Category Archives: Case studies

Breast Cancer – the importance of “the triple assessment”

In 2009 Mrs L was referred to hospital by her GP under the urgent 2-week rule after finding a lump in her breast.  She was seen by a Surgeon and underwent an ultrasound scan and a mammogram.  She was diagnosed with a simple skin cyst which did not require treatment.

Over 2 years later the lump was larger and painful.  This time in addition to scanning and clinical examination, she was offered a needle biopsy in order to get a tissue diagnosis.  Sadly, this confirmed that Mrs L was suffering from invasive breast cancer and the lump being investigated was the same lump she had been assured was not cancer 2 years earlier.

Mrs L underwent breast conserving surgery and axillary node sampling which revealed that the cancer had metastasised i.e. spread to her lymph nodes.  As a result, she then needed 6 cycles of chemotherapy and additional radiotherapy  The chemotherapy made Mrs L extremely ill.  She suffered alopecia, stomatitis, constipation, nausea, tiredness and musculoskeletal discomfort.  She was left extremely anxious and the additional treatment she required has left her with a life long increased risk of developing other debilitating and unpleasant conditions.

Mrs L made an excellent recovery and was able to return to work despite the setbacks and she instructed Armstrong Foulkes to investigate whether the treatment she had received was acceptable.

Independent expert evidence was gathered from a Radiologist, a Breast Surgeon and a Clinical Oncologist.  On the basis of their expert opinion, a claim was brought for 2 reasons:

a)            The ultrasound scan in 2009 had been reported incorrectly, and

b)            Mrs L should have been offered a needle biopsy in 2009.  Together with the other investigations – radiological and clinical, a needle biopsy would have formed what is known as “the triple assessment”.

With the triple assessment in 2009, Mrs L’s cancer would have been diagnosed 28 months earlier.  She would have avoided the cancer metastasising and she would have avoided having any chemotherapy at all and  would have only needed radiology to breast and avoided having the area above her collarbone irradiated.

The NHS Litigation Authority acting for the Trust denied any wrongdoing and Mrs L had no alternative but to start court proceedings.  Shortly after, the Defendant opted not to continue to defend the claim and they made an offer in settlement.   After some negotiations, Mrs L accepted a reasonable offer in full and final settlement of her claim.

Ashleigh Holt – June 2015

Hospital fails to learn from its mistakes

In 2007 Mr L developed pressure sores on both of his heels during a stay in hospital due to him not receiving an appropriate pressure relieving mattress. He instructed us to bring a claim on his behalf and as a result we were successful in recovering a significant amount of compensation.

Although Mr L’s wounds eventually healed he was required to follow a rigorous foot care regime in order to stop further sores developing, due to the increased vulnerability identified by our plastic surgeon.

In 2012 Mr L was readmitted to the same hospital. Mr L had diligently maintained his skin care regime and as a result had suffered no further pressure injuries to his heels. Despite being injury free for around 4 years after only two weeks in the hospital it was noticed that pressure sores had been allowed to develop on both of Mr L’s heels. When his notes were consulted it was quickly apparent that the nursing staff had failed to follow the required skin care regime for the entire time Mr L had been admitted.

Around a month after these second pressure wounds developed Mr L was told that he had contracted MRSA, with the infection having entered his body through the new sores on his heels. As a result he was again admitted to hospital and started on a course of very strong antibiotics with some very unpleasant side effects.

Unfortunately Mr L passed away shortly after this admission for reasons unrelated to the MRSA or his pressure injuries. After his death Mr L’s wife instructed us to bring a claim against the hospital for the suffering her husband had experienced before his death as a result of the pressure sores.

After investigating the claim we formally put our allegations of negligence to the hospital. The hospital admitted that they had been at fault but denied that Mr L’s MRSA was a result of the pressure injury. A very low offer of compensation was made. This was not accepted and as no further appropriate offers were made we issued court proceedings. Shortly after the issue of proceedings, and following further negotiations with the hospital, the case finally settled at an appropriate amount.

This was a very unfortunate case of a man repeatedly let down by the same hospital, and suffering entirely preventable injuries as a result. It is hoped that following Mr L’s second admission better procedures have been put in place at the hospital to minimise the risk of these preventable pressure injuries occurring in the future.

