anastomosis. It was noted that the perforation was at the site of a Vicryl suture. The operator presumed that at the previous operation on 27th July 2000 a hole had been made at the site which had been closed with the Vicryl suture.
Post operatively the deceased had a difficult recovery. She underwent a tracheostomy on 14th August 2000. She was subsequently discharged back to the intensive care unit at Bromley Hospital on 30th August 2000.
On 27th September 2000 the deceased was found to be unresponsive and unconscious. She was resuscitated. On 2nd November 2000 the deceased again required resuscitation and was transferred to the HDU. On 4th November the deceased had a further respiratory arrest. On the 13th November she had a cardiac arrest. She had CPR was intubated and ventilated.
On 27th December 2000 the deceased was discharged from the ITU back to the ward. On 1st February 2001 she had a PEG inserted.
On 19th April 2001 the tracheostomy was removed and the following day she was transferred to the Adult Rehabilitation Unit at Orpington Hospital. On 16th May 2001 she was seen by a psychiatrist who formed the impression that the deceased had suffered some cognitive deficit.
On 9th July 2001 she was discharged from hospital after a period of 347 days.
On 7th March 2002 her PEG feed was stopped and on 2nd September 2002 the gastrostomy removed.
On 21st May 2003 a CT scan revealed two areas of damage to the deceased's brain thought to be likely to be due to infarct. She was subsequently referred to the Community Psychiatric Nursing Service and a Consultant Psychiatrist.
On 8th October 2003 she was admitted to Lewisham Hospital with increasing shortness of breath and collapse. On 12th December 2003 she had a sudden decline and was unresponsive. Cause of death was given as bronchopneumonia.
The allegations of negligence
The Claimant contended that the Defendant was negligent in respect of the care afforded to the deceased whilst a patient at Bromley Hospital. In particular:-
- It was alleged that the operation performed on 27th July 2000 for the excision of the recurrent Crohn's disease mass was performed negligently. In particular the bowel was perforated at a site some 20cm from the anastomosis. This was either not noted at the time of the operation and only discovered upon re-operation at St Thomas's Hospital on 8th August 2000, or in the alternative the perforation was noted and insufficiently repaired.
- It was alleged that the placement of the central line in the right subclavian artery represented a standard of care below the requisite standard. This resulted in ischaemia and damage to the deceased's fingers.
- It will be alleged that the subsequent misplacement of a naso-gastric tube led to the deceased suffering a respiratory and cardiac arrest thus causing brain damage.
Causation
As a result of the perforation to the deceased's bowel she development peritonitis and septicaemia. In turn this resulted in her subsequent respiratory arrests and cognitive deficit.
The Defendant's Position
The Defendants maintained a denial of liability whilst at the same time made an early Part 36 offer of £50,000.00 plus costs in full and final settlement. This was rejected by the Claimant. After further negotiations the matter was concluded in the sum of £90,000.00 plus costs.
The damages were approximately as follows:-
Law Reform Miscellaneous Provisions Act 1934 Claim.
- Pre death pain and suffering - £24,000.00.
- Loss of earnings - £12,000.00.
- Gratuitous care - £40,000.00.
- Travel - £5,000.00.
- Miscellaneous aids and equipment - £7,000.00.
- Funeral costs - £2,000.00.
Case submitted for publication by Eddie Jones, JMW, Solicitors, Solicitor for the Claimant.
Solicitor for the Claimant, Kennedys.
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