Tag Archives: Teesside

Patients owed a duty of care by non-medical Emergency Department staff

The Supreme Court in Darnley v Croydon Health Services NHS Trust has unanimously decided that patients attending an Emergency Department are owed a duty of care not just by medical staff but also administrative staff such as receptionists.

Briefly, in May 2010, Mr Darnley was assaulted and struck on the head.  He complained of a worsening headache to his friend who took him to the Emergency Department of the Mayday Hospital in Croydon where he was booked in at 8:26pm.  He was told by the receptionist that he would have to wait between 4 and 5 hours to be seen.  19 minutes later at 8:45pm, feeling worse and wanting to go home to bed, Mr Darnley left the Emergency Department without informing anyone.  At home, he collapsed and an ambulance brought him back to hospital at 10:38pm.  He underwent emergency surgery but has been left with permanent brain damage.

The claim arose out of the information given by the receptionist as it was alleged the advice he would have to wait between 4 and 5 hours was inaccurate and misleading as he should have been told he would be seen by a triage nurse within 30 minutes.  At first instance, the Judge accepted the following:

  • Mr Darnley would have remained at the hospital had been told that he would be seen within 30 minutes of arrival.
  • Following triage, he would have either been admitted or told to wait and if he was told to wait, he would have waited.
  • If he had waited, his collapse would have happened in a hospital setting and he would have had earlier surgery and a near full recovery.
  • Mr Darnley’s decision to leave was based partly on the inaccurate that he was given by the receptionist about waiting times.
  • It was reasonably foreseeable that a person told he would have to wait for 4 to 5 hours might leave without treatment and then might go on to suffer physical harm as a result.

The claim however failed as the Judge held that there was no duty of care owed by the receptionist to patients attending the Emergency Department.  This was upheld by the Court of Appeal.

However, the Supreme Court has taken a different view and has held that the question is not whether a receptionist owes a duty of care to a patient, it is the hospital that owes the duty of care and this duty is well established.  As soon as a patient arrives at the Emergency Department and is booked in, the hospital owes that patient a duty of care which includes a duty to ensure a patient is not provided with inaccurate and misleading information.  As it is the hospital that owes the duty of care, there is no distinction between advice given by clinical and administrative staff.

Although this case relates to the advice given by a receptionist at an Emergency Department, the same principle can apply to advice given by clerical staff in any healthcare setting such as at GP surgeries or transport services.  It is important to remember that whilst a number of claims for injuries are the result of treatment provided by doctors, dentists and nurses, this is not always the case.

Kathryn Watson, December 2019

Legal 500 UK Guide to Solicitors 2020 – Tier 1 Firm in North East for Clinical Negligence!

The Legal 500 UK Guide describes itself as “the leading Guide to Law Firms & Solicitors in UK” . They research firms annually in each area of law and each geographical area and prepare rankings for firms and for the individual solicitors based on their findings. They seek the views of barristers who have experience of the firm and those who work there, and on their website say “These rankings reflect detailed analysis of law firm submissions and thousands of interviews with GCs and private practice lawyers, conducted by our team of experienced researchers…” After performing this in depth research they have released their 2020 Guide and we are thrilled to confirm that once again Armstrong Foulkes LLP has been praised for its expertise in Clinical Negligence.

The firm itself has been ranked as one of only 3 firms within the North of England to be assessed as Tier 1 or the top rated for Claimant Clinical Negligence work We are also the only firm outside of Newcastle in this prestigious Tier 1, described as a “boutique clinical negligence firm Armstrong Foulkes LLP focuses solely on the claimant side. The practice specialises in high-value litigation, as well as handling extensive post-issue litigation”.

We are honoured to read that feedback from those who were interviewed is that:

  • ‘The firm provides a level of expertise and is the standout clinical negligence firm in its geographical area’
  • ‘Armstrong Foulkes is a small specialist, boutique firm focusing on clinical negligence work for claimants and does it extremely well’
  • ‘Victims of medical accidents in the north east are lucky to have them’

As well as the firm, the individual solicitors working here were also recommended. Joanne Davies for the 1st time accompanies Hilton Armstrong in being ranked as a “Leading Individual” described as “knowledgeable, meticulous and determined’” and “very good at what she does‘. Hilton Armstrong and  Ashleigh Holt are recognised for their expertise in this work and Kathryn Watson is highlighted as a “Rising Star”. These rankings can be viewed at http://www.legal500.com/c/north/insurance/clinical-negligence-claimant#table_3837.

Thank you to those who took time to answer questions about us and our work. We are honoured to receive these rankings again and grateful for the recommendations and positive feedback given to Legal 500 Guide by those who have worked with us.

Joanne Davies – November 2019

Chambers & Partners UK Guide to Solicitors 2020 – Top Middlesbrough Clinical Negligence Firm

We are delighted to announce that Armstrong Foulkes LLP has once again been recognised in the “Chambers & Partners 2020 Guide to Solicitors” for its expertise in Clinical Negligence in Middlesbrough & surrounding area. Chambers & Partners annually research in detail legal firms and the solicitors who work there. They take the views of the firm’s clients and also of barristers who work with them. They then provide rankings/recommendations for firms in each legal and then geographical area. We are proud to have been ranked in this directory as the only Band 1 firm for Clinical Negligence in Teesside.

We are described as a “Stellar boutique firm with outstanding expertise in clinical negligence claims. Represents clients on a wide range of matters, including child brain injury, surgical negligence and delayed diagnosis cases. Further capabilities handling claims concerning neonatal injuries due to negligent care, as well as secondary victim claims.”

All 4 Partners also achieved impressive individual rankings as experts in this area of Law, Hilton Armstrong, Band 1, is praised by a client who asserts “He kept me well informed and provided good advice throughout.”. Joanne Davies “is very experienced and effective, with good judgement,” and Ashleigh Holt “is tenacious, good with clients and very perceptive”, both achieved again a Band 2 ranking. Kathryn Watson is, as suggested in this guide, indeed “one to watch” who according to a client “listens to everything I say and fights for my case.”

Our profile can be found at https://chambers.com/department/armstrong-foulkes-llp-clinical-negligence-mainly-claimant-uk-1:140:16346:1:162233

We are delighted and proud to be recognised again for the dedication and expertise shown by each and every one of our solicitors and would like to thank any past and current clients as well as barristers who have taken the time to speak to Chambers & Partners researchers on our behalf.

Joanne Davies – November 2019

Delay in Diagnosing Brain Haemorrhage – £80,000 settlement

Sheila was in her early 40’s when she went to hospital after a series of very painful headaches.  What she actually had suffered was a brain hemorrhage.  Tests were carried out and after a few days she was sent home.  She should have been kept in for more extensive tests and these would have revealed the full extent of her condition.  This would have resulted in a referral to the neurosurgeons and a routine operation where the bleed in the brain is treated by putting a coil on it.

A few days after her discharge home she suffered a second hemorrhage and she returned to hospital.  More extensive tests were performed including an MR scan of the brain.  She was informed afterwards that all was in order (she had not had a brain hemorrhage and did not need surgery) and she could go home.

