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Written on 19th March 2024 by Julie Marsh

Boyes Turner’s spinal cord injury (SCI) specialists secured an admission of liability from an NHS trust in a CES claim for a young woman whose hospital doctors failed to provide her with safety netting advice about her risk of cauda equina syndrome.  NHS Resolution, representing the NHS trust, denied liability in response to our client’s letter of claim but soon afterwards, when proceedings were issued, they admitted in their defence that the A&E doctor’s ‘safety netting’ advice to our client was negligent.  

Back pain and new sciatica symptoms led to risk of cauda equina syndrome

Our client had a two-year history of lower back pain. She had a telephone consultation with a GP surgery paramedic when her symptoms worsened after running, despite chiropractic treatment. The paramedic noted her history of low back pain and recent stiffness, with cramping and tingling down the inside and back of her right leg into her foot. She was referred for physiotherapy. At a further telephone consultation with a GP she complained of lower back pain, with overwhelming pain down her right leg, tingling in her toes and numbness. She was advised to look for sciatica stretches on the NHS website and prescribed medication for neuropathic pain. The GP planned to order an MRI scan.  

Hospital doctors fail to warn patient about cauda equina syndrome (CES)

The next morning the overwhelming pain in her right leg and across her back affected her ability to dress herself and get her children ready for school. Her feet felt like frozen blocks of ice, and she was so worried by her symptoms that she called a taxi to take her to hospital.  At A&E her back pain, three-week history of right leg pain, numbness, tingling and difficulty mobilising were noted, as well as no disturbance of bowel or bladder function and normal rectal sensation. The doctor noted lumbar disc prolapse (slipped disc) and discussed her case with the trauma and orthopaedic registrar.

The registrar did not see or examine our client in person, but advised that her symptoms would probably resolve in 6-12 weeks. Possible future options included an MRI scan, injection and surgery. A GP referral to the spinal clinic was planned. Despite her history of back pain, sciatica and worsening symptoms our client was discharged without any ‘safety netting’ advice about what to do if her symptoms worsened or warned of any specific cauda equina symptoms to look out for.

Red flag symptoms of cauda equina nerve compression

Later that evening, she noticed similar pain and tingling developing in the left leg to the symptoms in her right leg. Unaware that this was a red flag symptom of cauda equina nerve compression needing urgent treatment, she stayed in bed and the next day noticed genital numbness which spread down her legs over the next few days. This was another red flag for cauda equina nerve compression but without safety netting warnings she assumed that the numbness was a side effect of her medication. She emailed her GP surgery which responded two days later with a telephone GP appointment for the next evening. The GP noted her recent history of increasing pain, spreading numbness and loss of sensation, as well as weakness and reduced power in both legs, with normal bowel and bladder function. She was advised to attend A&E the same evening and after triage, assessment by a doctor and review in the trauma and orthopaedics department, she was referred to a more specialist hospital where she underwent decompression surgery the next day. 

Our client has been left with pain, fatigue, numbness and disability, including problems with mobility, pain, and impaired bowel, bladder and sexual function. 

Making a cauda equina syndrome CES claim after safety netting failures

We helped our client make a CES claim against the NHS trust whose doctors had discharged her without giving her safety netting information to help her recognise any dangerous symptoms of cauda equina syndrome and advice to seek urgent medical help if symptoms appeared. We pursued the claim on the basis that with correct safety netting information before her hospital discharge, she would have returned to A&E on the day her red flag symptoms appeared. This would have led to earlier diagnosis confirmed by MRI scan and urgent surgery, which would have avoided her disability. We invited NHS Resolution to admit liability on behalf of the NHS trust and to help meet our client’s immediate needs for rehabilitation.

NHS Resolution admit liability after court proceedings issued 

NHS Resolution’s initial letter of response denied that there had been any negligence by the hospital clinicians. However, when we issued and served proceedings NHS Resolution’s defence reversed their recently stated denial and admitted that the safety netting provided to our client was negligent, delaying her surgery by at least five days.

We are now obtaining an interim payment to meet our client’s immediate needs whilst we work with her and our experts to value the ongoing claim.

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.