General medicine cases
S v Ealing Hospital NHS Trust
(2001) - Failure to investigate ongoing confusional
state - intra-cranial bleed - fracture of skull in left
temporo-parietal area - patient died - settlement £12,000
H v Sevitt and Others (2001) - Delay in
diagnosing and treating thrombotic thrombocytopenia purpura (TTP) -
severe neurological deterioration including hemiparesis, sensory
abnormalities, confusion, restlessness and dysarthia - ventilated -
ITU admission - ongoing poor memory and loss of concentration -
settlement £240,000
Full case details
S v Ealing Hospital NHS Trust (2001)
S was admitted to Ealing Hospital on 5 October 1998, having
suffered an alcohol related fit. While he was in the accident and
emergency department, he fell from the trolley injuring his right
eye. S was admitted onto a general medical ward and at
approximately 08:30 on 6 October 1998, he suffered a further fall
injuring the left side of his head. He underwent a CT Scan within
approximately 20 minutes of the accident. The scan was reported as
showing no abnormality.
Between 7 October and the morning of 13 October, S’ condition
deteriorated. He remained confused (despite the withdrawal of
sedatives to prevent further fits), became doubly incontinent and
spent most of the time asleep. A further fall was recorded on the
fluid balance chart of 10 October 1998 but no accident report was
filed. Neurological observations were not performed on a regular
basis and were terminated on 10 October 1998. No neurological
assessments were undertaken by the medical staff after 6 October
1998.
At approximately 09:00 on 13 October 1998 S’ wife complained to
the nursing staff that her husband was unrousable. When S was seen
on a ward round a couple of hours later, he was discovered to be
unconscious. A CT Scan confirmed that S had suffered extensive
intra-cranial bleeding and there was a fracture of the skull in the
left temporo-parietal area.
Following consultation with the Regional Neurosurgical Centre,
it was advised that no treatment could be offered and S suffered a
respiratory arrest and died later that day.
Expert evidence was obtained from a consultant in general
medicine who confirmed that the management of S on the ward had
fallen below the required standard. There had been a failure to
investigate S’ ongoing confusional state after 6 October by means
of regular neurological observations, examinations and repeat
scanning. However, both the expert in general medicine and an
expert in nursing care agreed that no criticism could be made of
the failure to prevent S suffering the falls both in the accident
and emergency department and on the ward. Neurosurgical evidence
confirmed that if appropriate reviews had been undertaken, S’
deterioration would have been determined and scanning would have
revealed raised intra-cranial pressure. S would have been referred
to a Regional Neurosurgical Centre where action could have been
taken to relieve the raised intra-cranial pressure thereby
preventing S’ final deterioration. That being said, S would have
suffered permanent serious neurological deficit as a result of
injuries sustained following the second fall.
Hilary Barsey advised the family of the difficulties on the
issue of causation. A Part 36 Offer was made and following
negotiations, S’ widow accepted £12,000 in full and final
settlement of the claim.
H v Sevitt and Others (2001)
On 3 December 1997, H, a 50 year old male consulted his GP with
a history of a few days of sweating, malaise, mild cough, tiredness
and waking up shivering. On examination, H had lost weight. His
chest was clear and there was no lymphadenopathy. A diagnosis of a
possible viral infection was made.
On 8 December, H consulted his GP again complaining of dark
urine and feeling generally unwell. Blood tests were carried out
and the GP referred H to Dr Sevitt, consultant general physician
who arranged his admission to the London Clinic on 9 December. On
admission laboratory investigations were undertaken and showed
renal dysfunction with raised urea and bilirubin, poor reticulocyte
response, low haemoglobin (indicating anaemia) and there was a low
platelet count. H was given a transfusion of six units of platelets
and a course of intravenous antibiotics. Platelet transfusions were
continued daily until 15 December 1997.
Blood film results reported on 10 December 1997 showed
microangiopathic and haemolytic anaemia (MAHA). On 11 December he
was seen by Dr Kaczmarski, haematologist, who concluded “I would
recommend supportive care only, avoid further platelet transfusions
unless neurological signs manifest … plasma exchange not indicated
at present as it seems to be settling. May consider if develops
neurological problems”. Despite this advice, platelet transfusions
were continued.
On the nights of 11 and 12 December, H had neurological symptoms
and was noted to be confused. Post-infective HUS was queried. In
fact the correct diagnosis was thrombotic thrombocytopenic purpura
(TTP). On 13 December notwithstanding Dr Kaczmarski’s advice
platelet support was continued and plasma exchange was not
commenced. At 7:00 p.m. on 14 December, H suddenly deteriorated and
was noted to have left-sided hemiparesis, sensory abnormalities,
confusion, restlessness and was dysarthic. He was transferred to
the ITU.
On 15 December, H was again reviewed by Dr Kaczmarski who
specifically noted that H’s condition was behaving like TTP. He
recommended that further platelet transfusions be avoided and
plasma exchange be considered. Even with the correct diagnosis and
appropriate advice as to treatment, H was not given plasma exchange
but 10 further platelet transfusions were given.
On 18 December, H was transferred to UCH under the care of
Professor Machin.
C was discharged at the end of April 1998 on long-term
cyclosporin therapy and prophylactic dose aspirin and folic acid
with regular follow-ups.
Expert evidence from a consultant haematologist was critical of
the failure on or after 11 December 1997 to make the correct
diagnosis of TTP, which should prompt immediate plasma therapy and
immediate cessation of platelet transfusion. The delay in
diagnosing the illness and instituting appropriate treatment caused
H to suffer a life threatening illness requiring long-term ITU care
on a ventilator. The platelet transfusions contributed to the TTP
progression, the deterioration of H’s neurological function and the
need for ITU and ventilatory support. But for the negligence, H
would have been hospitalised for three to four weeks and would have
been back to work by 1 February 1998.
On 22 September 2000, the claimant made a Part 36 offer in the
sum of £300,000. This offer was rejected and so proceedings were
issued on 27 November 2000 and were served on 13 March 2001. The
defence made limited admissions in respect of breach of duty. In
November 2001, the defendants made a 'without prejudice' offer in
the sum of £50,000. On 14 December 2001, the defendants made a
payment into court of £75,000 which was rejected. Factual and
expert evidence was exchanged. Expert meetings took place and 21
days before trial, the defendants paid into court a total sum of
£200,000.
After negotiation, H’s claim was settled in the sum of
£240,000.
Paul McNeil conducted this under a
conditional fee agreement.