At home she suffered her third and the largest hemorrhage.  This time upon admission to the same hospital a proper diagnosis was made and Sheila was referred to James Cook University Hospital for the coiling operation.  Further enquiries by the hospital and a review of the previous MR scan showed that had the scan been properly looked at it would have revealed the first and second hemorrhages.

The hospital were quick to admit that they were responsible for the third hemorrhage but denied liability for the second one on the basis they acted reasonably in letting her go home (notwithstanding that she was sick in the discharge room) and that even if they kept her in she wouldn’t have been operated on in time to avoid the second hemorrhage.

Sheila was working casually at the time of the incidents but hadn’t been able to get back to her old job.  Her personality had changed.  Previously she was very outgoing and sociable but now she was introverted and anxious.

The settlement of £80,000 plus costs reflected the serious nature of the injuries that she suffered and the fact she hadn’t returned to work.

Hilton Armstrong – November 2019

Six year battle in claim for young mother’s death

Mrs C was diagnosed with a progressive, life-limiting auto immune disease affecting her lungs.  Due to the nature of her illness, she was managed between her  local hospital and a national centre for lung diseases in London.  In 2009 she gave birth to her first child, a son, and in 2012 she became pregnant again.   During the pregnancy, she developed a community acquired aspergilus infection.  This is a serious fungal infection and left untreated it can develop into a fungal mass in the lung cavity resulting in death.  Tragically for Mrs C  and her loved ones, the delay in diagnosing the infection and then inadequate treatment of it meant that she was unable to recover and she sadly passed away in hospital in 2013 only 6 weeks after having given birth to her daughter.

Mr C first sought our help shortly after his wife’s death.  We agreed to investigate the treatment his wife had received and obtained reports from a Respiratory Physician, an Obstetrician and a Thoracic Transplant Surgeon who were all critical about the standard of care Mrs C had received.

The medical evidence in this case was extremely complicated and further more by the fact that Mrs C had significant pre-existing lung damage and compromised lung function in any event.  However, our medical experts were critical of the lack of advice and information which had been given to Mr and Mrs C surrounding pregnancy and its impact on her mortality, the failure to refer her for assessment for a lung transplant and the negligent delay in diagnosing and appropriately treating the aspergilus infection.  Ultimately it was  concluded that the failure to treat Mrs C with anti-fungal medication earlier and over treating her with steroid medication caused her premature death.

The hospitals involved in the care of Mrs C denied that there were any failings in her treatment or care until 2018 when they eventually admitted that the infection should have been diagnosed several months sooner.  However, while they accepted they had breached their duty of care to Mrs C, they denied that this breach caused or contributed to her death.

With the continued support of our medical experts and a specialist barrister, we prepared to issue court proceedings against the local hospital Trust on behalf of Mr C and his children.    At this point, Solicitors acting for the hospital proposed that the parties attend a mediation meeting.  Mr C saw this as a positive step and willingly accepted the invitation and while this did not end with a settlement, it did allow the parties to narrow the issues between them and shortly after the mediation, but some 6 years after the death of his wife, Mr C accepted an offer in settlement of the claims.

This was a devastating and sad case.  The legal issues were complex and challenging and required detailed scrutiny and analysis which we were able to offer because of our many years of experience in practicing solely in medical negligence claims.  Mr C needed our help at the very worst time of his life to answer questions that he had but also to help him find the answers to questions he knows his children will have in the years to come.

In cases like this one, information can be what those left behind crave most.  Monetary compensation will never replace or make up for the loss of a loved one but it is also true that in many cases, losing a loved one can create a significant financial burden on families which compensation can help to relieve.  If you have suffered an injury or lost a loved one as a result of medical negligence, the team at Armstrong Foulkes LLP will be happy to discuss what has happened with you and help you where they can so please don’t hesitate to contact us.

Ashleigh Holt – October 2019

NHS Resolution latest annual report (2018/19)

This is the document that gives detailed audited and accurate information about the cost of claims against the NHS.  It is interesting reading and is usually at odds with what is reported in the media.  We are all led to believe that the NHS is on its knees as a result of people suing it.  Here are the facts:

  • £2.4 billion was paid out as a result of medical blunders. This figure includes damages and legal costs of both sides.  It is about 1.8% of the annual budget of the NHS, about the same as last year.
  • Bullying costs the NHS £2 billion a year.
  • Missed appointments cost about £1 billion a year.
  • Claimant legal costs have dropped 5.2% between 2017/18 and 2018/19.
  • Defendant legal costs have increased 8.3% over the same period.
  • Claimant legal costs as a % of all clinical negligence spend is now 19% – down 10 percentage points since 2016/17.

Yes, the cost of suing the NHS is high in terms of the stand-alone figure.  Yes, that money could be spent on training new doctors and nurses.  Is that a price worth paying?  Before you answer that remember the price could be zero if the NHS cut out the mistakes that even doctors say could and should be avoided.

Hilton Armstrong – October 2019

Small change in the discount rate still favours the Claimant

The discount rate is a percentage that is applied in claims where an injured person receives compensation now but this is to cover losses that they are expected to incur the future.  There is accelerated receipt of the money and the court therefore assumes that the injured person will invest their compensation and earn interest on it.

Between 2001 and 2017 the discount rate was set at 2.5%.  This was very favourable to the Defendants and it meant that if a Claimant was claiming 20 years’ worth of lost earnings the Defendants would only need to pay out just over 15 years’ worth as it was assumed the Claimant would be able to cover the missing years with the interest they had earned.

For many years, Claimant’s solicitors and organisations representing injured people said this was not good enough and that Claimants were being short changed.  They could not cover the loss with low risk investments as had previously been anticipated.

The Government, by way of the Lord Chancellor, did not look at this again until 2017 when the discount rate fell to -0.75%.

This caused a tidal wave of responses as insurance companies and the NHS lobbied for the discount rate to be reviewed again immediately as it would cost them millions in additional damages despite the savings they had previously and unjustly been making.  It was a very good time to settle claims for the Claimant as instead of recovering 20 years’ worth of lost earnings they were suddenly recovering nearly 22 years’ worth and the greater the period of loss, the greater the additional recovery for the Claimant.

In just over 2 years the Lord Chancellor announced the result of a review of the discount rate which was to be applied from 5 August 2019.  The new rate of -0.25% has increased but only marginally so, much to the chagrin of Defendants and their representatives who had expected a result much closer to the previous 2.5% rate.

While this is good news for the Claimant, it should be noted that the Government are clearly now going to review the discount rate more regularly and given the length of time it takes to settle the high value multi track cases where discount rates are applicable, there is no certainty that a case you take on today will reap the benefits of such a low discount rate by the time compensation is awarded in 4 years’ time!

Ashleigh Holt – September 2019

The First 100 Years Project – a History of Women in Law

I recently had the pleasure of hearing about this project in a talk to a packed conference from an inspiring lady Dana Denis-Smith, creator of the project. She explained that the hope is this endeavour will record in both writing and a video library the experiences of women in the legal profession since they were allowed to join in 1919 and help to demonstrate the progress made by women in legal careers over the last 100 years.

