Alpa joined Boyes Turner’s clinical negligence team in 2018. In her role as a specialist medical negligence solicitor, she recovers compensation for severely injured clients and their families. In this 60-second read, Alpa talks about amputation, its common causes from negligent medical care, and how she can help make a difference to her clients’ lives with compensation. Alpa, which medical conditions and their treatment most commonly lead to amputation? There are a number of different medical conditions which, if negligently treated, can lead to a patient needing an amputation. Many of the cases we see relate to the mismanagement of diabetes or the mismanagement of an unrelated injury in a person who has diabetes. Sadly, many of our amputee clients are patients with diabetes who have suffered foot injuries but then do not receive adequate treatment or onward referral to a specialist foot clinic. Sometimes amputation can be a result of meningitis or sepsis. In these cases, we are often investigating whether there was any delay in treating the conditions and whether an amputation might have been avoided with prompt treatment. In some cases amputation can be necessary for the treatment of certain types of cancers. As with cases relating to meningitis and sepsis, we will investigate whether there was any delay in the diagnosis or treatment of the cancer. How do you investigate whether there has been negligent treatment? One of the first things I do, when someone asks me to investigate their medical negligence claim, is to obtain their medical records and take their detailed witness statement. It is important that I hear from my client, in their own words, their recollection of what happened. I must then obtain the opinion of one or more independent medical experts to comment on the standard of care that my client received. This can be in relation to treatment provided at a hospital, walk-in-centre or GP surgery. Each client’s claim must be supported by medical expert evidence. Amputation claims can be complex and often require expert input from a number of different experts to establish whether there has been negligent treatment. We often also require input from experts specialising in vascular or orthopaedic surgery to advise on whether the amputation could have been avoided with correct treatment. In cases where the GP, hospital or NHS Resolution (acting for the NHS on their behalf) has admitted liability, we can often secure an interim (advance) compensation payment to help meet our client’s immediate needs. Interim payments can often be used to fund rehabilitation programmes, new prosthetics or a move to more suitable accommodation. One of the most rewarding aspects of my work is being able to see the difference that can be made with an interim payment and how it can make our clients’ lives easier and alleviate some of their hardship. Are there different types of amputation? Yes, there are many types of amputation. Where the client comes to us after they have been told they need an amputation as a result of negligent medical care, but before the amputation surgery takes place, we can often work with medical and prosthetic experts to ensure that their amputation is performed in a way that will optimise their rehabilitation and prosthetic options after the procedure. I have helped clients who have suffered amputations to upper and lower limbs. Each type of amputation brings its own implications and needs for the amputee. Amputations to the lower limb can include: above the knee (transfemoral); through the knee; below the knee (transtibial); where both legs are amputated (bilateral lower limb amputation); through the hip or knee joint (disarticulation); and different levels of amputations involving the foot, such as mid-tarsal, Lisfranc, Boyd and Symes. Amputations to the upper limbs can include: above the elbow (transhumeral); below the elbow (transradial); where both arms are amputated (bilateral upper); amputation through the shoulder, elbow or wrist joint (disarticulation); and hand, finger(s) or thumb amputation. What sort of challenges do your clients experience from their amputations? In cases involving lower limb amputations, one of the greatest challenges my clients face is in relation to mobility and walking. Using a prosthetic limb requires a lot of energy and takes a lot of perseverance and rehabilitation. It can take a while to get a prosthesis to fit comfortably and rest periods may be needed when the prosthesis has caused rubbing or blistering during which the prosthesis cannot be used. Some of my clients also suffer with ‘phantom limb’ pain. This is not uncommon in amputees and can be extremely painful and disruptive to our client’s lives. The pain can be constant or come and go and may need to be managed with medication. After an amputation, the amputee can become reliant on family and friends for help with everyday tasks such as cooking, cleaning, personal care and fetching and carrying items. Opening and closing windows can be a challenge for clients with amputated fingers and also for below knee amputees. This can be a difficult adjustment for the person needing the help who has lost their independence, but it also has an effect on the injured person’s wider support network. Many of our amputee clients are unable to return to work as a result of their injury or have to embark on re-training for a new role which can be difficult and challenging. Some clients are unable to return to the hobbies they used to enjoy prior to their amputation. Psychologically, it can be difficult for people to come to terms with an amputation. They may be self-conscious of their amputations or using their prosthesis in public or suffer emotionally from being unable to work or play with their children. It is always really important to bear in mind the psychological impact of an amputation as well as the physical impact. What difference can compensation make? The law says that the purpose of compensation is to put a person back in the position they would have been but for the negligent treatment. The reality for people who have suffered severe disability is that money alone cannot provide full restoration. However, I have seen the huge difference that compensation can make to our amputee clients’ lives, enabling them to pay for specialist private prosthetic input and high quality rehabilitation. A good prosthesis is the key to helping someone regain their mobility and independence. Our clients often face challenges in their own homes, such as narrow doorways which make it difficult to navigate a wheelchair throughout the house. Stairs can also be particularly challenging and many clients need single level accommodation so they can access every part of their home. Compensation can enable them to move to more appropriate accommodation or adapt a property to make it more accessible. Having the right specialist equipment can help an amputee regain independence as well, no matter what level of amputation. There are various items of equipment that can be funded by compensation to help with personal care, food preparation and meals, as well as equipment to increase independent mobility, such as specialist wheelchairs and adapted vehicles. Assistive technology can provide amputees with alternative ways to feel in control of their own home, such as by being able to open and close curtains/blinds and turn switches on and off. An amputation can leave a person feeling vulnerable, and assistive technology in the form of security devices can be useful and provide reassurance. Physiotherapy and occupational therapy (OT) are key elements of any rehabilitation programme for an amputee. Private therapy costs can form part of a claim for compensation. When valuing a claim of this nature, it is also important to consider the future needs of our clients and whether they may need more care and support in their older years as a result of their amputation. My clients’ ability to transfer safely in their home now and in the future is a common key concern in cases involving amputation. If you have suffered an amputation, or have been advised that you need an amputation, as a result of negligent medical care, you can talk to an experienced solicitor, free and confidentially, to find out more about making a claim, by contacting us here.