Mother left with cauda equina syndrome after MRI scan failures - £800,000 in compensation

“Crystal”, 44

Every aspect of “Crystal’s” life was affected when she suffered a delay in diagnosis of serious spinal condition cauda equina syndrome, but particularly her ability to work, personal relationships, and her mental health. After a case for medical negligence was brought against the hospital responsible by JMW partner and spinal injury specialist Sally Leonards, Crystal was awarded £800,000 in compensation to help her to rebuild her life.

What went wrong?

Crystal had a history of lower back pain for several years before she developed cauda equina syndrome.. When one night she developed pain that was more severe and also affected one of her legs, and found that her bladder was leaking urine, Crystal called NHS 111 for advice. The NHS 11 call handler told Crystal to go straight to A&E and her partner drove her to their local hospital, with the couple arriving in the early hours of the morning. At A&E Crystal was examined by a doctor who diagnosed her with sciatica and sent her home with advice to contact her GP surgery to request an MRI scan appointment.

Over the next few days Crystal’s symptoms persisted and she went to her GP to ask for an MRI scan. The doctor she saw advised Crystal that she needed to wait a week to see if things settled down. Crystal tried to obtain a further GP appointment a few days later because she was in so much pain but was unable to secure one. That same day, Crystal called NHS 111 and was told to return to A&E.

At the hospital, Crystal underwent a full neurological assessment, including checks on how her bladder was functioning. At this point there were no clear red flags of cauda equina syndrome because the leaking of urine was not thought to be caused by a neurological issue. Crystal was discharged back to the care of her GP and the hospital requested an MRI scan for her on a non-urgent basis. Crystal’s GP saw her a few days later and agreed to arrange the MRI scan.

After Crystal’s latest GP appointment her condition worsened and she began to show clear red flags of the start of cauda equina syndrome, including an episode of significant urinary incontinence when she wet herself. The scan took place about two weeks after the referral was made and, on this day, Crystal became aware of other issues with her bladder whereby she was struggling to pass urine when she felt the need to go.

The scan revealed a large disc prolapse near the cauda equina nerves at the base of Crystal’s spine. However, the doctor who reviewed the scan completely missed the substantial disc prolapse that had occurred near the base of Crytal’s spine and was compressing her cauda equina nerves, those that are essential to bladder, bowel, and sexual function, and also sensation and power in the lower limbs and saddle area. Crystal also had symptoms of cauda equina compression in the form of her recent urinary issues. As a result of the doctor’s reporting failures, neither Crystal nor her GP were informed that she was at risk of developing cauda equina syndrome, which would have enabled an urgent referral to hospital to be arranged so that emergency surgery could be carried out.

A short time after the scan, Crystal left the country to go on holiday and when she returned, she found she had received a letter from her GP asking her to make contact. By this point Crystal was experiencing further concerning symptoms regarding her bowel. She found that she had no feeling when passing a bowel movement even though she knew that she was doing so. In addition, when Crystal felt she needed to pass urine that she struggled to do so and that she could only pass small amounts. After reporting these developments to her GP, Crystal was referred for to neurological doctors at hospital for urgent follow up care.

Crystal was seen the next day by a neurosurgeon and admitted to hospital. A day later during the morning ward round she was diagnosed with cauda equina syndrome and surgery to attempt to relieve the pressure on her cauda equina nerves was carried out a couple of hours later.

Sadly, due to the fact that Crystal’s MRI scan was reported incorrectly, too much time had passed before surgery was carried out and, by the time the operation happened, Crystal’s cauda equina nerves were already damaged. As a result of this Crystal made a poor recovery and was left with permanent bowel dysfunction causing her to be incontinent. In addition, Crystal was left with pain and a burning sensation in her right leg and foot that disturbs her sleep nightly. She also has pain in her genital area that makes it very difficult for her to engage in sexual activity. As a direct result of Crystal’s disabilities, she developed anxiety and depression.

JMW’s investigation

Crystal and her partner were concerned that this distressing outcome may have been preventable if surgery had been carried out sooner and contacted JMW for advice. Crystal’s case was taken on by Sally Leonards, a partner in our medical negligence team who has won, and secured compensation on, many cauda equina cases. Sally’s team gathered all Crystal’s medical records and instructed the best independent medical experts working within the field of cauda equina care to give their view.

The experts uncovered the failure of the doctor to recognise the prolapsed disc that was compressing Crystal’s cauda equina nerves. This became a focal point of the case Sally built against the hospital trust. This failure had prevented any action being taken to provide Crystal with emergency surgery and she had been left for almost two weeks whilst her condition deteriorated.

Drawing on this compelling expert evidence and Crystal’s account of what had gone on, Sally wrote to the hospital responsible for the doctor with all the allegations.

Cauda equina compensation awarded

The strength of the case built by Sally enabled her to enter into negotiations with the hospital trust about the level of compensation that Crystal should be awarded. Utilising the expertise of other experts, Sally was able to identify that Crystal required a house on one level adapted for her disabilities and this was factored into her case. It was also clear from the evidence regarding Crystal’s condition and prognosis that she would not be able to work and therefore she required financial assistance to provide her and her family with security. Other items such as therapy, equipment and aids would also be essential for Crystal to manage her condition so these too were factored in.

The final amount agreed by Sally, Crystal and the hospital trust’s legal team was £800,000 to provide Crystal and her family with the financial means to cope with her avoidable disabilities.

Sally Leonards, a partner specialising in cauda equina syndrome cases at JMW who handled Crystal’s case, said: