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Mistakes happen when medical professionals fail to consider rare conditions. Nearly all cauda equina syndrome (CES) claims arise from GPs or (junior) A&E doctors mistaking the patient’s symptoms for more minor conditions, such as back pain.
A patient who complains of severe back pain may have other symptoms, which the doctor must check for to be sure that early warning signs of cauda equina are not missed. These signs and symptoms may include altered feeling in the lower limbs, sexual areas, perineum and anus, and urinary problems such as incontinence, retention and lack of sensation whilst urinating.
Early recognition of cauda equina is essential as, without emergency surgery, permanent disability occurs very quickly after the patient begins having symptoms.
A patient, who is thought to be developing cauda equina syndrome (CES) requires urgent neurosurgical review including an MRI scan of their spine and emergency surgery to release (decompress) the pressure on their spinal cord.
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Cauda equina may be missed when a doctor:
CES claims can also arise from:
Each client’s injury and the way it affects them is unique. Their compensation award takes this into account and reflects their individual circumstances. Most of our clients find that their CES disability reduces their independence and ability to carry out daily activities at home and at work. We work closely with our clients and a team of trusted experts to understand the impact that the injury has had on our client’s life.
Whilst compensation cannot take away the injury, it can pay for solutions to ease the day-to-day difficulties faced by people who have been injured by CES. Our past clients tell us that their compensation also provides peace of mind. A successful claim can replace lost income. It also provides the financial security that comes with knowing that their ongoing needs will be met.
We recover compensation for our clients’:
Boyes Turner’s spinal injury specialists have over 30 years’ experience of successfully handling cauda equina syndrome claims. We understand exactly what can and does go wrong and when a claim is likely to succeed.
We have recovered substantial compensation for clients whose CES treatment was negligently delayed, leading to:
Our thorough but sensitive approach to cauda equina cases gives each client the reassurance that their case is in skilled hands. Cauda equina can affect bowel and bladder function, sexual function and feeling around the genital, perineal and anal region as well as movement of the lower limbs. Whilst we understand that clients may initially be worried about discussing the deeply personal aspects of CES injury, our solicitors are experienced at supporting people through this process and putting our clients at ease.
As experts in successful cauda equina cases, we know the issues that the court needs to determine, and the information that independent medical experts will need to form their opinions. The key to winning a cauda equina claim is being able to give the court detailed and accurate evidence of the nature, timing and sequence of our client’s signs and symptoms. We achieve this by:
The more accurately we can establish the facts of our client’s condition, the quicker and easier it is to identify where negligent healthcare (such as delay or misdiagnosis) caused or worsened the client’s CES disability.
We do this by:
£1.33million compensation for a client whose permanent disability from CES was caused by delays in surgical decompression after an our-of-hours GP failed to recognise red flag signs of cauda equina and immediately refer him to hospital. Interim (advance payments) of £70,000 helped meet our client's urgent needs whilst we pursued his claim.
£800,000 compensation for a 40-year-old man after his GP failed to examine him and recognise red flag warning signs of cauda equina syndrome (CES). The failure to diagnose CES led to delays in surgical treatment, including a lumbar discectomy and decompression operation. He has permanent bowel and bladder damage, impaired mobility and sexual dysfunction. In addition to his settlement, our client received an admission of liability and letter of apology from the GP.
£400,000 compensation for a woman whose red flag warning signs of cauda equina syndrome were not recognised by her GP or hospital A&E staff. Her condition was finally recognised by a physiotherapist who referred her to a consultant spinal surgeon after our client paid for a private MRI scan. She underwent surgery but had already suffered permanent disability, including bowel and bladder incontinence, loss of sexual sensation, altered sensation around her left perianal region, buttock and left thigh, and psychological injury.