Dan Richardson, April 2015

Mother unable to have more children because of hospital’s mistake!

Mrs M was pregnant and as a result of a previous miscarriage, was monitored regularly throughout her pregnancy. She attended hospital at 29 weeks’ gestation for a routine scan. This showed that her baby’s movements were reduced which was of concern. She was given steroids and was advised to return for review the following day. Unfortunately, it was overlooked that she had raised blood pressure and a significant amount of protein in her urine (proteinuria), both of which are indicative of pre-eclampsia which is a dangerous condition for both mother and baby.

She returned to hospital the next day when it was noted that her baby’s movements had improved. Again, her raised blood pressure and proteinuria were overlooked. She was sent home and the plan was to review her in a few days’ time.

The following evening, Mrs M began to feel unwell and struggled to breathe. She was taken to hospital where she underwent an emergency caesarean section when it was discovered she had a large placental abruption. This is where the placenta comes away from the uterus before the baby is born resulting in internal bleeding. It can also cause harm to the baby if it is deprived of oxygen and nutrients as a result. Fortunately, Mrs M’s son was healthy but she had a more stormy time. She required a further operation shortly after the caesarean section because of ongoing bleeding, admission to intensive care, she developed abnormal renal function and pulmonary oedema and needed a blood transfusion. She was discharged home after 9 days and then advised at a follow up appointment that she should not risk a future pregnancy because of the damage it could do to her kidneys. This was upsetting to both her and her husband as although they have 2 sons, they would have liked a third child. However, they followed the advice given and her husband underwent a vasectomy.

The hospital admitted early on that it was substandard that they failed to diagnose the pre-eclampsia when she first attended hospital. They also accepted that had they acted upon the raised blood pressure and proteinuria, she would have been admitted that day and had the caesarean section before the placenta came away from the lining of the uterus. The claim settled shortly after court proceedings were issued for the sum of £30,000.

Kathryn Watson – November 2014

What’s in the box?

For many years Miss S had suffered with hay fever and had a repeat prescription for Cetirizine 10mgs, an antihistamine.  Her GP issued a repeat prescription and she collected this from her pharmacy and started to use it the next day.

The medication was in the same packaging as normal and had the label for Cetirizine 10mgs on the box along with her details.  A few days after starting to take this medication Miss S began to feel unwell and her face became swollen.  Miss S developed a rash all over her body and face which was very itchy and painful. The rash to her face would also bleed causing scarring.

After about 5 days Miss S checked the medication she had been taking and she discovered that the tablets inside the box were in fact Citalopram 10mgs which is an antidepressant.  When she raised this with the pharmacy she was told these tablets were meant to have been given to a 90 year old patient with dementia!

We often receive enquiries where somebody has been prescribed the wrong medication or given somebody else’s prescription by mistake.  If this is spotted early enough and you are fortunate enough not to take the medication then there is no claim in law as it is not enough to simply show that something has gone wrong.  You also need to prove it caused you some injury and loss.

Unfortunately for Miss S as the box and all of the packaging/labelling indicated it was her normal prescription she took the tablets for a number of days and therefore did suffer an allergic reaction as a result of the mis-prescription.

Miss S received an apology from the pharmacy and a settlement to compensate her for the allergic reaction and the period of infection, rashes, itching and facial scarring which she suffered.

Andrew Walker – October 2014

Prostate cancer diagnosis delayed by 5 years

Mr P was originally seen by a Practice Nurse at his GP surgery in 2005 for a general check-up and advice on his lifestyle.  During the appointment he had blood taken for analysis which included PSA testing for the early signs of prostate cancer.

The PSA level was found to be almost 4 times higher than the normal range and when checked again several months later it was still very much outside of the normal range but his GP failed to make any referral or arrange a further review having advised Mr P that the results were quite unreliable and could have been caused by other things such as riding a bike.

In June 2010 Mr P saw his GP complaining of passing blood in his urine.  A PSA check at this time found his level had rocketed and he was referred urgently to a urologist who made a diagnosis of cancer of the prostate and commenced Mr P on treatment.  Sadly it became apparent that the delay in diagnosis had allowed the cancer to progress and as a result Mr P’s life expectancy was significantly shortened.

