Boyes Turner’s cauda equina syndrome (CES) solicitors secured an admission of liability from an NHS trust after hospital staff failed to arrange an emergency MRI scan for a patient with cauda equina red flag symptoms. Our client suffered permanent disability affecting her mobility, bladder, bowel and sexual function, owing to the resulting delay in surgical treatment for her cauda equina nerve root compression. New symptoms and safety-netting failure Our client had a history of lower back pain but developed a new symptom of pains shooting down her leg. For several months she managed the pain in her back and leg with painkillers prescribed by her GP and then called NHS 111 after a sudden onset of leg swelling, numbness and shooting pains up and down her leg. Following their advice, she attended the hospital’s A&E within an hour and was referred to the spinal team. The next day, the hospital records noted that she had symptoms of bladder dysfunction as well as the back pain, leg numbness and excruciating pain, but no saddle anaesthesia or problems with her bowels. The working diagnosis was progression of her disc herniation (slipped disc) with possible nerve impingement. An x-ray of her spine showed no injury or misalignment, and bladder scans showed she was not fully emptying her bladder. She was later noted to have had an isolated episode of vaginal numbness. She was told that she needed an outpatient MRI as soon as possible and was discharged from hospital with liquid morphine painkilling medication. She was not given safety-netting warnings about signs and symptoms of cauda equina syndrome or to return to hospital if there was a change in her symptoms. Failure to act on red flag symptoms for cauda equina syndrome (CES) Five days later, she contacted the hospital in the morning as her symptoms were worsening, with new symptoms of numbness in her ‘saddle area’. Correct treatment at this time would have been to recognise her repeated ‘saddle area’ numbness symptoms as red flags for cauda equina syndrome and arrange for her to have an emergency MRI scan, which would have shown impingement on the cauda equina nerves and would have led to emergency decompression surgery. Instead, she was told that she needed to wait for the outpatient MRI scan but warned to attend A&E if her symptoms worsened. The next day, she contacted her GP with ongoing numbness in her leg and buttocks area. The GP advised that she needed an urgent MRI scan and contacted the hospital spinal team. Meanwhile he told her to go to A&E. At the hospital she was taken immediately to the spinal ward where her worsening pain, leg, vaginal and perianal region numbness, reduced anal tone, and bladder symptoms were noted. An MRI the same day revealed disc extrusion affecting the cauda equina nerves. She underwent spinal decompression surgery the next day but was left with permanent disability from cauda equina syndrome. Admission of liability, apology and interim payment We pursued a medical negligence claim for our client and secured a formal apology for our client and an admission of liability from NHS Resolution. The NHS defence organisation admitted that the hospital should have called our client in for assessment when she contacted them with further ‘saddle area’ numbness symptoms, instead of advising her to continue to wait for the outpatient MRI scan. They accepted that if she had been correctly assessed, she would have undergone an urgent MRI scan which would have shown the same results as the later MRI, and this would have resulted in emergency decompression surgery, which would have avoided or reduced her ongoing disability. We secured a £50,000 interim (advance) payment to pay for mobility aids and specialist equipment, as well as psychological counselling and support, whilst we work with our client and our experts to value the claim in preparation 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.
