Boyes Turner’s cauda equina syndrome (CES) spinal cord injury (SCI) specialists secured a £205,000 settlement for a client left with impaired bladder, bowel and sexual dysfunction after hospital delays in scanning and surgical treatment for cauda equina nerve root compression. The contested case was settled at a mediation. Prolapsed L4/5 intervertebral disc (slipped disc) and increasing symptoms Our client had a past medical history of back pain, and a previous diagnosis of a bulging intervertebral L4/5 disc which had been managed with physiotherapy and painkillers. Three years later, his pain became more severe with additional symptoms of foot drop with pins and needles in his left foot and upper left thigh. He was referred for an MRI scan which revealed a prolapsed (slipped) L4/5 disc. Diclofenac injections did not ease his pain. He attended the defendant hospital’s A&E and was advised to continue his exercises and painkillers. At this time he still had normal perianal, perineal and genital sensation and normal bowel, bladder and sexual function. He continued his exercises for two months but was still in pain. An emergency ambulance crew attended him at home but did not take him to hospital, advising that A&E would not be able to do anything to help him. He remained in bed at home with pins and needles in his left leg. Symptoms and signs of cauda equina syndrome (CES) The next afternoon as he got out of bed, a sudden numbness flooded his buttocks, genitals and thighs. He suspected that he was experiencing symptoms of cauda equina syndrome (CES). He called NHS 111 and was told to make his own way to hospital. He arrived by taxi at the hospital at 4pm. At the hospital he expressed his concerns about his cauda equina symptoms, but he waited an hour and 39 minutes to be examined by an emergency doctor. The doctor noted that he had reduced sensation in his testicles and bladder retention. He was admitted, and the on-call radiologist was alerted to his need for an MRI scan for suspected CES. Delayed MRI scan and decompression surgery cause avoidable permanent disability from CES The MRI scan took place around three and a half hours later, and confirmed cauda equina compression from the slipped L4/5 disc. The clinical and neurosurgical teams were alerted and more than an hour and half later, just before midnight, the radiologist confirmed the radiological diagnosis of CES to an A&E doctor, who then spoke to the neurosurgical specialist registrar who agreed to review our client indicating that surgery would probably take place the next morning. After further delay, our client was reviewed and then left on the neurosurgical ward overnight before finally undergoing L4/5 laminectomy and discectomy surgery to release the pressure from his cauda equina nerve roots the next morning. During the overnight delay, our client deteriorated further, developing weakness in his legs and urinary dysfunction which needed catheterisation. He was discharged from hospital four days later with improvement in his back and leg pain, and good mobility, but has been left with permanently impaired urinary, bowel and sexual function. NHS Resolution denied liability We helped our client pursue a claim against the hospital on the basis that our client’s permanent disability was caused by their negligent delay in performing the MRI scan and then their failure to carry out the necessary emergency decompression surgery until the following morning. Our client’s deteriorating CES symptoms meant that he was at serious risk of developing permanent disability if surgery was delayed. Our experts believed that his disability would have been avoided with correct and timely decompression surgery on the evening of his admission to hospital. NHS Resolution denied liability and maintained their defensive stance throughout the proceedings. They argued that the decision to defer surgery until the morning was justified by guidance warning of the increased operation risks from nighttime surgery. We pursued the claim on the basis that any such risk was overridden by the widely accepted urgency of decompression surgery in patients with suspected cauda equina symptoms, which was recently reflected in the GIRFT CES guidance and the CES pathway. £205,000 settlement at mediation provides compensation to pay for private medical treatment After receiving the defence, we invited NHS Resolution to meet with us at a mediation, which resulted in an agreed out-of-court £205,000 settlement of the claim. Our client’s compensation will ensure that he can meet the costs of his additional needs arising from his disability, including private medical treatment for his progressive bowel and urological dysfunction. If you or a family member have suffered severe injury as a result of medical negligence or have been contacted by HSSIB/MNSI 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.