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Hypoxic ischaemic encephalopathy (HIE) brain injuries caused by lack of oxygen to the baby’s brain around the time of birth are the most common cause of claims from negligent maternity and neonatal care. These injuries are devastating, often causing the child a lifetime of physical and/or intellectual disability and leaving them forever dependent on others for all their daily needs.
At Boyes Turner, we understand the impact that HIE birth injuries have on the child and their family, now and into the future. Our cerebral palsy specialists have helped hundreds of families affected by HIE birth injuries to claim their child’s entitlement to compensation to help pay for care, adapted accommodation, therapies, specialist aids and equipment, special education and lifelong needs.
HIE (each letter is pronounced separately as H.I.E) is a shortened form of the medical term hypoxic ischaemic encephalopathy.
Hypoxia = Lack of oxygen.
Ischaemia = Lack of blood supply to an area of the body.
Encephalopathy = Disease or damage which affects the brain.
Newborn babies who are diagnosed with HIE have suffered an injury to their brain from a disruption to their blood oxygen supply during pregnancy, labour, and delivery or immediately after birth. This can lead to cerebral palsy and neurodevelopmental injuries.
Other medical terms such as asphyxia or anoxia are sometimes used to describe brain injuries at birth from lack of oxygen.
Many of the parents who come to us after their child’s birth injury know little about HIE, but are beginning to realise that mistakes or problems at birth may have injured their child’s brain.
They may have been contacted by the hospital trust where their baby was born or invited to meet with representatives from NHS Resolution, HSIB or MNSI. This is because all stillbirths, neonatal (newborn) deaths or brain injuries to babies from HIE must be reported by the NHS.
If you have contacted about the birth of your baby, you should contact us for free, independent, specialist legal advice straight away.
If negligent care during pregnancy, labour, delivery or immediately after birth has caused your child to suffer an HIE brain injury, your child may be able to obtain to an immediate interim payment and will be entitled to substantial compensation. If you are considering making a hypoxic brain injury claim, we can offer both Legal Aid and no win no fee (Conditional Fee Agreement) funding options. We will talk the options through with you so that you have all the information you need to make a decision on which funding mechanism to use.
Our clients receive the highest standards of advice and representation and are always treated with compassion, outstanding care and understanding of the physical, emotional, psychological and financial impact that life-changing injury can have upon their lives.
HIE is a serious condition with long-term consequences for the child. There are different grades of HIE which indicate the severity of the injury to the brain.
Newborn babies who are suffering from HIE may show any of the following signs and symptoms in the first few hours or days of life:
Babies who have HIE often need help with breathing and may need resuscitation and ventilation immediately after birth. They require specialist neonatal care and may be transferred to the neonatal unit (SCBU, NNU or NICU). If the baby has moderate or severe HIE, they will usually be treated with therapeutic hypothermia, also known as ‘controlled cooling’ or simply ‘cooling’.
The following tests are often used to provide a formal diagnosis.
The umbilical cord blood test that is carried out immediately after the baby’s birth provides information about whether the baby was deprived of oxygen (hypoxia) during labour and delivery. As soon as the baby is born the midwives test samples of blood which they take from the blood vessels in the umbilical cord.
The umbilical cord has one vein and two arteries. The vein takes food and oxygen from the mother (via the placenta) to the baby. The two arteries take the waste (including carbon dioxide, lactic acid) from the baby back to the placenta/mother. When a baby has been starved of oxygen in labour, the blood sample from the umbilical artery contains an abnormally high level of acid.
APGAR scores are another commonly used way of checking the condition of a newborn baby. The acronym ‘APGAR’ comes from the five things that are checked and scored when carrying out the test.
The midwives rate the baby’s appearance, pulse, grimace, activity and respiration, at one minute, five minutes and ten minutes of age. Each sign is given a score between zero and two. The combined total score (out of ten) at each point in time that the test is taken gives a general impression of the newborn baby’s health.
The APGAR score is less reliable than the umbilical cord blood test because it depends on the midwife’s observation of the baby. However, if a baby has low APGAR scores at five and ten minutes of life, this may indicate that they have HIE.
