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Written on 8th March 2019 by Rachel Makore

This week we asked Alpa Rana, an associate - solicitor in the clinical negligence team, about her experience of successfully investigating cauda equina medical negligence cases

What information do you need from an individual who has concerns about delays in the diagnosis and treatment of cauda equina? 

I always listen to the client’s recollection and their concerns about the care they received first. It’s really important to understand exactly what has happened and how the client feels about it. To understand whether an investigation should take place, I usually ask the client to let me know:

  • What symptoms they experienced and for how long – particularly any changes in bowel or bladder function.
  • Details of the relevant attendances at the GP or hospital and advice they were given
  • What diagnosis they have been given
  • What treatment has been advised/given
  • The impact of the diagnosis and/or treatment

Can you investigate a case whilst an individual is still having treatment?

Yes. The fact that a medical negligence case relating to their cauda equina is ongoing should make no difference to the medical care the patient receives. It is best to investigate a claim as soon as possible, as the client’s recollection of events will be clearer. 

There are also legal time limits for bringing a claim for medical negligence, so it is better to investigate concerns as soon as possible after the patient suspects that errors have occurred

How are claims arising from delayed diagnosis and treatment of cauda equina funded?

Usually the case will be funded by a Conditional Fee Agreement (also called a “no win no fee agreement”) with After The Event insurance. This means that the client doesn’t have to pay any legal costs at the start of the claim and will not be liable for any costs if the case is unsuccessful. In a successful claim the majority of the claimant’s legal fees are paid by the defendant. I take great care in explaining the funding arrangement in detail to my clients to make sure they are entirely comfortable with the agreement. Where a claim, even if successful on its merits, is unlikely to be financially viable for the claimant, I let them know at the outset as we would never advise a client to pursue a disproportionately expensive claim.

How do you investigate whether a GP or the hospital acted negligently?

All cases are different and there is no one-size-fits-all approach to investigating a cauda equina case. I will, however, always need the GP and hospital medical records so in every case I request these and consider them carefully. I take a detailed statement from my client and, if necessary any family members or friends, to record clearly their recollection of what happened. 

Medical negligence claims must be supported by expert evidence and so the breach of duty evidence will depend on where my client initially attended and so I usually need to instruct a GP or an A&E expert, if the concern is with treatment received at an A&E department. The instructed expert will comment on whether the treatment was negligent and if so, what should have happened instead. I then need to instruct a consultant neurosurgeon to comment on causation ie whether the injury could have been avoided and the impact, if any, of the negligent treatment, for example, whether the outcome for my client would have been better.

Other medical experts may also be required. We select our experts carefully according to the needs of the individual case.

How do you calculate the level of compensation in a case arising from delay in diagnosis of cauda equina? 

The valuation is tailored to the individual client. No two cases are the same because no two clients are the same. I discuss with each client the physical and psychological impact of the negligence, and the extent of their financial loss. We take into account the side effects of any avoidable treatment/ surgery, whether they have been able to go back to work or are now on reduced hours and so experiencing a loss of earnings, whether they need extra help at home with cleaning and other chores. 

Cauda Equina Syndrome often causes permanent symptoms and so medical treatment or therapy may be required to alleviate the pain and discomfort they are experiencing, so I look at my clients’ needs for help not only now but also for the rest of their lives. I include the costs of any treatment or therapy required in the claim. I usually instruct experts to help assess the client’s current difficulties and their future outlook. This might involve evidence from experts who specialise in urology, pain, care, accommodation and psychiatry. 

Why do you think it’s important for cauda equina cases to be investigated?

Each of my clients have their own reasons for pursuing a medical negligence claim. Some say closure is the most important reason for them. They want to know if things went wrong in their medical care and what could have been avoided. As a delay in diagnosing cauda equina can lead to lifelong and life changing symptoms, most of my clients are seeking help and support to put their lives back on track with private medical treatment and therapy specific to their needs. Others are concerned about the financial implications for their family if they can no longer work to their full capacity and want the help that a successful claim can provide by alleviating the financial hardship. Cauda equina can happen to anyone, of any age or walk of life. It is vital that the medical professionals are aware of the red flag symptoms and act fast.

I therefore think that it is paramount that negligent cases are highlighted and investigated to ensure that there is continued awareness of the signs and symptoms of cauda equina so that all medical professionals are aware of the symptoms as the consequences of a delay in diagnosis are life changing and usually permanent.

Our cauda equina expert solicitors have helped lots of people over the years recover significant compensation to help with their ongoing symptoms and rehabilitation to make their quality of life the best it can be.

If you or a loved one have suffered from a delayed diagnosis of cauda equina syndrome then email the team to talk about making a claim at