Mr P’s GP quickly accepted that he had failed his patient in not referring him to a urologist in 2005 and that a diagnosis at this time would have afforded Mr P a better outcome and prognosis.

Court proceedings were issued and because Mr P chose to settle his claim in his lifetime rather than leave it to his widow to deal with, the main dispute between the parties was about how to deal with Mr P’s “lost years claim”.  A claim for lost years arises when a claimant is denied the opportunity to earn an income as result of their life being shortened due to the Defendant’s negligence.  Mr P eventually accepted £190,000 in full and final settlement of his claim.

Ashleigh Holt – August 2014

Injection injury denies student dream career

This was a nerve injury case which went to trial. The Claimant was awarded £94,386 which was made up of PSLA (£16,000), past loss of earnings (£32,500), future loss of earnings (£40,000), miscellaneous (£675) and interest of £5,211.

Peter was 17 and studying for his ‘A’ levels when he had a sudden onset of stomach pain. His mother took him to an out-of-hours GP surgery where a diagnosis of suspected appendicitis was made. Peter was in pain so the GP gave him a pain relieving injection into his left thigh. He was then taken to hospital and had surgery to remove his appendix.

When he recovered from his surgery he discovered that he had numbness in his left leg just below the knee and into the foot – a “drop foot” injury. This usually occurs when there is some damage to the peroneal nerve which runs all the way down the leg. The only time when this could have happened was when the GP gave him the pain killing injection into his thigh.

He and his mother were not going to do anything about this until they were advised by the Neurologist at hospital that they should go see a Solicitor. In cross-examination the Neurologist denied this.

Peter brought a claim against the GP who gave him the injection, alleging that the needle was inserted into the incorrect area, namely into the peroneal nerve, and this caused his disability. The case was defended throughout and went for a 5 day trial in Middlesbrough County Court with 2 experts on each side. Only £16,000 of the sum he was awarded was for pain and suffering for the injury, the rest was for past and future loss of earnings. Peter had hoped to go into a career with the Forestry Commission but that was not possible as he was now unable to move effectively on uneven ground.

Hilton Armstrong – June 2014

P.T.S.D. After Childbirth

Mrs C was scheduled to give birth to her third child by caesarean section. One week before the procedure was to be carried out her waters broke. She became very concerned as her waters were red with blood. Mrs C’s partner took her straight to the Maternity Assessment Unit (MAU) at James Cook University Hospital. Once inside Mrs C was directed to simply sit in the waiting room, surrounded by other pregnant women and couples, despite being distressed and her lower half being entirely covered in blood. Unbeknown to her at the time she had suffered a placental abruption, this occurs when the placental lining comes away from the uterus causing massive bleeding and endangering both the baby and the mother, it is an emergency situation.

After 15 minutes in the waiting room, surrounded by other patients, Mrs C was finally seen by a midwife. The midwife was horrified with Mrs C’s condition and called for a doctor urgently. As a result Mrs C was admitted and immediately underwent an emergency Caesarean section. Thankfully this was successful and Mrs C gave birth to a healthy baby girl.

Physically Mrs C recovered well from the ordeal; however she began to suffer from panic attacks, constantly running through what happened from the bleed to the birth in her head. She was later diagnosed as suffering from Post-Traumatic Stress Disorder (P.T.S.D.) and began attending Cognitive Behavioural Therapy to help come to terms with the incident.

Mrs C initially spoke to her midwife about the delay in her being seen at the hospital and submitted a complaint through the Patient Advice & Liaison Service (PALS) service. She came to see us after she did not receive a satisfactory response as to why she had not been seen as a priority when she attended hospital in such a condition.

We sought the opinion of independent medical experts as to the quality of Mrs C’s care.  These experts felt that while the placental abruption could not have been avoided the 15 minute delay before being examined was traumatic and unacceptable. It was this entirely avoidable delay, rather than the abruption itself, that had so seriously affected Mrs C and resulted in her anxiety and PTSD.

We put these allegations to South Tees Hospitals NHS Foundation Trust. They admitted that the care had been substandard and soon after made an offer of compensation, which Mrs C accepted.