Where there is concern that a baby has suffered an injury to their brain, an MRI scan can identify which areas of the brain have been damaged. MRI brain scans are used to diagnose other conditions affecting the brain as well as HIE. The cause of the injury and its timing and severity can often be identified by the pattern of injury on the MRI scan of the baby’s brain.
When a baby has moderate or severe hypoxic ischaemic encephalopathy or HIE from oxygen deprivation but is expected to survive, they must be treated with therapeutic hypothermia, more commonly known as ‘cooling’.
This treatment has been found to slow down the rate of damage that is caused to the brain from hypoxia (lack of oxygen). If correctly administered, controlled cooling can significantly reduce the injured baby’s permanent physical disability.
During cooling, the temperature of the baby’s brain is lowered from normal body temperature of 37°C to between 33°C and 35°C.
In our experience as specialist claims solicitors acting for children with neurological disability, we recognise that cooling helps reduce severe physical disability from HIE, but caution that it does not always provide a total cure. Cooled babies are sometimes left with ongoing subtle, neurological impairments which only become evident when the child struggles to keep up at school. In these cases, the child and young adult may need significant care and support both at school and as they transition into work and independent life.
Examples of negligent care which can cause HIE and lead to a hypoxic brain injury claim include the following:
HIE brain injuries are complex and can lead to a range of neurological impairments and disabilities.
Each of our clients’ injuries will have a unique impact on their health, physical and mental capabilities, and their life. In each case we work with a team of experts to ensure that we understand the full extent of our client’s injury and disability. This ensures that we can assess how their condition will develop and secure compensation which meets their additional needs for the rest of their life.
Our clients’ injuries and disabilities often include one or more of the following:
Compensation claims for HIE birth injury are among the highest settlements that we achieve for our clients.
This is because the compensation reflects not only the injury, but the lifelong cost of meeting the additional needs that arise from our client’s disability.
Each client’s compensation is carefully calculated to compensate them for the way their injury will affect their lives, in the context of their own personal and family circumstances.
Following HIE birth injury, our clients’ settlements often include compensation for:
It takes extensive experience of birth injury claims and specialist expertise to investigate, understand and assess the financial impact of a birth injury on a baby’s life. Boyes Turner’s nationally acclaimed cerebral palsy and birth injury lawyers have acted for brain-injured babies for over 40 years. We are experts at recovering substantial interim payments and maximum compensation settlements for our clients.
£21 million settlement ( £6.59m plus lifelong, annual payments of £250,000pa) for a teenager whose hypoxic brain injury and cerebral palsy was caused by negligent maternity care at the time of his birth. After forcing an admission of liability from the defendant hospital, we secured an interim payment of £250,000 to meet our client’s needs whilst the claim was ongoing.
Liability settlement in an ongoing claim for a boy who suffered an HIE brain injury from lack of oxygen immediately before and immediately after his birth. The injury left him with dyskinetic cerebral palsy, cerebral visual impairment, epilepsy and learning disability. A period of cooling probably significantly reduced the extent of his neurological damage. The 90% liability settlement was obtained despite apparently normal midwife records of the unborn baby’s heart rate during labour and the defendant hospital’s denial of liability.
£19 million settlement (£3.9m lump sum plus lifelong payments of up to £158,500pa) for a girl who suffered an HIE brain injury and dyskinetic cerebral palsy as a result of negligent delays in her delivery. We secured an admission of liability, an apology and an interim payment of £200,000 to meet our client’s immediate needs whilst the claim was ongoing.
Multi-million dollar settlement in an international claim for a child who suffered an HIE brain injury as a result of oxygen deprivation during delays in his delivery at a London hospital. Our client’s compensation reflects the costs of meeting his additional needs from his disability in his current country of residence.
£5million plus lifelong payments of up to £232,750pa plus guaranteed full funding of a Treloar’s SEN placement for a boy who suffered traumatic and HIE brain injuries from an attempted forceps delivery which delayed his birth. We secured an early admission of liability and judgment against the defendant and interim payments totalling £900,000 to meet our client’s immediate needs arising from his cerebral palsy and severe disability whilst the case was ongoing.
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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.
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.
Fran has been an amazing support through a very difficult time for me and my family. Always available to speak and kept me in the loop with anything happening, she has been so kind, and I thank her so much for helping and getting my mum the justice she deserved.
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.