Boyes Turner’s cauda equina syndrome (CES) claims solicitors secured a £300,000 settlement for a 78-year-old woman after hospital delays in diagnosis and treatment of signs of deteriorating cauda equina syndrome left her with impaired bowel and bladder function, neuropathic pain, leg weakness and perineal numbness. New red flag symptom of CES ignored for patient with spinal stenosis Our client had a complex medical history with multiple conditions, including symptomless spinal stenosis (narrowing of the spinal canal with resulting compression on the spinal cord), back pain and sciatica, occasional urinary stress incontinence, and hypertension which slightly reduced her life expectancy. She was referred to her local hospital after she visited an out-of-hours GP complaining of increased low back pain, pain in both legs, a recent episode of urinary incontinence and a new red flag symptom of perineal (genital) numbness. She was seen in the hospital’s emergency department (A&E), where cauda equina was queried as a possible diagnosis. An MRI was planned and she was admitted to the ward, but the first MRI scan did not take place until the following day. MRI scans during her week-long stay in hospital were reported as showing no radiological acute change in her condition which would indicate the need for urgent surgical decompression, but they showed that she had severe spinal canal stenosis at L4/L5 with cauda equina compression, and the radiologist emphasised the clinical importance of potential cauda equina syndrome (CES). An opinion was obtained from a spinal registrar at a more specialist hospital, who declined to transfer her for decompression surgery on the assumption that she was simply suffering the ongoing effects of her longstanding spinal stenosis. She underwent bladder scans and investigations of her urinary symptoms during her stay in hospital, in response to her concerns, but these were assumed to relate to her pre-existing stress incontinence, and she was discharged from hospital a week after her initial A&E attendance. Late surgical decompression too late to avoid permanent CES disability Ten days later, our client was seen by a spinal specialist doctor as an outpatient at a different hospital. By this time she was experiencing bladder retention, reduced sensation in the ‘saddle area’ and perineal numbness. The doctor diagnosed CES and recommended admission for urgent L4/5 decompression surgery. The surgery took place the following day, but our client was left with ongoing impairment of her bladder and bowel function, leg weakness affecting her balance and mobility, neuropathic pain and reduced perineal sensation. Unchanged radiological evidence provided false reassurance despite new CES red flag symptom CES spinal cord injury (SCI) disability claims most commonly arise from delays in diagnosis of acute disc prolapse and delayed surgical decompression of the patient’s cauda equina nerves. In this case, however, our client had a longstanding, pre-existing spinal stenosis, with no apparent change in her condition when considered solely on the basis of radiological evidence from her scans. This provided false reassurance to the doctors at her local hospital and the spinal specialist at the specialist hospital, who failed to recognise and act swiftly on her new red flag symptoms of perineal numbness and altered urinary function. Helping our client make a cauda equina syndrome compensation claim Our client remained unaware that she might have grounds for a medical negligence compensation claim until six years later when she met specialist CES solicitor Julie Marsh at an event hosted by a CES support group. She instructed us to help her make a claim, and we quickly notified the two defendant NHS trusts of the claim and obtained their agreement to extend the limitation deadline for the purposes of issuing proceedings, subject to the disputed date of knowledge. We issued and served proceedings on the basis that, given our client’s new red flag symptom, she was negligently discharged by A&E and should have undergone emergency decompression surgery, which would have avoided her CES disability, with a secondary case that further delays during her admission also materially contributed to her disability. NHS Resolution denied liability, relying on the lack of radiological change to support their argument that there was no indication for acute emergency surgery in the absence of bladder retention when our client attended A&E. In their joint defence the specialist hospital accepted that our client’s need for urgent surgical decompression should have been recognised on the fourth day of her admission, when bladder retention would have been evident, and by which time they argued it would have been too late to avoid most aspects of her disability. £300,000 settlement provides home adaptations and increased accessibility Supported by our medical experts, we prepared the case for a liability trial, whilst pushing NHS Resolution to meet with us to discuss settlement at a mediation. Negotiations finally took place at an RTM (round table meeting) a few weeks before trial, resulting in a £300,000 settlement for our client. Our client’s settlement will enable her to make necessary adaptations to her home and garden to make them more accessible and suitable for her cauda equina syndrome disability. 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.
