Inadequate assessment in A&E delays CES diagnosis

Mr C, a postman by profession, had a history of low back pain and sciatica for which he had received physiotherapy and which led to an improvement in his symptoms. In 2015 he had a flare up of his back pain and sciatica.  
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On 2 June, our client woke up in significant pain and attended the A&E department at the Defendant’s hospital where he was triaged and later seen by a doctor.  He advised MDS Medical Law that at the time he was assessed by the doctor, he was suffering from numbness and pain in both legs, and during rectal examination, he told the doctor that he felt tingling and numbness in his anus. The doctor told him that all was fine and, despite our client’s insistence that he be reviewed by a senior doctor for a second opinion, he was discharged and not referred for an MRI.  

Our client experienced faecal incontinence that night and called an ambulance. He was readmitted to the Defendant’s hospital by which time he had not urinated for 24 hours. On examination, at the Defendant’s hospital it was felt he had Cauda Equina Syndrome, and an urgent MRI was requested. CES was diagnosed and our client subsequently underwent decompression surgery.  

Following a thorough investigation by MDS Medical Law and the obtaining of evidence from experts in the fields of neurosurgery, A&E medicine, and radiology, a claim was pursued on the basis that there was an inadequate and negligent assessment at our client’s first attendance as he was not asked about his urinary function or any abnormal sensation in the buttocks or genital areas and a full examination of his perineum was not undertaken.  It was our client’s case that had he been asked to urinate; he would have had difficulty passing urine and that a proper examination would have shown evidence of sensory abnormality. It was our client’s case that any one of these abnormal signs should have led to a suspicion of cauda equina syndrome and the need for an emergency MRI scan, and ultimately a diagnosis of cauda equina syndrome would have been made and decompression surgery performed on the day he first attended.

Further investigation into the standard of the surgery performed the following day meant that there was also a case that the decompression surgery, itself, was performed negligently.  

This was a complex case where there was a conflict between the evidence given by our client and that recorded in the Defendant’s hospital records and provided by the Defendant’s clinicians.  The case settled 8 years after the date of the original negligence.

MDS Medical Law were able to achieve a six-figure settlement which will enable our client to obtain the treatment, therapies and care that he requires now and in the future