C had a long history of chronic back pain. For a number of years she had attended the hospital of the defendant trust regularly for investigation and treatment.
In November 2004, C had an MRI scan which confirmed bulging of the disc at L4/5 and L5/S1. In 2006, C started to hobble and in December 2006, her GP noted problems on the right side and made an orthopaedic referral. On March 9, 2007 C underwent an MRI scan of her lumbar spine. The results revealed “moderate size central disc prolapse at L5/S1. Both S1 nerve roots involved. Very small central disc prolapse at L4/5. Both discs are degenerate”. On March 29 a letter to C’s GP referred to compression of the nerves emerging from the spine.
From March 30, C was noted by her GP to have chronic lower back pain and observed to be limping and she could not sit for long. In his notes he stated that he did not observe any “red flags” and arranged to review her three weeks later. On April 20, C was again reviewed by her GP. She was noted to be limping and she was diagnosed with sciatica. On May 8, she was seen in clinic by the clinical specialist physiotherapist still in a lot of pain. Her GP noted on May 15, that C was limping and that she could not sit for a prolonged period.
On May 25, C attended another hospital as an outpatient. She had fainted the previous evening and that seemed to have exacerbated her back pain. It was noted on examination that she was “in pain – hobbling” and had developed weakness in her left leg. The attending GP did a thorough examination, and noted that at that stage there was no perineal anaesthesia. The notes specifically stated, ‘no loss of perineal function/sensation’. C was discharged, and was advised about red flag symptoms – that if she had saddle anaesthesia or sphincter disturbance then she should be reviewed immediately.
On May 26, at 1930 a call was made by C’s fiancé to the out of hours service. C was seen by the out of hours GP that evening and he noted that “since mid afternoon seems to have lost sensation around anus and urethral area, no sensation whilst passing urine, otherwise well in herself, cant control”. The GP noted “red alert” and an ambulance was called. The GP’s differential diagnosis was ‘?? disc prolapse? cauda equina syndrome”
At 21.52, C arrived in the emergency department of D. Her presenting complaint was noted as ‘loss of feeling’. At 23.15, C was examined and it was noted: “Known to have prolapsed disc for a few year. Couple of days ago was lifting something. Later on, pain started in left leg followed by numbness. Now feeling numb in upper thigh and bottom. No history of incontinence or retention. No loss of power”. C was examined and the notes indicated that she had nerve root impression: not cauda equina syndrome. The plan was stated as “reassurance” and that C was advised about warning signs especially if she could not pass urine or became incontinent, faecal incontinent, or constipated/unable to pass stools despite feeling then she was to return ASAP for reassessment , otherwise she was advised to see her GP in a couple of days for re-evaluation.
C’s symptoms did not improve and on May 29, she visited her GP, complaining of ‘some urinary incontinence and numb genitalia but intermittent and these symptoms led to acute admission for assessment’ …. Her GP advised her that he would try to expedite her appointment for a nerve root block.
By May 30, C’s symptoms had deteriorated. Her GP, carried out a ‘safety net call’ to C and he noted that she was “frankly incontinent of urine” and experiencing “increased saddle anaesthesia”. He referred her as an orthopaedic emergency to an Orthopaedic Surgeon.
C sustained injury and brought an action against D alleging that D was negligent in (i) failing to admit her for an urgent MRI scan on May 27, 2007 and to undertake decompression and urgent discectomy within 24 hours of that admission. C contended that but for D’s negligence she would most likely have been in incomplete cauda equina and her condition would have been as follows: her bladder and bowel would have been normal; sexual function would have been largely normal; weakness in her foot would have improved and there was a 70 per cent chance it would have recovered; she would not have required crutches to mobilise and she would not have needed a foot orthosis or elbow crutches; there would have been no cramps and she would most likely not have been depressed.
Liability admitted in part.
Injuries: C was left doubly incontinent, with weakness in her left leg and foot and ongoing pain in her back from cauda equina syndrome.
Effects: C has ongoing mobility problems resulting from the following: weakness in her left foot with no power to push off on the left foot resulting in instability; her left lower limb tires very easily and she walks using two crutches; cramp in the left lower limb at night resulting in disturbed sleep; a limp on the left side; reduced sensation in the perineal area, the left lateral thigh, the left lateral leg and the lateral aspect of the left foot; weakness in the left ankle plantar flexor and the left knee extensor; absence of the left ankle jerk. C cannot go up and down the stairs and therefore has to climb the stairs on all fours. She has had a number of falls down the stairs because of weakness in her leg. She continues to have back pain which makes it difficult for her to stand or sit for any length of time.
C remains under the care of a Consultant Urological Surgeon. She suffers recurrent urinary tract infections and is treated regularly with prophylactic antibiotics. C has no urethral sensation and has to self catheterise. That is a permanent condition and she will require catheters for the rest of her life. C will not be able to work again because of her condition.
Out of Court Settlement: over £500,000.