Amputation is becoming more common in the UK with increasing numbers of people requiring surgical removal of limbs, hands or feet to treat complications of diabetes, arterial disease and serious infection. Whilst lifestyle choices, such as smoking, diet, activity levels and self-care, increase an individual’s risk of amputation, many amputees may not realise that their disability was caused by negligent medical care. Conditions such as meningitis and diabetic complications can lead to serious injury, but in most cases, with swift action and correct treatment, life-changing amputation should be avoided. Where an otherwise avoidable amputation was caused by medical mistakes or delays in treatment, the amputee may be entitled to claim compensation for their disability and its financial consequences. Types of amputation The term ‘amputation’ refers to surgical removal of a part of the body. The disability that follows amputation depends on how much of the limb (or limbs) are removed. The level of the amputation (and the remaining stump) will also determine whether the patient will be able to regain some mobility or dexterity. Unless the surgery takes place as an emergency, the patient’s later rehabilitation may benefit from having a prosthetist (specialist in making and fitting artificial limbs or digits) involved in the surgical team’s planning of the amputation procedure. Early prosthetic advice may also reduce the need for further additional surgery. Through-foot (including Charcot and Lisfranc amputations) and toe amputations affect walking and balance. Ankle disarticulation (Syme amputation) removes the ankle, leaving a person able to mobilise without a prosthesis. Transtibial or below-knee amputations are above the ankle but below the knee. Amputation at this level retains full use of the knee but makes it difficult for amputees to put any weight on the remaining stump. Knee-disarticulation (through-knee) amputations remove the lower leg completely. Whilst the stump can bear weight, it is difficult to create a prosthesis Transfemoral (above-knee) amputations are at thigh level, allowing the person to sit upright. The stump cannot take the entire bodyweight. Hip disarticulation (through- hip amputation) removes the entire leg although the upper femur might be left so that a prosthesis can be fitted. Hand, partial hand and digital amputations include parts of fingers and fingertips. Loss of the thumb affects the person’s ability to grasp objects. If more than one finger is amputated surgery may be carried out to reconstruct muscles to assist with grasping. Wrist disarticulation removes the hand at the wrist joint. Metacarpal amputation removes the entire hand but leaves the wrist intact. Elbow disarticulation or transradial amputation removes the forearm at the elbow. The remaining stump can bear weight. Transhumeral amputation removes the arm from above the elbow Shoulder disarticulartion and forequarter amputation remove the whole arm, shoulder blade and collar bone. What are the most common medical negligence causes of amputation? Complications of diabetes One of the most common causes of lower limb amputation in the UK is diabetes and its complications. The increase in the numbers of Type 2 diabetics has been linked to an alarming rise in the number of lower limb amputations. Earlier in 2020 Public Health England and Diabetes UK reported that 27,465 diabetes-related lower limb amputations were carried out in this country over the last three years. Diabetes is a serious condition caused by excessive levels of sugar in the blood. The number of people with Type 2 (lifestyle- related) diabetes is currently increasing at an alarming rate. Leading diabetes charity, Diabetes UK, estimates that around 5 million people in the UK are suffering from the disease. One million of those don’t know they have it, as they have not been diagnosed. People with diabetes are 20 times more likely than those without the condition to suffer an amputation. People with diabetes are at higher risk of amputation through a combination of side effects of their condition. Chronic high blood sugar damages their blood vessels, affecting their circulation to their feet and legs. The condition also causes nerve damage which reduces sensation or feeling in their feet. Another complication of diabetes is loss of vision from retinopathy. The combined effect of these problems means that someone with diabetes may not notice (by seeing or feeling pain) a minor foot injury, such as a small cut or blister. Instead of treating the minor problem and protecting their feet, they remain unaware of the injury and continue to walk on the foot or allow a small cut to become infected. Without careful, daily foot checks and specialist foot care, small infected wounds become ulcers, which are the originating cause of 80% of amputations. Over time, if ignored, minor ankle sprains and foot injuries can develop into more serious deformities, such as Charcot foot. By the time a serious infection, ulcer, or deformity has developed, the injury is much harder to treat. The increased amputation risk to diabetic patients and the importance of specialist foot care are well known. Given the speed with which diabetic foot problems can develop into limb-threatening illness, the NICE Guideline, Diabetic foot problems: prevention and management, recommends that people with diabetes have rapid access to a multi-disciplinary foot care team when they have a foot problem. Despite this guidance, and the shocking numbers of diabetes-related amputations, Diabetes UK reports that 1 in 6 hospitals still do not have multidisciplinary specialist foot care