£275,000 compensation for a client with a history of back pain whose GP failed to recognise his red flag signs of cauda equina syndrome and refer him to hospital as a medical emergency. When our client attended A&E three days later, an MRI scan revealed a lumbar disc prolapse with cauda equina. He underwent emergency surgical decompression but was left with permanent disability, including fatigue, leg pain and weakness, and impaired urinary, bowel and sexual function, as a result of the GP’s delay in referring him to hospital.
£250,000 compensation for a client with a history of back pain and surgery, who suffered permanent disability after hospital delays in diagnosis of signs of CES. She was finally referred for emergency spinal surgery after arranging a private appointment with an orthopaedic surgeon via her health insurance. She now has permanent disability from severe pain and numbness in her leg and foot, lack of sensation in the ‘saddle’ area, impaired bowel and bladder control, and a psychological injury.
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Cauda equina syndrome (CES) is a rare but serious neurological condition caused by compression of the nerves in the spinal column.
‘Cauda equina’ is the name given to the nerve roots at the base of the spinal cord. The cauda equina nerve roots emerge from the holes between the vertebra (bones in the spine) and fan out into a bundle of fibres - like a horse’s tail. ‘Cauda equina’ is Latin for ‘horse’s tail’.
These nerves are important for the lower body. Some control the legs and feet. Others give feeling and control to the bladder, bowel, anal and genital areas.
Cauda equina syndrome or CES occurs when these nerve roots are compressed or squashed. CES is a medical emergency. The nerve root compression which leads to CES can be caused by:
Cauda equina syndrome requires emergency surgery. If not treated urgently, it can leave an individual with permanent and devastating disabilities.
Symptoms of cauda equina syndrome include:
Cauda equina syndrome can be difficult to diagnose because not all of the above symptoms will be experienced. The symptoms can be of varying degrees and over different timescales.
Cauda equina syndrome is a rare condition but it is also one of the most common types of negligence claim against GPs. Doctors must be alert to "red flag" symptoms and ready to act quickly to ensure CES patients receive urgent treatment.
When the nerves at the base of the spine are squashed, this causes pain, weakness, numbness and disability. Without emergency surgery to relieve the pressure on the nerves, this disability can very quickly become permanent.
Cauda equina surgery usually involves a laminectomy. In this operation, part of the vertebra (back bone) is removed to free up more space and take the pressure off the nerves. During surgery any slipped disc which was pressing on the nerves will be removed.
Compensation claims for cauda equina syndrome usually arise from medical delays in:
Claims also arise where a patient with back pain is sent home without advice about the importance of seeking urgent medical help if CES symptoms develop.
Once the patient has red flag symptoms, even short delays in treatment of this dangerous condition can leave the patient with permanent disability.
Cauda equina syndrome is caused by compression of a group of nerves, which can be very susceptible to injury. These nerves supply the muscles of the legs, the bladder, the bowel and genitals. If the pressure is relieved quickly, the nerves should recover without leaving the individual with permanent disability.
Causes of cauda equina syndrome include:
Surgeons working in this field of medicine will say that urgent surgery can prevent symptoms getting worse and can sometimes allow the patient to fully recover. However, once permanent damage has been caused to the spinal cord, reversal of symptoms is unlikely.
Cauda equina syndrome is a surgical emergency, owing to its devastating consequences and the limited time within which surgery can make a difference. Until the patient crosses the threshold from incomplete cauda equina syndrome (CESI) to complete cauda equina syndrome (CESR), urgent surgery is mandated. If caught soon enough, surgery can prevent further permanent injury and may lead to some recovery of function.
Guidelines published by the National Institute for Health and Care Excellence (NICE), the British Association of Spine Surgeons (BASS) and the Society of British Neurological Surgeons (SBNS), together with recognised standards of good practise all require doctors to recognise and react quickly to red flag warning signs of cauda equina syndrome (CES).
Early signs of CES may be difficult to diagnose, as the patient’s main complaint may be back pain which can have many less dangerous causes. However, as CES is potentially so damaging, doctors are expected to take the necessary steps to identify or rule out CES when a patient complains of symptoms which could be an early warning of the condition.
