Boyes Turner’s spinal injury claims solicitors secured an admission of liability from an NHS trust after negligent hospital delays in MRI scanning, diagnosing and surgically treating a patient’s cauda equina nerve compression left her with permanent CES disability. Sudden escalation of back pain and new symptoms Our client’s back pain began with a deep ache in her gluteal muscles, which she tried to manage with stretches and physiotherapy. Two months later, her pain escalated suddenly with a tingling sensation down the back of both legs. She called NHS 111 and was advised to attend A&E. At A&E she was passed to the Urgent Care Centre, where she was noted to have pain and numbness at the back of both thighs and was unable to manage a straight leg raise. No examination of sensation was carried out. She was discharged with strong painkillers and advice to arrange an MRI scan through her GP. The next morning she awoke in pain and took painkillers at 5.30am. She awoke again at 8.30am in excruciating pain but managed to get to the toilet and pass urine. An hour later, she called 999 and was advised that she must attend A&E for assessment but they could not send an emergency ambulance. When she explained that she could not move, they told her to call NHS 111. She called NHS 111 and reported her ongoing severe pain, tingling and numbness in her buttocks with no bladder or bowel symptoms. Two further calls took place with an NHS 111 clinician in which she reported severe, deep gluteal pain and altered sensation in the back of both legs spreading to her buttocks. She rated her pain level at 10 out of 10, occasionally reducing but returning in waves. She thought her lack of bowel movements over the previous two days were from taking co-codamol painkillers. An ambulance was called. At 11.13am a paramedic arrived who noted her inability to mobilise, bilateral worsening sensation in her gluteal muscles, and tingling/pins and needles with an occasional feeling of warm air or water running down her legs. With Entonox pain relief she walked to the bathroom and noted a subtle change in her ability to pass urine, which she reported to the paramedic. By the time the ambulance arrived nearly four hours later, she was having difficulty passing urine. Delays in medical review, MRI scan, CES diagnosis and neurosurgical review despite red flag symptoms Our client arrived by ambulance at the hospital’s A&E department at 3.27pm (Day 1). Her history of gluteal and coccyx area pain, worsening pins and needles spreading from the back of both legs to her buttocks and difficulty passing urine was noted but she waited until 11.13pm to be reviewed by a doctor. The medical notes record the doctor’s impression as: ‘?cauda equina. Sciatica.’ A referral was made to the neurosurgeons at a more specialist hospital, who responded at 1.29am (Day 2) asking for more information. The query was answered by the A&E doctors at 6.38am, and the neurosurgeons asked to be informed after an MRI had taken place or following any other relevant clinical or radiological findings. In the meantime, our client remained in pain with worsening sensation around her ‘saddle area’. The plan was for her to be admitted under the orthopaedic team. By 8.33am, our client’s medical records show that cauda equina syndrome (CES) was suspected, and the plan was for her to have an urgent MRI scan with pain relief to help her tolerate the scan. A tolerable MRI scan finally took place at 4pm the next day (Day 3) and revealed a large central disc herniation at L5-S1 (at the lumbosacral joint in her lower spine) with severe narrowing of the spinal canal and likely cauda equina compression. The neurosurgeons were advised and she was finally transferred by blue light ambulance, arriving at the specialist hospital at 9.50pm. She underwent spinal decompression surgery at 3.07am (Day 4). CES claim leads to hospital’s admission of liability Our client was left with cauda equina syndrome (CES) disability, affecting her mobility, bowel and bladder and sexual function. In addition to her physical disability, she suffered a psychological injury. We helped her make a CES claim for compensation from the defendant hospital on the basis that her disability was caused by their negligent delays in medically reviewing her after she attended by ambulance, arranging an MRI scan and diagnosing her CES, resulting in delays in neurosurgical decompression. Given her red flag symptoms of cauda equina nerve compression, they failed to follow guidelines set out in the GIRFT National Suspected Cauda Equina Syndrome Pathway and ensure that our client had an MRI scan within four hours of a timely review. With timely MRI scanning, correct diagnosis and transfer for surgical decompression treatment, our expert believed our client would have made a good recovery and retained normal power and sensation in her legs as well as normal bladder, bowel, and sexual function. The defendant hospital responded to our letter of claim with an admission that their negligent delay in performing an MRI scan and in diagnosing our client’s condition had caused our client to suffer avoidable CES disability. We are now working with our client and our experts to assess the full impact of our client’s disability and her additional needs that arise from the negligent delays in her treatment. Our client’s immediate needs will be met by an interim payment whilst we prepare for settlement negotiations. 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.