teams (MDFT). Boyes Turner’s amputation lawyers regularly help recover compensation for diabetic amputees after GP and hospital failure to recognise their increased risk of potentially limb-threatening injury and to refer them urgently for specialist foot care treatment. Our recent cases include: a client who suffered amputation after delayed diagnosis and treatment of Charcot foot. a client who suffered sepsis and amputation after a nurse practitioner failed to refer him urgently to a multidisciplinary foot care team after a minor foot injury. Infection – meningitis, septicaemia, sepsis Severe infection, such as meningitis and septicaemia (blood poisoning), is a cause of amputation. Meningitis and septicaemia are medical emergencies which require urgent admission to hospital and intravenous antibiotics. Delay in diagnosis, referral or correct treatment can be fatal or can result in devastating disability including multiple amputation. When septicaemia or blood poisoning occurs, the infection is rapidly spread around the body, causing damage to blood vessels. The body reacts to the infection by prioritising the blood supply to the vital organs, such as the heart, brain, lungs, liver and kidneys. This reduces the blood and oxygen supply to the extremities, such as the finger and toes, hands and feet, and the skin. Without sufficient blood and oxygen these peripheral areas begin to die (necrosis). In these circumstances, amputation may be necessary to protect the rest of the body and save the patient’s life. Where delays in diagnosis of infection lead to meningitis, septicaemia/sepsis and severe disability from amputation, the patient may be entitled to compensation for the disability and its financial consequences that arose from the delay. We regularly recover substantial compensation for severely disabled clients who suffered amputation as a result of delayed treatment of severe infection. In a recent case, our amputation lawyers negotiated a £750,000 settlement for a woman with multiple amputations, involving both hands and feet, after delayed, inadequate treatment of post-operative sepsis and necrotising fasciitis. Jan has kindly shared with us her experiences– you can read more about how compensation has helped her begin to rebuild her life. Peripheral ischaemia and thrombosis Peripheral ischaemia, where an extremity of the body is deprived of oxygen, is another cause of amputation. Ischaemia can occur as a result of blood vessels becoming blocked by a blood clot or thrombosis, or mistakes in surgical or medical treatment of patients with vascular disease. Our amputation experts have helped many amputees recover compensation to manage their disability and rebuild their lives after medical, surgical or medication mistakes and delays have led to amputation from peripheral ischaemia. We obtained a £450,000 settlement for a 70-year-old man with vascular disease after mistakes in his post-operative anti-coagulation medication led to thrombosis, ischaemia and below-knee amputation. In another case we recovered £900,000 for a client who needed a below-knee amputation after he suffered a thrombosis during delays in treatment of a popliteal aneurysm. We secured a substantial compensation for a client who suffered amputation after incorrect medical advice and treatment for popliteal aneurysm. You can find out more about his experience of making a claim here. How we help after negligence causes amputation Life after amputation is challenging. The loss of one or more limbs, hands or feet may leave the amputee immobile and dependent on others’ help to manage every aspect of their daily life. In addition to struggling with their own self-care needs, they may be unable to look after their children, return to their former work to earn an income or participate in family, social or leisure activities. Physical disability may be worsened by the emotional and psychological impact of their limb-loss experience and ongoing pain. Recovery from amputation surgery requires physical strength and emotional resilience. Healing may be complicated by wound infection or stump sensitivity. This can delay rehabilitation with physiotherapy and or reduce the amputee’s ability to use prosthetics. Our severely injured clients’ experience is that the NHS rarely provides the quality of support, rehabilitation, prosthetics or other specialist equipment that is needed to restore them to a level of independence where they can return to work or cope at home. Family members are often left to take on the role of carer. Combined, these physical, emotional and financial struggles put an enormous strain on the entire family. Where mistakes in medical care result in amputation and disability, we can help restore independence and ease financial hardship through compensation. Compensation settlements are individually tailored to the client’s own circumstances, but can help pay for: Tailor-made prostheses (artificial limbs) and future replacements as needed; Rehabilitation; Psychological counselling; Therapies (such as physiotherapy, occupational therapy); Adapted vehicles; Specialist wheelchairs and equipment; Home adaptations; Care, support and domestic assistance; Special educational needs (SEN) if the amputee is a child; Vocational rehabilitation or re-training; Loss of earnings; Medical costs, such as surgery or pain management; Other reasonably incurred expenses, such as travel to and from hospital appointments. If you or a member of your family would like to find out more about claiming compensation for amputation caused by medical negligence, contact one of our specialist solicitors by email mednegclaims@boyesturner.com
