Boyes Turner’s CES claims specialists have secured an admission of negligence from an out-of-hours doctor who failed to examine a patient with emerging signs of cauda equina syndrome. The failure to examine the patient and refer immediately to hospital for an MRI scan and surgery, or to warn him about the need for urgent hospital treatment for worsening signs of cauda equina syndrome led to a delay in his surgical treatment. He has been left with pain and hypersensitivity in his legs, bowel and urinary impairment, and depression. Back problem affecting legs, bowel and bladder suggested cauda equina syndrome Our client had suffered back problems, including chronic back pain and sciatica, for approximately 10 years. His back pain began to worsen and he developed spasms in his legs. Over-the-counter painkillers were ineffective. He called his GP surgery and an emergency appointment was arranged for him to see a GP later that day. The doctor who saw him noted that his back pain had worsened but he was able to walk and work and there was no bladder or bowel involvement. (Alteration in bowel or bladder function or sensation are both potential red flag signs of spinal cord compression and cauda equina syndrome.) He was given a prescription for strong painkillers (codeine) and advised about what to do if his condition worsened. This is known as safety-netting. His condition worsened over the next few days. He was seen at home by a paramedic practitioner from the GP surgery. He had pain over his buttock down to his ankle, was struggling to pass urine and had not opened his bowels for two days. The paramedic discussed the patient’s condition with two GPs on his return to the surgery. One suggested a spinal referral. The other contacted the patient but did not arrange to examine him or to refer him to hospital for further investigations. Loss of bladder control – red flag symptom of CES A week later, he contacted the out of hours service. The records noted severe pain, little feeling in his left leg and a new loss of bladder control. The out-of-hours doctor visited him at home, diagnosed sciatica and gave him an injection of the anti-inflammatory painkiller, Voltarol. Despite the out-of-hours service call handler’s note of the patient’s ‘new loss of bladder control’ – a red flag sign of cauda equina syndrome – the visiting doctor did not examine him, or refer him to hospital for urgent investigation and treatment of cauda equina syndrome. No cauda equina safety-netting warnings were given. The next day, the patient could no longer tell when he was passing urine. His wife called the GP practice asking for an emergency appointment. She called again and discovered that her husband had been scheduled for a normal appointment instead of an emergency appointment. He was taken to hospital by 999 ambulance for emergency department (A&E) review with suspected cauda equina syndrome. He was admitted to hospital where an MRI scan revealed that a protruding disc was pressing on both his S1 (at top of the sacrum) nerve roots. He had decompression surgery later that day and recovered well from the operation but has been left with ongoing bladder and bowel impairments, leg pain, leg weakness and numbness and depression. Making a claim for cauda equina syndrome after medical negligence We pursued a claim for compensation for our client’s injuries against the out-of-hours doctor who failed to act on our client’s loss of bladder function, a red flag sign of cauda equina syndrome, when he visited him at home. The claim was made on the basis that correct treatment would have involved examining our client and referring him to hospital for emergency review and treatment with suspected cauda equina syndrome. The doctor’s failure to do so led to a critical 24 hour delay in treatment which contributed to his ongoing disability. The out-of-hours doctor admitted that he failed to examine our client or provide safety-netting advice. He denied that our client’s eventual surgical decompression was delayed or that our client’s impairments were caused by the mistakes in his treatment. Following these admissions, our CES specialists entered into negotiations with the defendant doctor’s legal team and achieved a 70% liability settlement for our client. A substantial interim payment will help meet our client’s immediate needs whilst the case continues towards final settlement. You can read about the compensation we recovered for our client and the final settlement of this claim here. If you have suffered disability from cauda equina syndrome (CES) or spinal injury as a result of medical negligence, you can talk to one of our solicitors, free and confidentially, to find out more about making a claim by contacting us here.