GPs and hospital doctors should do this by:
Doctors must record in the patient’s medical notes:
If cauda equina is suspected, the doctor must refer the patient urgently for surgery to decompress (take pressure off) the cauda equina nerves before the patient suffers permanent loss of function and disability.
Red flag symptoms of cauda equina may include one or a combination of the following:
Medical negligence is when a medical professional, such as a doctor, midwife, or nurse, or other healthcare practitioner is negligent if they act in a way that falls below any acceptable standard of care.
If someone is injured as a result of medical negligence, they are entitled to compensation for any injury that was caused and for the financial consequences of that injury.
Medical negligence claims that involve severe injury and disability should always be handled by specialist medical negligence solicitors. It takes experience and skill to successfully prove that medical negligence has caused a patient’s injuries, and to secure the highest levels of compensation.
Anyone who has suffered serious injury or disability as a result of negligent NHS or private medical care can make a medical negligence claim for compensation. Special rules apply to children, adults with mental incapacity, and claims arising from a fatal injury/someone’s death.
Children and teenagers under the age of 18, or anyone with mental incapacity, must make their claim via a ‘litigation friend’. This is usually a parent or guardian in the case of a child, or a partner or other adult family member in the case of an adult with mental incapacity. The solicitor handling the claim takes instructions and works closely with the litigation friend whilst ensuring that decisions are made in the best interests of the child or mentally incapable adult who is making the claim. You can find out more about making a claim for a child.
Some important decisions, such as agreements to settle a child or mentally incapable adult’s claim, must be approved by the court. Arrangements must also be made to safeguard the child or mentally incapable adult’s compensation, whether from an interim payment, lump sum settlement or agreed future payments. Depending on the claimant’s circumstances, this may be done by paying the money into a Court Funds Office account until the child is 18, by appointing a Court of Protection deputy or setting up a personal injury trust. You can find out more about Court of Protection deputyship and personal injury trusts.
If the claim is for bereaved family members and dependants after medical negligence caused someone’s death, the claim must be made by the deceased’s personal representative (executor or administrator of their estate) on behalf of all who are entitled to compensation as a result of the death. You can find out more about making a fatal injury medical negligence claim here.
The NHS has a responsibility to provide its patients with a safe and acceptable level of care. If a patient is seriously injured or their condition is made significantly worse as a result of negligent NHS care, the patient may be entitled to claim compensation.
Compensation can help meet the costs of care, therapies, equipment and home adaptations that are needed when an NHS mistake causes injury or disability that permanently affects the patient’s life.
We are experts at helping clients receive the compensation they deserve from the NHS. We understand the concerns that patients and their families sometimes have about claiming against the NHS. You can read our answers to many of the most common questions on our NHS claims page or speak to one of our solicitors about your own claim by contacting us.
Whilst we cannot guarantee that any particular claim will settle out of court, we take great care in investigating and preparing each claim that we take on. Our clients’ claims usually settle successfully without the need for a contested trial.
Occasionally, cases can only be concluded by a formal court hearing, such as where:
Where our client’s claim is complicated by any of the above, we may advise our client that for the case to proceed, it must go to a court hearing. Our caring and highly experienced medical negligence solicitors and barristers ensure that our clients are always kept informed and supported.
Even in non-contested cases, there will be occasions when the case is brought for shorter hearings before the court, such as after a settlement for a child or brain injured adult without mental capacity takes place. In these cases, the lawyers for both sides present the agreed settlement to the court for the judge’s approval.
Each claimant’s compensation is calculated in accordance with mandatory rules based on their individual circumstances.
Compensation for medical negligence should put the injured person back in the position that they would have been in if the negligence hadn’t happened, in so far as money can.
In a medical negligence claim, the amount of compensation depends on:
Compensation for medical negligence usually includes a sum for the injury, and sums to compensate for financial losses and the cost of meeting the needs that arise from the disability.
