At 36 years of age, Dan was very familiar with back pain. He’d lived with the condition since his 20s and, on the advice of his doctors, had managed a troublesome bulging intervertebral L4/5 disc in his lumbar spine with painkillers and physiotherapy. Recently, however, his back pain had become more severe, with new symptoms of foot drop and paraesthesia ( pins and needles) in his foot and thigh. An MRI scan revealed that the troublesome L4/5 disc had slipped. He tried diclofenac (NSAID) injections and when they didn’t work, he sought help from A&E, but was told to continue with his exercises and painkillers. Eventually he called an ambulance, but the crew who came to his home refused to take him to hospital, advising that A&E would not be able to help him. Unable to do anything else, he stayed in bed at home. Recognising red flag symptoms of cauda equina syndrome The next afternoon as he got out of bed, Dan experienced a sudden numbness which flooded his buttocks, genitals and thighs. He remembered that he had been warned by the ambulance paramedic and other doctors that symptoms like this could be caused by cauda equina syndrome (CES). He knew he needed help. Dan recalls, “I knew that something was wrong at that point, when it happened, when I felt that flood and that snap. But I didn't know what to look for, and the symptoms that I’d been having were mainly surrounding pain. But all those other symptoms I was having… It was just like, ‘Help me, just help. I need someone to actually help me and sort this out. I'm in pain. I don't know what to do’.” Hospital delays and further red flag symptoms Dan called NHS 111 and was told to make his own way to hospital. He called a taxi and arrived at the hospital later that afternoon. At the hospital, he expressed his concern that he had cauda equina symptoms, but it was a further hour and 39 minutes before he was seen by an emergency department (ED) doctor. “I wasn't aware of the sense of urgency. What I was aware of was my confusion, but also an apathy, because everywhere I'd gone, every time I'd been in, everyone I'd seen, and the ambulance service… they'd all just been like, ‘No you're fine. You're fine. You're fine’. So, when I'm in the A&E that day and they're doing all those tests, they're still saying, ‘No, we don't think this is cauda equina’ but now I cannot feel anything below the waist.” By the time Dan was examined by a doctor, he had developed bladder retention. He was admitted to the hospital with suspected CES. An MRI scan 3½ hours later confirmed that his cauda equina nerve roots were being compressed by the L4/5 disc, which had slipped. It was nearly midnight by the time a radiologist confirmed and communicated the MRI diagnosis of CES to an A&E doctor, who then asked for him to be reviewed by the neurosurgical specialist registrar. He remained on the neurosurgical ward overnight, where he developed further distressing symptoms of weakness in his legs and urinary dysfunction. The following morning, he finally underwent surgery to remove the slipped disc and release the pressure from his cauda equina nerves. No communication, no information, no support Dan recalls that nobody at the hospital ever discussed with him what his condition might mean, either before or after his surgery. “They go through the general anaesthetic risks… you know, you could go blind. That's the only one I remember them saying. You could go blind because of the position of the operation. That was it. And then I wake up and I'm lying there and I still don't know that things are wrong. I'm like, I can't feel. Why can I not feel my legs still? Why can't I move my feet? What's going on here? And it was days before anyone came and tried to explain that to me.” He was discharged from hospital four days later, with no information about what to expect from his condition, and with no signposting or ongoing support. “There was absolutely nothing. I had no indication from anybody in the hospital on discharge as to what would happen or what to expect. Somebody came around at some point and just said, “Stand up. Put your hands on the bed. Can you raise this foot? Can you do this?” And of course, I'm determined, so I tried to do it, but any kind of movement means you can do it. So that was it. I had no idea what to expect at all. Frightening, really. “After discharge, it was minute by minute. So, it was like, OK, we're going. We're trying to leave hospital, and I'm saying, ‘Can I have a wheelchair?’ Then that became another barrier. I couldn't get one, so I struggled out of the hospital by myself. My partner helped me up. I was using the walls. I could barely get out of the taxi. I got through the door and I met with stairs, as we lived in a flat. It took me, oh I reckon, 10 minutes to get up one flight of stairs, maybe longer. And my poor partner. I don't know what she was thinking but I was just thinking I need to get up these stairs. I was thinking minute by minute at this point.” Making a claim for cauda equina syndrome compensation Whilst the surgery relieved Dan’s back and leg pain and he eventually regained his mobility, he was left with permanent urinary, bowel and sexual disability. “My partner was very positive. ‘You'll improve. You'll get better now’, but I absolutely couldn’t see how that could happen. "The unjustness of what had happened was what drew me to my web browser. I typed in cauda equina spinal injury NHS failure, or something like that, and then was reading on blogs and having a little look about and seeing that people had experienced similar things.” Dan’s search led him to Ben Ireland at Boyes Turner’s clinical negligence team, and ultimately to a successful claim for compensation from the NHS trust. However, whilst appreciative of the successful outcome, Dan remains frustrated by NHS Resolution’s defensive response to what has happened and refusal to acknowledge that the hospital delays in performing the MRI scan or decompression surgery were negligent and responsible for Dan’s disability. “I felt some satisfaction from the litigation but that was largely from the money. But what I didn’t get, which is what I wanted and why I set out to do what I did, was to establish, ‘What have you [the NHS] learned from this? What are you going to do differently? How are these things going to change your policies?’ “During the litigation process, looking back at some aspects of my medical treatment, the specialists would point out, ‘Well, that's within the normal parameters’, instead of questioning why it shouldn't be. It's quite clear that there's something fundamentally wrong with that. So, what are the hospitals, the NHS, the ICBs… going to do about that? And I think that's what I'm missing from this… a sense of achievement or justice around their learning, because they [NHS Resolution] apologized and they thanked me in the meeting, but it was largely meaningless. You know, they would have gone and never thought about that again. What's happening in the NHS? That's what I want to know, because you only have to go to the support groups or go online to see that it's clearly happening more and more.” Access to specialist medical advice and information Through the claim Dan was able to gain more understanding of what has happened to him, with access to specialist advice and support for his CES-related needs. At times, this was uncomfortable, particularly as he began to realise the potential impact of his injury. “I only got any of the help or insight into my disabilities because of litigation. So, had I not sought litigation, I wouldn't be any the wiser, because I'd still be flailing around trying to get people to help me. The medical expert’s report was fascinating. I remember reading it a lot. I found it helpful because it gave me insight into what was happening in my own body and why it was happening. Some of the things that were written were very clinical, but because of my job [as a social worker], it was like reading work stuff, and so I could separate myself emotionally from that. “I got more and more angry, as we discussed things in legal meetings and evidence was found, and I went to appointments and spoke to more specialists and learned, that's it, that's the way it is now. I remember, in particular, reading a sentence saying something like ‘this man will experience bladder and bowel issues by a certain age,’ and I'm like, you don't know that. None of us know that. And I do still believe this. I might improve one day by a tiny amount or I might get worse. So, I take things like that with a bit of a pinch of salt and just understand that, in relation to me specifically, no one really does know for certain. So, I think you've got to be rational when you read those things. Some of those things gave me severe anxiety because my frame of mind at that time was quite heightened, because I was thinking and talking about this every day, all the time.” Mediation leads to settlement of the contested CES claim Despite NHS Resolution’s defensive stance throughout the proceedings, they agreed to enter into alternative dispute resolution (ADR) via a mediation, which ultimately resulted in a substantial compensation settlement for Dan. Dan recalls his thought process before and during the mediation; “It was horrible because I had to make decisions! Ben and the barrister might have had the right ideas about where we would have gone, but when it came to it, the decision was for me to make. I just thought, ‘This isn't about greed. You're in this place. This is a completely reasonable amount of money’. But it felt like a ridiculous amount of money. It was anxiety inducing, going in and out and then waiting and coming back. But then, there was a point in the mediation where they jumped from quite a low figure to up here, and I could see that with another two times backwards and forwards we could get there, and I felt comfortable with that. I'd gone into it thinking, ‘Right, what can I do to sort myself out now, so I don't worry at all?’ That's all I was thinking. I'd set my own limits for myself, because I know what I'm like, and I thought that if that's the way I'm going to deal with it, then I'll be happy. And it was better than I expected. I went into it knowing what I wanted and we far surpassed that. So, I was happy with that.” Dan experienced multiple benefits from making a claim On balance, was making a claim worth it? “I’m glad I did it, largely for all the medical attention that I had. The detail in the report is one thing, but there's something about the care and attention that you get. There's something human about it that legitimizes what you're experiencing and that is what was missing, sadly, from the NHS, but I got with the private care through litigation, which is such a scary prospect for the general population. “And when I think about it, the whole thing was almost cathartic. I was going to a specialist and I was talking to Ben, which took the burden off my partner, but those things were also achieving something for me positively. I wasn’t just going to counselling and talking it through. I actually had agency in my situation to change it, to take some positive action for myself, and that that's what helped. I was talking it through with people that were helping me to get to a legitimate outcome. And I felt well guided through the litigation, albeit with some unknowns, but at no point did I feel like there wasn't a map or a plan. Sometimes it was exhausting, actually being in litigation, but I thought that Ben was pretty good at explaining what would or might happen. “If someone came to me and asked if they should do this in a similar situation, I would say yes. And I would say, ‘You will be supported. At first it may feel clinical or awkward, but it won't if you start to reflect on it and just open yourself up to it’. It depends, I suppose, on who the person is and how they're going into it and what they're going into it for, and I guess, everybody's going to feel it differently, aren't they?” Making plans for the future after CES With the successful claim behind him, Dan is now beginning to look towards the future. He doesn’t deny his frustrations but he is beginning to see the way forward and is taking sensible steps to plan for whatever lies ahead. “Blindly somewhere inside, I still think that something might improve. I've since spoken to Spinal Injuries Association, for example, and actually got an appointment from them, which is really good. Previously, I was just lethargic about it. I was just like, well, what's this? This is it. This is my life now. I'm disabled. Well, great, thanks. It didn't seem like it was my fault. Why did it happen to me? We would all say the same thing, wouldn't we? Why has it happened to me? Well, it has. “So, I've done the things that I needed to do to set myself up so I don't worry about money. So, I think for me it was just about making sure that I was secure. And for the first time in a long time, I feel financially safe and comfortable.” 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.