I am ashamed to admit that despite being a female solicitor I had little knowledge of the journey taken by and the hardships endured by my predecessors whose actions have allowed me to practice law today. I was fascinated to hear the stories of these women whose determination, perseverance and courage paved the way for all future women wanting to enter a career in law.

100 years ago the Sex Disqualification (Removal) Act 1919 was passed, without which women would never have even been able to  be accepted into this and many other professions previously considered only suitable for men. However, even before the 1919 Act there were pioneers fighting for the right to join this males only profession. Janet Wood in 1878 became the first female to complete a law degree despite the fact she was not allowed to be officially granted the degree she had passed with first class honours! Later came Eliza Orme who in 1879 was refused permission to sit the Law Society exams to become a solicitor. Despite this she persevered in pursuit of this career and in 1888 became the first woman to actually earn and receive the law degree she had studied for at University College London, although she could not then practice law. Finally in 2020 Madge Easton Anderson had the privilege of becoming the first female solicitor admitted to the Law Society after the passing of the 1919 Act.

The Project has researched and recorded as many of the very inspiring women and trailblazers who irrevocably changed for the better women’s opportunities in this profession. In addition to this they have taken video diaries from many inspiring female legal professionals still alive, whose stories of their fight to be given equal rights and opportunities, even fairly recently, are recorded forever for future generations. I imagine it will be hard for the next generation of women to believe there was ever a time when they had no freedom to choose their profession and that is testament to the incredible women included within this project.

The Digital Museum and all other information about this remarkable “First 100 Years” project can be found on their website https://first100years.org.uk

Joanne Davies – August 2019

Hospital’s failure to treat infection resulted in “flesh-eating disease”

H underwent a caesarean section to deliver her first baby.  Whilst in hospital afterwards, she felt very unwell, with a raised temperature, feeling hot and cold, shivery and had an increased heart rate.  She also suffered from a lot of pain in the caesarean section wound.  Her blood test results were abnormal indicating she had an infection but despite this, she was discharged home to look after her new born son.

The following day, she went to see her GP who diagnosed a wound infection and prescribed antibiotics.  The day after, she had deteriorated further so she returned to hospital where she was diagnosed with necrotising fasciitis, commonly known as the flesh-eating disease.  She required 4 surgeries to remove large amounts of dead tissue which were incredibly painful for her and left her with scarring to her stomach.  She was distressed both by her own illness and the separation it caused from her new born baby and she subsequently developed post-traumatic stress disorder.

It was the evidence of our expert that she had clear signs of infection throughout her admission to hospital and these simply were not acted upon.  Had she been prescribed antibiotics at any time before her discharge 5 days after the caesarean section, the infection would have resolved and it would not have progressed to necrotising fasciitis.

The hospital denied this and suggested that the disproportionate pain she experienced following the surgery was because she was overweight. We alleged this pain was, amongst other symptoms, a sign of infection.  H’s weight was a common theme throughout the claim and reflected disparaging comments about her weight that had been made to H whilst she was in hospital.

As the hospital was of the view their treatment was reasonable, as was the decision to discharge her, we proceeded to issue court proceedings and the claim settled shortly thereafter.

If you suspect you or a member of your family has received negligent treatment and would like some advice as to how best to proceed, please contact us on 01642 231110 and one of our solicitors will be happy to speak to you and advise you on the merits of a clinical negligence claim.

Kathryn Watson – August 2019

A head injury after fainting

Simon was in his mid 20’s when he dislocated his finger.  He went to the Accident and Emergency Department of his local hospital.  He was seen by a nurse who successfully put his finger back into joint by manipulating it.  However, whilst she was doing this Simon fainted and fell to the floor, hitting his head and knocking himself unconscious.

To avoid this sort of thing happening it is standard practice for patients to be seated whilst manipulations are taking place.  The nurse failed to follow this practice on this particular occasion.  The hospital therefore admitted fault quite quickly.  All that had to be decided was how much compensation should be awarded.

At first sight, it did not seem as if this would be much.  Simon was off work for about 3 months and then got back to his pub management job.  However, as with a number of head injuries, it took time before the full effects became apparent.  After about a year or so Simon thought his memory was deteriorating.  Before the fall he was able to recall everyone’s telephone number and deal with several tasks at the same time.  His inability to continue to do this led to frustration with his job and difficulties in his personal relationships.  As time went by these problems became greater and they resulted in him losing his job and his marriage breaking down.

The claim settled a month before the trial to decide the amount of compensation was due to take place, for £125,000.  Happily Simon has learned techniques to cope with his memory defects which have enabled him to be reunited with his wife and embark on a new career.

Hilton Armstrong – July 2019

Government now picking up the tab for GP errors

Historically, GPs and any staff in general practice, including nurses, needed to arrange their own personal indemnity cover with a medical defence organisation in order to indemnify them in claims against them for medical negligence.  This would be in a similar way to you or I arranging insurance cover against loss or damage caused by us or others to our cars or our homes.  However, the position for all claims arising from incidents that occurred on or after 1 April 2019 against anyone working in primary care NHS services is that they will now be handled by NHS Resolution under the Clinical Negligence Scheme for General Practice.  (CNSGP).

The main function of NHS Resolution, formerly known as NHS Litigation Authority is to manage claims made against the NHS  in England.  The main reason for the introduction of this latest scheme is to reduce the cost of indemnity cover for individual health care providers but what are the benefits and pitfalls for the Claimant.

NHS Resolution have been doing this type of work for many, many years so they are well versed in how to manage the claims and having one single point of contact for claimants will be helpful in those cases where the GP or staff member has moved on and the Claimant is having difficulty tracing them or confirming their medical defence organisation details and whether they indeed had indemnity cover.  It will also allow scope for other settlement options that weren’t open to GPs previously such as periodical payment orders i.e., where the injured party receives an annual sum for an element or elements of the claim rather than one large lump sum.  This is usually applicable in cases involving catastrophic injuries and this type of settlement can be very attractive to such injured claimants.

NHS Resolution is however not a perfect model.  We routinely see claims being defended, despite admissions of unacceptable treatment being previously made by way of complaints or the Trust’s own root cause analysis investigations.  The cases then have to be pursued and litigated increasing the costs in the claim and the amount of time it takes to reach a settlement.

At this early stage, it is too early to tell if this is a good move but what we can almost certainly guarantee is that we will hear about the increased costs to the tax payer of dealing with these claims.

Ashleigh Holt – July 2019

Bicep injury attracts compensation of over £60,000

In addition to his usual daily employment, Mr B worked as a bouncer a few evenings a week to supplement his income and support his large family.  It was on one of these evenings that he felt something snap in his left upper arm which immediately felt painful and weak.  The following day, his arm was still painful and a bruise had started to form just past his left elbow.  Within 48 hours there was heavy red bruising around the arm and his bicep muscle appeared to be moving under his arm.

