Boyes Turner’s cancer negligence solicitors secured an admission of liability and a £95,000 settlement for the family of a 71-year-old woman who died after extravasation errors led to delays in her chemotherapy treatment. Extravasation is the medical term for a leakage of anti-cancer drugs or other fluids from a vein into the tissues which surround it. If extravasation occurs during chemotherapy treatment for cancer, specialist treatment protocols must be followed, as ‘vesicant’ chemotherapy drugs can damage the skin, causing serious harm. Extravasation during chemotherapy treatment for lymphoma The patient (our client’s mother) was diagnosed with stage IV(b) B-cell lymphoma, a rare and aggressive form of cancer. Two weeks after her cancer diagnosis, she attended the defendant hospital for the first of six planned cycles of Rituximab CHOP (‘R-CHOP’) chemotherapy. The chemotherapy treatment included the vesicant drug, doxorubicin. The nurse began administering the doxorubicin via a cannula in the patient’s hand, but after around 3ml had been administered, the patient complained of symptoms of extravasation, including pain and burning in her hand, The nurse stopped the treatment, called for assistance and unsuccessfully tried to draw back any doxorubicin that might still be in the cannula. The patient’s hand was eventually reviewed 20 minutes later by a junior doctor who had not been trained in the management of extravasation injuries. The doctor noted the extravasation injury, and that the back of her hand was red and swollen. She was treated with intravenous (IV) hydrocortisone (a steroid which calms the body’s immune response), and hydrocortisone cream and a cold pack were applied to the area, with the cold pack to be replaced every 30 minutes for four hours. The nurse re-sited the cannula, and the rest of the chemotherapy was given. Negligent treatment of the extravasation injury led to skin damage and skin graft surgery The hospital staff failed to follow the hospital’s own guidance protocol for the treatment of the patient’s extravasation injury. This included failing to mark and digitally photograph the extravasation injury, elevate the patient’s arm in a sling, encourage finger movements, inject hydrocortisone into the skin around the area, administer an antidote or refer the patient to the plastic surgery team. She was discharged after review by the consultant haematologist. Over the following weeks, the patient was treated with antibiotics for pain and swelling for ‘chemotherapy burns’ on the back of her hand, and later with Aveeno and antihistamines for blistering and itching at the extravasation site. She was also admitted to the hospital for investigation of a transient ischaemic attack (TIA or mini stroke) but there was no formal follow-up of her extravasation injury, which the hospital’s protocol mandated should take place within one week. Whilst in hospital three weeks later for her second cycle of chemotherapy, a haematology specialist noted that she had a significant chemotherapy extravasation at the site of chemotherapy injection and that the back of her hand looked swollen, inflamed and ulcerated, but again no further action was taken. She was seen three weeks later by a consultant haematologist who found ‘very evident and extensive damage with necrotic (dead) tissue and clear evidence of infection’. He referred her to the consultant plastic surgeon, who found that she had minimal range of movement in her fingers, swelling, reduced sensation in the fingertips, and a necrotic eschar (area of dead tissue] which needed debridement (surgical removal). He wrote to the patient expressing his concern about the lack of earlier intervention for the extravasation injury and arranged for a serious incident investigation, which eventually found multiple failings in her care. Over the following weeks, she needed two surgical procedures to remove (debride) the dead (necrotic) tissue on the back of her hand, three skin graft operations and leech therapy. Her untreated injury and multiple surgical procedures delayed her life-saving chemotherapy treatment, leading to a progression of her aggressive cancer. She finally received a reduced third dose of chemotherapy more than four months after her second dose, but deteriorated and was transferred home for end-of-life care, where she died a few days later. Admission of liability and compensation settlement After the deceased’s death, her daughter and executrix instructed us to pursue a claim for compensation against the hospital. We put a claim to the hospital on the basis of our medical expert’s opinion that their negligent management of the extravasation injury caused our client’s mother to suffer additional pain, multiple surgical procedures and delayed her chemotherapy treatment, advancing her death by up to five years. We secured an admission of liability from NHS Resolution, who were acting on behalf of the hospital. We entered into settlement negotiations and secured an out-of-court settlement of £95,000, which included a loss of dependency claim for our client. If you have suffered severe injury in an accident or as a result of medical negligence or have been contacted by HSIB/HSSIB/MNSI/CQC or NHS Resolution, you can talk to a solicitor, free and confidentially, for advice about how to respond or make a claim by contacting us.