As a result Mrs C recovered compensation for her long lasting psychological injuries. She was also compensated for the cost of the CBT sessions, both in the past and those she will need to help put this incident behind her. This case shows that sometimes psychological injuries can occur independently of physical injuries, but can be just as damaging with on-going consequences for the patient.

Dan Richardson

Wrong Size Hip Replacements at Wrong Angle

Mr K was advised that he needed to have both hips replaced; it was planned that this would be done in 2 separate operations about 4 months apart. To avoid lengthy waiting lists he was referred for this surgery by Middlesbrough Primary Care Trust’s “Choose and Book” system to an Orthopaedic Surgeon at the Woodlands Hospital, Darlington. This meant that the NHS would pay for his treatment at this private hospital. The same surgeon performed both hip replacements.

Following his hip replacements Mr K. was in a great deal of pain and he found it harder to get around than before the operations. This made it hard for him to continue working and he was off work for long periods of time as he was not fit enough for his job as a youth worker. As he was unable to commit to work with the charity where he was employed he missed out on an opportunity for promotion there.

He approached us over a year after the initial surgery when he felt his concerns were not being taken seriously by the surgeon and he was not being offered any treatment to improve his situation. At the suggestion of his solicitor here at Armstrong Foulkes he requested his GP organise a referral to a particular well-respected surgeon at a local NHS trust for a second opinion. He was advised by this new surgeon that both hip replacements needed to be removed and new ones put in. That surgeon performed repair operations to each side and corrected the problems. After these surgeries Mr K was finally able to walk and move around comfortably and he no longer suffered daily pain. Basically he was in the position he should have been in after his first 2 hip replacement operations.

We investigated on his behalf and he was examined by our own independent medical expert who told us that the first two surgeries were performed negligently as the replacement hips were the wrong size and had been inserted at the wrong angle. The NHS Trust did not accept responsibility for the negligence straight away and we issued court proceedings against them. The case settled shortly afterwards.

Mr K. received compensation for the unnecessary pain he suffered and the fact he had to undergo 2 further operations to correct the problems which he could have otherwise avoided. He also successfully claimed compensation for his lost earnings, the loss of the job opportunity and the care and assistance he needed from his wife before the problems were corrected.

Joanne Dennison – February 2014

Hospital treatment causes cardiac arrest and post-traumatic stress disorder

Mr G suffers from a mild form of Chronic Obstructive Pulmonary Disease (COPD) which is a lung condition that causes difficulty breathing.  Although he would get breathless walking up hills, he experienced very few problems with this condition.

One afternoon in November 2010, his condition got worse and he became very breathless.  The practice nurse at his GP surgery recommended he go straight to hospital which he did.  He was diagnosed as suffering an exacerbation of his COPD and he was started on oxygen therapy.  Unfortunately, the flow rate of oxygen given was much too high and this caused his condition to worsen dramatically.  This was not picked up by the doctors until he had become so ill that he suffered a cardiac arrest.  He needed CPR and during the course of this, 4 of his ribs were broken.

Mr G’s physical recovery went relatively smoothly and no permanent damage had been caused.  However, he was so traumatised by the events of that afternoon that he developed post-traumatic stress disorder.  He struggled to come to terms with what had happened and spent much of his time thinking about it which made him very emotional.  He lost all faith in the hospital and as he was adamant he would not go back there, he and his wife moved from their home which they had lived in for over 20 years to be in the catchment area of another hospital.  Fortunately, after receiving counselling, he made a good recovery.

Our expert was highly critical of the treatment provided by the hospital.  He was of the opinion that Mr G’s was not a serious case when he attended hospital and his treatment should be “bread and butter” and “well known to even the most junior doctor”.  He also concluded that Mr G would have been much better if he had just stayed at home rather than go to the hospital as it was the treatment he received and not the COPD which caused his deterioration.

The hospital initially denied they were at fault but shortly after court proceedings were started, they made an offer of settlement and Mr G accepted £30,000 in compensation.

Kathryn Watson – November 2013

Pressure sore causes death

K was in her late 80s when she was admitted to hospital with a pinched nerve in her neck which left her unable to move her arms or legs.  Surgery was not recommended due to her age and she remained in hospital awaiting physiotherapy which unfortunately she was never able to undergo.