Mr B attended his local Accident and Emergency Department and was seen by an Emergency Care Practitioner.  She examined his arm and diagnosed a partial rupture of his left bicep.  She discussed the diagnosis with a doctor and then discharged Mr B with advise to rest the arm.  Mr B accepted the advice but became concerned after a few months that his arm was just not improving so he consulted his GP who referred him to an Orthopaedic Surgeon.  He was eventually seen by a specialist 9 months after the original injury and was diagnosed with a complete rupture of his bicep however secondary reconstruction at this late stage carried a 40 – 50% risk of nerve injury resulting in further permanent disability seriously affecting the function of his arm.  Mr B was strongly advised against any surgical intervention and a subsequent ultrasound scan confirmed the diagnosis.

As a result of the continued weakness and discomfort in his arm, and the lack of treatment options, Mr B was unable to continue working as doorman and he continues to be at a disadvantage on the open labour market.

Initially Mr B made a complaint to the Trust about the standard of treatment he had received.  The Trust’s first response was to advise that they had referred him to physiotherapy and had therefore discharged their duty of care.  Mr B objected to this and following a meeting with the Trust, they conceded they could not confirm that a physiotherapy referral had been made.  Mr B sought our help at this point and we agreed to investigate his case and offered him a “no win, no fee” agreement.

With the assistance of independent expert witnesses in the fields of Nursing and Orthopaedic Surgery, we discovered that there is a duty on examining clinicians to confirm or refute if a patient has suffered a total rupture.  This would usually be by way of a scan or a referral to the fracture clinic so that the patient can be examined by an Orthopaedic Surgeon.  There is some urgency in getting the diagnosis in an injury like this as repairs are easiest and most successful if carried out within 3 weeks in which case the patient will usually recover 95% of their original strength.  A referral to physiotherapy would be inadequate when the nature of the injury has not been confirmed.

A formal Letter of Claim setting out our allegations was sent to the Trust and a full admission of breach of duty and causation was admitted within the 4 month pre action protocol period in which the Defendants have to respond.  An initial offer of settlement was made in the sum of £10,000 however this was rejected because of the loss of earnings he had suffered in being unable to continue his door work.

Negotiations commenced and just before court proceedings were to be started the Defendants made a reasonable offer in full and final settlement of the claim.

The injury Mr B suffered is considered relatively minor.  He had a good degree of function remaining in his arm.  He was able to continue in his main employment and while being a doorman was no longer suitable for him, he was able to undertake other types of evening jobs if he wanted to in order to minimise his loss.  Therefore the element of the compensation he received for the actual injury was assessed at around £12,500 meaning that he recovered over £50,000 in past and future loss of earnings.

It is not uncommon for injuries considered less serious than others to attract higher awards of compensation because of the impact the injury can have on other areas of a person’s life.  Someone can have limited pain but they may suffer other restrictions in their life that they can be compensated for.

If you have suffered a similar injury, it is worth taking the time to get some from a specialist solicitor before dismissing it as being “not worth it”.  Our solicitors are more than happy to discuss this with you.

Ashleigh Holt, June 2019

Success Rates when you sue the NHS

The latest NHS Annual Report provides some interesting facts that don’t always make it into the mainstream media.  For example:

  • The number of claims made in 2018 was just over 10,000, down from 12,000 in 2013.
  • Only 54% of claims made result in the payment of compensation.
  • 40% of successful claims are worth under £25,000.
  • 40% settle for between £25,000 and £100,000.
  • 20% settle for over £100,000.
  • Claimants legal costs are down 6%.

So, there is no increase in claims, half fail and of the rest, just under half go for under £25,000.  Enforcing your legal rights when something goes wrong is not bankrupting the NHS.  Don’t always believe this myth that we are in the midst of a ‘Compensation Culture’.

Hilton Armstrong, June 2019

Best Medical Claims Law Firm – Northern UK & Leading Specialist in Clinical Negligence Law 2019

I am delighted to announce that we have achieved another award recognising our achievements and specialism in Clinical Negligence in the North East of England. Armstrong Foulkes LLP were successful in being named the “Best Medical Claims Law Firm – Northern UK & Leading Specialist in Clinical Negligence Law 2019” in the inaugural SME Legal Awards. Confirmation of our award can be found at the SME News Website where the press release states

“The legal industry plays a significant role in the UK economy, not only in terms of employment numbers but their overall contribution to the national economy, exports and the UK’s trade. As such, SME News is proud to introduce the inaugural UK Legal Awards to its roster, with the intention to recognise and spotlight the very best that this innovative and competitive industry has to offer.

 As an independent awarding body, business size or reach are not the only deciding factors for our nominations. Rather we focus more on the quality of dedication and innovation within the work done and in forming positive relations with clients.

 Kaven Cooper, Award Coordinator discusses the success of this year’s programme: “It is with great pride that I present the winners of this prestigous awards programme. Congratulations to all my winners, and best of luck for the future.”  

SME News prides itself on the validity of its awards and winners. The awards are given solely on merit and are awarded to commend those most deserving for their ingenuity and hard work, distinguishing them from their competitors and proving them worthy of recognition.”

We pride ourselves on offering a “personal service” where you case is handled by experienced Solicitors practising only in this area of law and with our practice handling cases largely in the local area we can offer availability by in person to speak to your solicitor when required reinforcing our company motto of “personal care for medical claims”. We are honoured to be recognised as a leading firm in Clinical Negligence Law in our area.

Please do visit the SME Legal website for more details at https://www.sme-news.co.uk/2019-the-2019-sme-legal-awards-press-release for the press release and https://www.sme-news.co.uk/2019-armstrong-foulkes-llp for our award page.

As always do not hesitate to contact us and speak to one of our qualified solicitors on 01642 231110 on a no obligation basis if you have suffered medical negligence or have concerns about treatment you have received.

Joanne Davies – May 2019

Delay in diagnosis of ruptured oesophagus

In December 2015, Mr H underwent surgery to his left hand.  Afterwards, he vomited as a result of the anaesthetic he had been given, experienced a lot of pain and then began to vomit blood.  He was given an anti-emetic (to stop him being sick) and pain relief.

Over the next few days his condition deteriorated and he was in a lot more pain.  An x-ray and CT scan were performed which showed he had ruptured his oesophagus.  Unfortunately, due to the delay in diagnosis, it was no longer possible to surgically repair his oesophagus and it had to be left to heal by itself.  However, Mr H required open surgery to insert a tube into his stomach through which he was fed for 4 weeks.  He then had to gradually reintroduce drinking and eating, firstly with water, then juice, followed by soup and finally a soft diet.

A few weeks after his discharge from hospital, Mr H had to be readmitted to hospital as his oesophagus had re-ruptured.  Once again, he had to be fed through a tube into his stomach.

The hospital admitted very early on that they should have diagnosed the ruptured oesophagus much earlier when, on the balance of probabilities, Mr H would have undergone surgical repair and avoided all the subsequent problems.  After negotiation between the parties, the case was settled for £45,000.

If you or a family member think you may have received substandard medical treatment and would like advice on bringing a medical negligence claim, please telephone us on 01642 231110 and one of our solicitors will be happy to advise you.