Our medical negligence solicitors ensure clients receive their compensation in the way that is best suited to meet their needs.
Depending on our clients’ injuries, individual circumstances and needs, we can recover compensation to pay for:
Where medical negligence caused someone’s death, compensation may be claimed by the deceased’s dependants and on behalf of the deceased’s estate. Compensation in a fatal injury medical negligence claim can be paid for:
There are three ways to fund a medical negligence claim, legal aid, no win no fee, and legal expense insurance.
A medical examination is usually needed to assess our client’s injury. Where our client has suffered multiple injuries or both physical and psychological injuries, they may need to be examined by specialists in each area. This is important to make sure that our client’s injuries are fully assessed and understood, so that they can be properly compensated.
If a medical examination is needed, we instruct the specialist and make the arrangements. We ensure that they have access to our client’s medical records and are aware of the background to the claim. The hospital or doctor against whom the claim is being made may also ask for our client to be examined by their medical expert.
The law states that, in most cases, someone who has been injured as a result of medical negligence has three years from the date of the negligence which caused the injury to issue court proceedings. If they fail to issue court proceedings within that time, their claim will be statute barred, meaning that they lose their right to bring a claim.
There are the following exceptions to the three-year rule:
Regardless of your time limit, we recommend that you contact our medical negligence solicitors as soon as you can, even if at that stage you are only considering whether to make a claim.
By contacting us early, it avoids later problems with deadlines and allows us to advise you on how to collect and preserve essential evidence. This enables us to ensure you have the best chance of securing your entitlement to full compensation for your claim.
If a baby, child, or teenager under the age of 18 makes a claim for compensation for injuries caused by medical negligence, their claim is made on their behalf by a ‘litigation friend’. This is usually a parent or guardian.
As the child’s solicitor, we have a responsibility to make sure that all decisions relating to the claim are made in the best interests of the child. To do this, we work very closely with the child’s family. Some important decisions, such as settlement agreements or the amount of money that is allocated to a child in a claim involving more than one claimant, must be approved by the court.
We are specialists in helping families obtain full compensation for children who have been very severely injured, leaving them with permanent disability and lifelong specialist needs. Our expert children’s claims service includes a dedicated Court of Protection team who help our clients protect, budget and access their compensation via deputyship and trusts, and an SEN team to ensure that their special educational needs are met. Find out more about how we help families, children, and teenagers with children’s claims.
If you think that you or a family member have received negligent medical treatment or have experienced malpractice, we recommend that you speak to one of our friendly, experienced clinical negligence claim solicitors as soon as possible.
You can contact us by telephone or by email. Your enquiry will be handled confidentially and preliminary advice in relation to pursuing a claim will be given free of charge.
Our medical negligence solicitors will ask you to tell us briefly what has happened, advise you about the limitation deadlines (time limits) which apply to your claim and whether we are able to help you investigate your claim.
Once our initial investigations have taken place, we will notify the defendant (hospital or doctor) of your intention to pursue a claim and invite them to respond, giving them an opportunity to admit liability, before court proceedings are issued.
If liability is admitted, we will enter judgment and apply for an interim payment as soon as possible to meet any urgent needs that you may have as a result of the negligently caused injury.
If liability is disputed, we will discuss with you the further steps that we need to take to progress your claim.
Our extensive guide on making a medical negligence claim explains the whole process, if you require any further information.
The duration of a medical negligence claim depends on the individual circumstances of the client’s case. The claim is likely to take less time to conclude where:
Circumstances which make the claim more complex and therefore take longer to resolve include:
Our medical negligence solicitors work hard to secure early admissions of liability and substantial interim payments so that we can begin to alleviate financial hardship and provide essential care, respite, specialist equipment, therapies and home adaptations long before the claim has settled. With liability judgments secured and interim funds in place, the individual and their family are able to focus on rebuilding their lives whilst we concentrate on valuing and negotiating settlement of the claim.