Just over two months later she was discharged into a care home but during her time in hospital she had developed a grade 3 pressure sore on her right heel which had become infected.  She sadly passed away a further two months later, with the death certificate recording one of the 3 causes of death as her infected pressure sore.

The case was investigated on behalf of her family/Estate and the hospital accepted that no appropriate risk assessment was carried out during her time at the hospital. They accepted that this would have identified that K was at a high risk of developing pressure sores, and that she should therefore have been nursed on a pressure relieving mattress.  They also agreed that no appropriate care plan was prepared or wound assessment carried out which meant that once the pressure sore had been noticed it continued to deteriorate without the required treatment.

The hospital agreed that as a result of the substandard nursing care she received she went on to develop a grade 3 pressure sore on her right heel which became infected and on the balance of probabilities, contributed to her death. K’s estate accepted £15,000 compensation representing funeral expenses, travel expenses on behalf of her relatives and her pain and suffering up to an including her death.

Andrew Walker

High Street Optician fails to prevent loss of eye sight

In May 2007 Frederick complained of some blurring of the vision in his right eye when seen by an Optometrist at a popular high street Optician for his regular eye test.  In August 2007 he re took the test and was assured there was no deterioration.

In February 2008 Frederick attended an alternative Optician who referred him to the Opthalmology clinic  at a local hospital with raised intraocular pressure in his right eye.  He was diagnosed as suffering from glaucoma.

Frederick had suffered a significant loss of vision in his right eye to a level leaving him functionally blind in that eye.  He had also lost approximately 20 – 30% of the peripheral vision in his left eye. 

It transpired that the intraocular pressure in Frederick’s  right eye had been significantly raised above normal upper limits during the May and August examinations and  that this should have prompted a referral to hospital at this time allowing his condition to be diagnosed and treated allowing him to maintain normal visual acuity in the right eye and avoiding any significant loss of his peripheral visual field in his left eye. 

Court proceedings were started and Solicitors acting for the high street Optician quickly confirmed they would not be defending the claim.  Frederick accepted a settlement of £65,000 in damages plus payment of his legal costs.

 

Ashleigh Holt

Old Age Is No Reason For Substandard Treatment

Pamela was in her seventies when she fell at home and fractured her wrist. She had a cast fitted and was reviewed 6 weeks later when the cast was removed. Her wrist was bent and had healed at 25 degrees. The doctor told her he did not need to re-break it but would refer her for physiotherapy. She felt that the reason the doctor was not doing more was because of her age and that he ignored her request to do whatever was needed to allow her to keep optimum function in the wrist.

She decided to have surgery privately as she leads a very active life and needs good use of her wrist. This cost her over £4,000 and did improve wrist function. However, there is still pain and weakness in the wrist and slight numbness around the thumb.

After court proceedings had been started, solicitors for the hospital accepted that before the wrist was put in a plaster cast, Pamela should have been offered manipulation to reduce the degree of angulation. They also admitted that if her wrist had been manipulated, it would probably have avoided the surgery. It was agreed between the parties that although 50% of her remaining symptoms were due to the corrective surgery, which would not have been necessary if she had been treated properly, the remaining 50% were as a result of the original fracture. As these symptoms would have occurred even with proper treatment, she could not recover compensation for these. Pamela was offered £14,000 which included the cost of the surgery, which she accepted.

Starting surgery without necessary equipment

Arthur had suffered with Rheumatoid Arthritis in his hands for several years. He was admitted to hospital for a procedure in which some of the diseased joints in his right hand were to be replaced with artificial implants. Arthur was prepared for surgery. He was given a General Anaesthetic and the Surgeon set about making the necessary incisions and preparing the bones in the hand to accept the implants.

It was at this point that the Surgeon realised that not all of the necessary components for the surgery had been ordered. No available implants were to be had for a further two days. As a result, the operation had to be abandoned and Arthur had to wait over two weeks for another operation date.

The hospital agreed that this was unacceptable treatment and paid Arthur compensation of £4,250. In addition, they arranged a more robust system to ensure that the correct implants were ordered in good time and that detailed lists of requirements for each operation were available and checked one week before the operation.