Kathryn Watson – May 2019

LIMITED TIME TO CLAIM- DON’T DELAY IN SEEKING ADVICE

A lot of people are aware, mainly from television and radio advertisements, that you have 3 years to bring a personal injury/clinical negligence claim.  This is what is known as the limitation period.  If you do not start court proceedings within 3 years of the allegedly negligent treatment, or within 3 years of when you suspected or ought to have suspected you may have received negligent treatment if that is later, you may be barred from bringing a claim.

What these adverts often do not make clear is what needs to be done before you will be in a position to issue court proceedings.  These adverts often relate to simple personal injury or road traffic claims.  Clinical negligence claims are by their very nature much more complex and the following steps need to be taken before we can issue court proceedings:

  • We need to obtain all of the relevant medical records.  Under the Data Protection Act 2018 (for living patients) and the Access to Health Records Act 1990 (for deceased patients), the holder of these records, such as the hospital or GP, has one month to disclose them to us.  Frequently the records are not disclosed to us within this time and we have to threaten or, in some cases issue, proceedings purely for a court order for disclosure.  If we need a court order, this can take several months to obtain.
  • We then need to obtain expert evidence on breach of duty (what if anything was done wrongly) and causation (whether this caused any injury).  The experts we use are at the very top of their field and so are usually very busy with NHS work, their private practice and other medico-legal work.  It is therefore not unusual to have to wait several months for a report but as cases stand or fall on the expert evidence, it is important we go to the right expert even if this results in some delay.  In a lot of cases, we need more than one expert to assist us in proving the claim.
  • Once we know what our allegations are, we need to put these to the Defendant under the pre-action protocol.  The Defendant then has 4 months to investigate and respond.
  • During this time, we need to investigate the long term effect the injury has caused and the value of the case.  This is frequently far from straight forward, particularly when someone’s prognosis is not yet known, often because they are still receiving treatment for their injury.
  • Should the Defendant make a reasonable offer of settlement once they have investigated the claim, court proceedings will not be necessary.  However, if they deny they did anything wrong or even if they admit it but make too low an offer, we will then need to issue proceedings.

People frequently contact us regarding a potential medical negligence claim only a few weeks or months before the limitation period expires.  This is completely understandable; they have often had a life changing injury which has monopolised their time and attention, lost a loved one which has taken some time to come to terms with, or sometimes they simply hope they will make a full recovery and so will not take matters any further.  Whatever the reason, these people have been through an awful time and 3 years can pass by very quickly.

Whilst these people have our utmost sympathy, we are unable to take on a clinical negligence claim if we do not have enough time to investigate.  Whilst there is the possibility of the Defendant agreeing to give us extra time to investigate or a Judge allowing the claim to be brought out of time, there is no guarantee we would be able to secure either option and ultimately the claim may fail, not because of the merits of the claim, but simply because it has been brought too late.

If you think you or a family member has been injured as a result of medical treatment, please seek advice as soon as possible.  Whilst the limitation period may not start as soon as the negligence occurred if you were unaware of it and had no reason to suspect otherwise, the 3 year period will start to run as soon as you suspected, or ought to have suspected, you may have received negligent treatment.  This is known as your “date of knowledge”.  You have 3 years from your date of knowledge to bring a claim, and this can range from the time the negligence occurred, if you were aware of it straight away, to several years later.

We appreciate that should you have been injured as a result of medical treatment, you and your family will have a lot to deal with without the added stress of a legal claim.  However, by the time you feel able to investigate the claim, it may be too late and you may be unable to secure compensation for your injuries.

Our solicitors try to make bringing a claim as easy and stress-free as possible as we understand that you will no doubt be going through a very difficult time.  If you would like advice about treatment you or a family member has received, please telephone us on 01642 231110 for some free, no obligation advice from one of our solicitors.

Kathryn Watson – April 2019

Lexcel Award – excellence in Legal Practice Management and Client Care

We are delighted to announce that following re-assessment in February 2019 our firm were awarded again the Lexcel Award for meeting a high quality of standards in practice management and client care. The Award is made by the Law Society of England & Wales if a firm can demonstrate excellence in the ways they manage the practice and deal with clients. Once awarded there is an annual assessment and a more thorough assessment every 3 years to ensure that a firm continues to meet the requirements for this. We were first awarded this by the Law Society in 2015 and are pleased that we continue to perform to the high standards expected to qualify for this.

Our staff work hard to ensure we maintain the standards in the seven different areas that are assessed:

  1. structure and strategy,
  2. financial management,
  3. information management,
  4. people management,
  5. risk management,
  6. client care,
  7. file and case management.

In many areas we were noted to have met and also exceeded the necessary requirements. The assessor commented that the firm “was a very notable demonstration of Lexcel compliance” and that “it was a pleasure to discover all of the requirements Lexcel standard has been met and no non compliances raised”. We are proud to have qualified for this award again and will continue to strive to meet and exceed these standards in the years to come.

Joanne Davies – April 2019

Amputation of the arm

Bill is a charming 78 year old retired seaman.  He fell at home and dislocated his left shoulder.  He went to hospital but didn’t receive the proper treatment.  The doctors failed to diagnose what is known as a false aneurysm.  This is where blood is left and then clots in an area where it shouldn’t be. In Bill’s case, the internal bleed was from his left shoulder into his left upper arm.

Over the following weeks/months his left arm became very swollen and painful.  When he was eventually referred to the Orthopaedic Surgeons, action was taken.  Unfortunately this was too late to save his left arm which had to be amputated at the shoulder.

His Consultant at the hospital was very honest with him and said that had he seen him sooner he probably could have sorted out the problem without the arm being lost.  We took the case on and secured an admission of blame from the hospital.  We settled the claim shortly after starting court proceedings.

Bill, whilst delighted with the settlement, like all injured patients, would have preferred to be fully able rather than have the compensation.

Hilton Armstrong – March 2019

Coronary disease misdiagnosed as tennis elbow

During the Christmas holidays Mrs A developed pain going down her left arm and pain from her right ear travelling down into her jaw, neck and top of her chest.  The pains would come and go in waves and would wake her from her sleep so when things did not resolve after a few days she attended a Walk in centre to see a GP.

The GP carried out an examination and diagnosed her as suffering from gastro-oesophageal reflux due to over indulgence in the festive period and tennis elbow for which she should take Paracetamol.

Mrs A’s symptoms continued and she began to feel worse.  She planned to make an appointment at her own GP practice when it re-opened but she was not afforded this opportunity and suffered a cardiac arrest at home in the meantime.  Her collapse was witnessed by her youngest child whose screams alerted Mrs A’s husband.  A 999 call was made and Mr A performed CPR until the Paramedics arrived.  Mrs A was taken to hospital but died a few days later.

Mr A approached us to investigate the standard of care that his wife had received from the GP who had seen his wife.  With the assistance of an independent GP expert witness and an independent expert witness in Cardiology we were able to establish that the GP had failed in his duty of care to Mrs A in not identifying that her symptoms could have a cardiac cause and to refer her urgently to hospital for investigations.  We were able to say that on the balance of probabilities, the results of these investigations would have been abnormal and lead to Mrs A being commenced on an acute coronary syndrome pathway including medication and stenting of blocked arteries.

With this treatment, she would have avoided the cardiac arrest and importantly she would have survived and lived to an old age.