Compensation is carefully structured to ensure the best provision for the injured person’s needs. Our clients often benefit from different types of compensation, including:
Where healthcare is found to be (legally) negligent, then the claimant (the person making the claim) must prove that their injury was caused or significantly worsened by the negligent care.
This is important because the patient may already be very ill when they receive negligent medical care. In those circumstances, they must prove that their injury (and its financial consequences) would have been avoided or greatly reduced if correct treatment had been given. This aspect of the medical negligence claim is known as ‘causation’. Causation must be proven, even if negligence is admitted, for the claim to succeed and compensation to be awarded.
Negligence and causation must be proven by supportive opinions from medical experts. We instruct experts in the same field of medicine as the negligent care to tell us whether the care that was given was of a reasonable standard. If negligence is proven, we ask medical specialists in the type of injury suffered, to confirm whether our client’s injury was caused or made worse by the negligent treatment, or would have been reduced or avoided with correct care.
In a medical negligence claim, compensation will only be paid for injuries and loss that we can prove were caused by the healthcare provider’s negligence. Once we know what mistakes were made, the next step (causation) is to identify the extent of the injury or disability that was caused by those mistakes.
Proving causation in complex medical negligence cases requires both medical expertise and understanding of the law. We often succeed in claims where NHS Resolution (the NHS’ defence organisation) has denied ‘causation’. You can read more about how we overcome difficulties with causation in complex birth injury cases.
Apr 2020
Our medical negligence and personal injury teams have been nationally recognised for over 20 years because of their expertise, empathy and commitment to securing maximum compensation for our clients.
What has to be some of the most testing horrible times was dealt with in a dignified, honest, approachable and truly empathetic manner. I could not begin to do Susan justice for her handling of our case.
I approached Boyes Turner after my claim was turned down by one of the Medical Negligence Claim company. My wife was a victim of medical negligence.
Boyes Turner have acted so efficiently on our behalf and was able to win our case. Anytime we contact them, their customer service was very good as they kept us fully informed of every level our case has developed. They are very friendly and approachable and great in their professional advise. I would strongly recommend anyone approach them for their legal and medical negligence services.
Thoroughly professional, knowledgable and approachable with communication and updates as and when needed, in what can be a drawn out process, I was always comfortable asking questions and always received answers which were clear and understandable. Highly recommend
I came to Boyes Turner desperate after searching the web for a firm to use for my sons case. He was only a few months so my mind was all over the place, but from the very first point of contact I felt a sense of relieve and belonging. I was welcomed and looked after by amazing staff who always communicated everything so well and went the extra mile to explain things and ensure I understood what was happening every step of the way (THANK YOU SUSAN BROWN). Susan was amazing I felt like I not only had a solicitor but someone who understood my emotions as a mother and always handled me with so much compassion and that was all I needed to keep me going for the 6 years of the case. Years went by in a breeze because of how professional Boyes Turner was. I am so greatful I went through it all with them and mananged to get my son a good compensation. We look forward our new life where my sons needs are priority after struggling for so long. Thank you Boyes Turner and thank you Susan Brown. My family and I are ever indebted.
From the moment I picked up the phone and spoke to Richard Money-Kyrle I knew I had done the right thing by choosing Boyes Turner to take our claim forward and to represent my son. Both Richard Money-Kyrle and Alpa Rana have worked on our case and they both have been amazing throughout, explaining every step of the way and anything we didn’t understand and keeping me updated constantly. This gave me and my family a lot of reassurance. Both Richard and Alpa are friendly and gained my trust and have been really easy to talk to which has made the process a whole lot easier and smoother than anticipated. The outcome of the claim was far more than I could have wished for and that was down to their hard work and expertise I couldn’t fault them they have been brilliant throughout the whole process I would recommend Boyes Turner to anyone.