Solicitors for the GP initially admitted breach of duty but denied that that the failure to refer Mrs A to hospital had made any difference to the outcome.  Formal Court proceedings then had to be started and the Defendants quickly made a full admission of liability for Mrs A’s death.

Mrs A had been the primary carer for her children while her husband worked and as a result the majority of the compensation claimed was for the loss of care and services Mrs A had provided to her family.  A 6 figure settlement was agreed between the parties and was  approved by the Court.

Acute coronary syndrome can be misdiagnosed as the symptoms, particularly in women, can mimic other conditions and can be atypical.  The consequences of failing to pick up on early signs can be catastrophic and as illustrated in this case, it can be fatal.  Early diagnosis and treatment is essential.

If you have suffered as a result of a missed or delayed diagnosis, we would be happy to discuss this further with you.

Ashleigh Holt – February 2019

The Legal 500 UK 2019 awards

We were delighted to have been shortlisted for this prestigious national award.  We didn’t win it but managed to get down to the final 8 firms in the country! The category we were in was:

  • Insurance: Individual: outside of London of the year – Hilton Armstrong

According to Legal 500 “Over many months of thorough research, we have conducted 70,000 interviews with in-house counsel, law firms and sets in the UK to pin-point the most capable, expert practitioners and firms operating at the top of their game across a number of different business sectors. The awards are unique in the legal industry as they recognise each element of the profession equally, representing the very best law firms, chambers, silks, in-house lawyers, business leaders and general counsel operating within the UK market”

The full list of categories is available  here:

The shortlists for the law firm awards are available to view here: https://www.legal500.com/assets/pages/awards/uk/2019/uk-2019-firms-shortlist.html

Hilton Armstrong – February 2019

Favourable changes in claims for surrogacy

As a firm we have previously acted for clients who have lost the ability to conceive and carry a child naturally as a result of medical negligence.  Until very recently our hands have been tied as to what our clients could claim for.  We have been able to recover as compensation the costs of IVF treatment and in some cases for our clients to engage a surrogate in the UK to carry a child on their behalf and the expenses associated with this but there are strict limits which reflect the current law in the UK which in turn have meant a limit on compensation levels.

Despite surrogacy becoming increasingly popular and accepted, the law in the UK has not quite kept up with this so while surrogacy is legal, it is also restricted, particularly when compared to the laws in other countries such as the USA.  Notably:

  1. In the UK no one can profit from surrogacy.  Therefore the surrogate can only claim her expenses.
  2. In the UK, once the child is born, the surrogate is regarded as the legal mother.  This is even the case where the surrogate has carried someone else’s biological child.  A court order is required to give the intended parents the correct legal status and it is possible for the birth mother to refuse to part with the child.
  3. In the UK, the surrogate will chose the parent/parents she wants to assist.  This is often done at “parties” which can be intimidating and frightening for couples who have already been dealt a vicious blow.

In the recent case of XX and Whittington Hospital NHS Trust (2017) EWHC 2318 QB, a High Court Judge held that XX’s claim for the expenses of using a surrogate in California where commercial surrogacy is widely accepted and legal were not recoverable because commercial arrangements in the UK were illegal and it was against public policy.  He therefore limited XX’s claim to using her own egg’s and a surrogate in the UK and the associated costs of that.  The total compensation he allowed for this was £74,000 which was intend to produce two children.

Despite the damning judgement, the Judge did suggest that the Supreme Court which is the final court of appeal in the UK may see things differently.  XX was therefore allowed to appeal this decision and the matter was heard at the Court of Appeal in November 2018.  The outcome was that her appeal was successful and it was held that she should not be barred from recovering reasonable compensation for her loss which would include the costs or entering into a lawful commercial surrogacy contract in California.  She would not be breaking any laws.

This is an exciting development in this area of the law.  Claimants from the UK who need to engage a surrogate can now claim the costs entering into a contract with a surrogate in the USA who essentially carries and gives birth to other people’s children for a living.  Claimant’s will now no longer be restricted to having to use their own eggs but will be able to use donor eggs from a surrogate of their choice or another donor and they will be able to return to the UK with the child legally theirs.

The obvious downside to this in terms of the “public purse” is the difference in cost.  In the USA, to produce two live births via a surrogate the associated costs will run into perhaps hundreds of thousands but to someone who has been told they will not be able to have a child, no amount of compensation can restore them to how they would have been but for the negligence.

If you have been affected by infertility as a result of failed or unacceptable medical treatment, please contact us to discuss this further.

Ashleigh Holt – January 2019

Court allows patient to seek further compensation should she develop progressive lung condition

LH suffers from asthma.  In 2006, when she was 13 during a PE lesson at school, she used her inhaler which had been in her pocket along with 2 earrings.  She felt a sharp scratch in her throat and began to cough badly.  She then discovered one of her earrings was missing and assumed she had inhaled it when she had used her inhaler.  She immediately went to A&E when she explained what she thought had happened.  The doctor treating her thought she had instead swallowed the earring.  No x-ray was performed, she was reassured and sent home.

Over the next few years her asthma worsened and in 2014, she underwent a chest x-ray as a result of her increasing problems which included shortness of breath and a persistent cough.  This x-ray showed the earring in her lung which had collapsed as a result.  Fortunately, the earring was successfully removed and LH’s symptoms improved.

The hospital very quickly admitted that a chest x-ray should have been performed when she attended A&E in 2006 and this would have revealed the presence of the earring in her lung.  They admitted it would have been removed and she would have avoided the deterioration in her asthma from 2006 to 2014, along with the collapse of her lung.

However, they denied the long term effects this incident has had on LH.  It was the evidence of our expert respiratory physician that as a result of this incident, LH now has a 25% risk of developing bronchiectasis, a progressive life altering lung condition which may affect her ability to work and care for herself.

LH had 2 options to compensate her for this risk.  Firstly, she could settle on a full and final basis for 25% of what she would receive if she did develop the condition (to reflect the fact there is a 75% chance she will be fine).  Secondly, she could settle the case on the basis that she will not develop the condition but reserve the right to return to court for further compensation should she go on to develop bronchiectasis.  This is known as provisional damages.  It was our advice that this latter option provided far greater security and ensured she would receive full compensation if the worst happened.

LH followed our advice and sought provisional damages.  This was resisted by the hospital for a long time but they eventually conceded and the claim settled shortly before trial for £20,000 and the right to seek further damages should she be diagnosed with bronchiectasis at any point in the next 25 years.

This case highlights that when a mistake has been made, the long term consequences are often unknown until a thorough investigation has been completed.  Here, LH was unaware there was any risk to her future health as a result of what had happened until we obtained evidence from an expert in respiratory medicine.

If you or a family member are concerned by medical treatment you have received and the potential effect it has had on you, please do not hesitate to contact us and one of our solicitors will be happy to advise you.

Kathryn Watson – January 2019

Failure to prevent MRSA results in Amputation

Mrs K slipped on ice injuring her left knee.   At hospital she was told she needed surgery to repair her patella tendon was required. Unfortunately the hospital failed to follow their own infection control procedures and did not properly decolonise her.  This means they did not clean the relevant areas where she may have been carrying MRSA on her body before the operation and provide antibiotics which would prevent MRSA afterwards.

After the surgery she noticed pus leaking from the bottom of her plaster cast.  She was eventually diagnosed with an infected left knee wound and she had further surgery to treat this but again without proper MRSA prevention steps.  After this second surgery, she was diagnosed as being infected with MRSA and the correct treatment was then provided however this involved a third operation to remove some of the infection which had also reached the knee replacement joint which had to be taken out.

Over the following 9 months the infections failed to clear and this had a massive impact on her  health and her family life. She struggled to get around her home and her family had to convert a room downstairs for her to sleep in as she couldn’t make it upstairs. Mrs K was left with no option but to have a left below knee amputation.

We were approached by Mrs K after the amputation. After investigating the standard of treatment she received we were able to put the case to the Defendant NHS Trust who admitted a failure to follow their own infection control procedures and prevent the MRSA infection resulting in the amputation. Mrs K was forced into a wheelchair due to a wholly unsuitable NHS prosthetic limb which she could not wear for long periods of time and was not very flexible.

Due to the admissions made we were able to refer Mrs K to a private prosthetic company who properly assessed her needs including a desire to be more active with her young family. We secured funding from the Defendant to obtain an excellent microprocessor waterproof prosthetic limb which was in the past offered only to those injured members of the Armed Forces. This prosthetic limb, which was properly fitted to her stump allowed her to be more mobile, to walk on surfaces she had been unable to do so with the NHS prosthesis and to go swimming with her family. This made a massive difference to her life.

Mrs K had several other unrelated health problems which delayed full assessment of her claim, but the parties were able to reach a settlement which will allow her to fund the maintenance of and replacement of her prosthetic limb for life, to purchase more suitable single storey accommodation and support her financial needs now and in the future arising out of the amputation. Mrs K has said she feels she can now move on with her life.

MRSA is present on many people’s bodies and causes no harm in the absence of an open wound. However before any surgery like this a person should be tested for MRSA and the area decolonised and therefore fully cleaned of the MRSA infection. Hospitals have very clear infection control policies to prevent this kind of mistake occurring and a failure to follow these policies is difficult to defend.

Early funding for physical needs or equipment required because of the mistakes made by NHS Trusts can often be secured if the Trust accept responsibility for injuries. These payments can allow life to be improved for those who have been injured long before the case is settled.

If you would like to discuss a similar situation or any treatment you have received which you feel caused you an injury or worsened an existing injury please don’t hesitate to contact us.

Joanne Davies – December 2018

Top rankings again for Armstrong Foulkes LLP!

We are delighted that once again, we have received the top ranking in 2 prestigious guides to UK solicitors; Chambers & Partners and The Legal 500.  These rankings, which we have held for many years, are reviewed each year following interviews from clients and legal professionals with whom we work.

We are the only firm in the Teesside area to be awarded a Band 1 ranking for Claimant clinical negligence work by Chambers & Partners and we have also been awarded a Tier 1 ranking in The Legal 500.  We are described as a top-quality boutique with a superb reputation for complex clinical negligence claims and expertise in a wide range of matters”.  Our solicitors are praised for being “friendly, prompt when communicating and have really good specialist knowledge of their subject” and that “nothing fazes them and they obtain good results for their clients, who they place at the centre of each case.”

In these publications, Hilton Armstrong is described as “a tough and determined litigator” with “excellent judgement” who always explains matters clearly, is always approachable and keeps us informed as to what is happening and why.”

Joanne Davies is hailed for being “extremely meticulous” with clients reportedly being particularly impressed by the “very proactive, clear and understanding” way she handles claims.

Ashleigh Holt, who is described as being “experienced and intuitive” is applauded for conducting litigation “with exemplary vision and skill”. Interviewees report her to be “very organised, engaged with the issues and understanding of the situation.”

Kathryn Watson is also recommended with sources admiring “her knowledge and client service” with one client reporting “you can tell that she cares.”

We are proud to continue to hold top rankings in these two reputable publications and are gratified to receive such positive feedback, particularly from our clients as their opinions are what matter to us most.

If you or a family member have concerns about any aspect of medical treatment and would like no obligation advice from one of our solicitors, please do not hesitate to contact us on 01642 231110.

Kathryn Watson – December 2018

Delay in Diagnosing Stomach Cancer

Catherine was 53 when she died of stomach cancer.  2 years earlier her GP had referred her to hospital after she went to see him complaining of a feeling of fullness in her tummy.  She had an endoscopy, and biopsy, and was told all was clear and that she probably just had an ulcer.  This came as a great relief to her husband, Keith, and their children.  Unfortunately, as they were to find out a year later, the Pathologist had made a mistake when examining the biopsy.  She was not in the clear.  She had cancer which needed operating on.  By the time this was discovered it was too late and she died 2 months later.

The hospital were quick to admit that the Pathologist had made a mistake but defended the claim on the basis that even if the cancer had been diagnosed earlier, Catherine would still probably have died.  Shortly before a trial date was fixed we managed to persuade the hospital’s Solicitors to settle out of Court for £57,500.  As Catherine did not work and the children had grown up, it is a sad fact of the English legal system that compensation for the Husband and adult children in cases such as this can never reflect the true value of the loss.

Hilton Armstrong – November 2018

Hospitals are responsible for the advice given by receptionists! – Darnley v Croydon Health Services NHS Trust

The Supreme Court have this month ruled that incorrect information on waiting times at A&E given by a  receptionist at the Mayday Hospital, Croydon resulting in permanent brain damage could be considered negligent. The Court decided that it justified an award of compensation in the same way as incorrect doctor’s advice or treatment would.

Mr Darnley attended A&E with a head injury and feeling very unwell, only to be told by the receptionist that there was a 4 or 5 hour waiting time before he could be seen by a doctor. After waiting for 19 minutes and feeling very unwell he left unable to face the prospect of several hours wait. He was returned to hospital later that night as an emergency. He was diagnosed as suffering a large bleed on the brain and despite surgery he suffered permanent brain damage. He and his legal team argued that he been treated sooner or immediately on collapse he would have made a nearly full recovery.  He made a claim for compensation against the NHS Trust who run the hospital for the brain damage suffered and its effect on his life.

The A&E receptionists working there agreed that in this situation they would usually advise a patient would seen by a Triage Nurse in 30 minutes and/or would consider priority Triage but neither admitted to giving the mistaken advice. Mr Darnley argues that if he had been told this he would never have left hospital after 19 minutes and the bleed would have been diagnosed and treated sooner. When this was first heard by a Judge the claim was unsuccessful. It was appealed and the Court of Appeal ruled that it was not negligent for incorrect advice on waiting times to be given by the receptionist and that the injury was not caused by this in any event.

Mr Darnley then appealed this further to the Supreme Court who have this month ruled that a receptionist giving waiting time advice in an A&E department like this has a duty of care to the patients to act appropriately. They are responsible for the advice given in the same way any medical professional is. These receptionists/non-medical staff were given the role by the Trust as the first point of contact and owed a duty to the patients. They also stated that there was a direct link between this advice on waiting times and the injury he suffered as a result and that earlier diagnosis would have resulted in admission and earlier treatment with a nearly full recovery.

This is an important case as it establishes that incorrect advice from non-medical staff working for NHS Trusts, in particular an A&E receptionist, which results in an injury to a person could justify a claim for damages like any other compensation claim arising out of negligence by medical professionals. The circumstances of each case and whether the  advice caused an injury will need to be considered but if you feel you have been in a situation like this please do not hesitate to speak to one of our solicitors on 01642 231110 for a free no obligation chat.

Joanne Davies – November 2018

Second Opinions – how to get them

A lot of what Doctors and lawyers tell you is their opinion and not necessarily factual.  As professionals we need to exercise our judgment based on our experience.  Often what we say is not what you want to hear, but it is our job to tell it as we see it.

So, for example your doctor may tell you that after looking at the scans your cancer is inoperable and only palliative care is required.  Or, the slipped disc in your back requires surgery that may result in you having to give up sport or work.

From the patient or client’s point of view sometimes this can be hard to comprehend and accept.  So what can you do if you are not convinced by what your doctor has told you?  You need to follow these steps:

  1. Ask the doctor to explain again. Step by step, and slowly.  Are they absolutely certain that their view is correct?  At this point your doctor will probably accept that there is a range of opinion but go on to explain why they think they are right.
  2. If you still feel unconvinced by their explanation ask them if they would object to you obtaining a second opinion. They are unlikely to disagree.  Usually they will recommend one of their colleagues, or alternatively you may have your own idea of who to go to.
  3. If your treatment is under the NHS it is even possible to choose a doctor from outside the hospital you are being treated at. If that is the case you would need to contact them and make arrangements for a consultation.  If you are paying privately then you would have to pay for the second opinion.
  4. When you see the new doctor after a discussion they will give you their own opinion. It may be the same as your original doctor or it may be different. If different you will need to talk about transferring your care to the new doctor.

It is important to understand that by asking for a second opinion you are not falling out with your doctor.  They will not be offended at all.  On the contrary they will probably encourage it as they will feel a lot more comfortable about your intended treatment if another doctor agrees with them.

Hilton Armstrong – October 2018

District Nurses mismanagement of pressure sore leads to death of disabled patient

Mrs R was a mother of 3 in her early 50s and suffering from Multiple Sclerosis when she developed a pressure sore to her sacrum.  This was identified during an admission to hospital.  When she was fit to be discharged arrangements were made for the community nursing team to manage the sore.

Despite identifying the sore as grade 3 and noting that an air mattress was needed, this was not then ordered for a further 30 days.  Over the next few weeks it was clear that the wound was deteriorating and becoming necrotic.  A Tissue Viability Nurse (TVN) was eventually asked to see Mrs R and she prescribed good treatment which would soften and debride the wound and kill and protect against bacteria however this advice was not followed and instead a dressing was applied which would not alter the wound status.

The wound continued to worsen and became inflamed and the TVN recommended hospital admission as it was suspected that she was becoming septic.  Mrs R was treated with intravenous antibiotics but her pressure sore was now described as grade 4 and so she was discharged from hospital with a Topical Negative Pressure (TNP) dressing however the district nursing team were unable to manage the TNP and it transpired that it had not actually been working since she was discharged from hospital.

Over the next few days Mrs R looked increasing unwell.  She was losing weight and was suffering nausea and her family were struggling to cope with the dressing of the wound and caring for her.  The community nurses continued to visit but the record keeping became sparse and less detailed.  Mrs R continued to decline until she was admitted to hospital after being found unresponsive.  On admission, bone was seen to be clearly visible through the wound to her sacrum.  She was severely septic and no treatment could be offered.  She sadly passed away shortly after, only 5 months after the sore was first noticed.  It was concluded that the most likely source of the infection was her pressure sore.

We were approached by Mrs R’s husband and sons to investigate the standard of care their wife and mother had received and the independent expert reports we obtained were damning of the standard of nursing case given to Mrs R.  In particular, the independent nursing experts was of the view that they had failed to:

  1.        Arrange for pressure relieving equipment soon enough
  2.        Arrange for a TVN visit soon enough
  3.        Follow the TVN’s advice and the Trust’s own policy for managing pressure wounds
  4.        Manage dressings appropriately
  5.        Arrange for further review/earlier re-admission to hospital

With proper treatment the view was that Mrs R’s sore would have healed and a second medical expert agreed that the failures in her treatment and care resulted in her death from sepsis.

When these allegations were put to the Trust responsible for the community/district nurses, we were faced with denials and the Trust were very keen to push the burden and the blame on Mrs R and her family.

As a result court proceedings were commenced but shortly after solicitors acting for the Trust entered into negotiations to settle the claim and Mr R agreed to accept a five figure sum.

This was a terribly sad case.  Mrs R and her family had been dogged by her ill health for years but they had rallied.  For her to be failed so absolutely when she desperately needed help most devastated them.

Pressure sores require careful and intensive treatment.  They don’t resolve on their own and as this case shows they can prove to be fatal.  If you or someone you know has suffered a pressure sore or deterioration of a sore due to poor medical care and treatment, please contact us for a free discussion.

Ashleigh Holt – October 2018

Failing to act on abnormal Echocardiogram leads to heart failure

Mr P was referred to a Consultant Respiratory Physician at James Cook University Hospital after developing shortness of breath and a cough in 2014.  Over the next 3 months the Consultant arranged a series of investigations including an Echocardiogram (Echo).  This showed Mr P had a mild left ventricular systolic impairment.

Mr P was told the Echo was normal and 3 months later he was referred to another hospital for a second opinion.  The referral letter requesting the second opinion advised that the  Echo was “normal”.

Mr P’s condition continued to deteriorate.  By March 2016 he was struggling with day to day activities.  He was unable to sleep as he was struggling to breathe when he lay down.  He could not make it upstairs to bed.  In May 2016 he attended a review appointment and his condition prompted his Consultant to admit him to hospital there and then for further investigation.  A second echocardiogram now showed significant left ventricular dysfunction and Mr P was told he was in severe heart failure.  His left ventricle was narrowed and his aorta was only working 15 – 20%.

Mr P’s care was transferred to a Cardiologist and he was started on a number of anti-heart failure medications.  He was initially unable to return to work as a HGV driver as his condition had to be reported to the DVLA and his driving licence.  It was later returned when a further echocardiogram showed that he was responding to the medication and his condition had improved.

We investigated the standard of care Mr P had received with an independent Respiratory Physician and Cardiologist.  They confirmed that he should have been referred to a Cardiologist following his first Echo and he would have been commenced on treatment 2 years earlier.  Had this occurred, the progression of his condition would have been slower and he would not have developed heart failure in 2016.

These allegations were put to the Trust and were admitted.  A financial settlement was achieved quite quickly for a 5 figure sum.  However, Mr P had lost 2 years of his and his young son’s life and his heart condition had been accelerated.

If you have suffered an injury as a result of a test or investigation being wrongly reported or interpreted and you would like to discuss this please contact us for free no obligation advice.

Ashleigh Holt – September 2018