Accident & Emergency news


A bionic hand for Alan following amputation

At the age of 9, Alan Gifford lost both his hands after contracting a rare infection. Alan was born with a complex heart condition, and he contracted an infection following open heart surgery.  Unfortunately he had to undergo amputation of both hands as a result of the infection. He then spent 6 months in hospital recovering from his infection and the amputation. Bionic arm for Alan - Boyes Turner Solicitors

In June 2015, Alan’s friends and family began a campaign to raise money for a pair of custom made bionic hands for Alan. It was his dream to be able to ride a bike and hold a fork, things we do without even thinking about, on a daily basis.

This month Alan received his first bionic hand. Alan had been working with a prosthetics company, Touch Bionics, in Scotland on a hand that allows him to do the things he has always dreamed of.

Touch Bionics are a provider of world leading prosthetic technologies, and work to achieve the best possible outcomes for people with upper limb deficiencies. Touch Bionics products include the myoelectric prosthetic hand and prosthetic finger solutions, and they have been working closely with Alan to help him achieve new found confidence, function and a degree of independence.

Alan’s hand has cost £28,000 but the value to him is immeasurable.

Now Alan’s family are continuing to raise money to fund a second hand, so that Alan can have even more independence.

What causes amputation?

Upper limb amputation can happen for a number of reasons.  In Alan’s case, he contracted an infection, and unfortunately the effects of this could not be reversed so that his hands could be saved?

More commonly, both in the press and in public, we see amputation claims involving lower limb amputations.  Quite often these can be associated with diabetic foot problems that untreated, can escalate into more serious problems.

However, just last year I wrote about the case of Hermione Rose, who suffered with meningococcal septicaemia, and lost both arms and legs as a result of the infection.

Like Alan, Hermione has received a prosthesis, and has been learning to use her new prosthetic arm. Perhaps upper limb amputations are more common than we think, but just are not publicised enough?

Whatever the cause of the upper limb amputation, if it was caused by medical negligence or a negligent traumatic injury, it might be possible to recover compensation. As part of that process it is important that the issue of a prosthesis is carefully investigated.

Unfortunately quite often the most advanced prostheses involving electronic components and made to measure fittings, are not available via the NHS, and have to be purchased privately. The cost of the prosthesis can run to hundreds of thousands of pounds. This is not a cost that can easily be met by an average amputee and their family, resulting in fundraising events as we have seen with Alan Gifford.

Some people are concerned about advancing a claim for negligence. It is understood that compensation is not going to put the individual back in the position they were in before the negligence and amputation occurred.  But consider the bigger picture.  What will their care needs be? How will these be met? How will they access private therapy and occupational health services? What kind of prosthesis will be offered on the NHS?

Where possible we will ensure that these costs are recovered as part of the claim.

RBH under investigation after A&E department target is breached multiple times

The Royal Berkshire NHS Foundation Trust is being investigated for repeatedly breaching the NHS’ four hour waiting target for Accident and Emergency services. The target is that 95% of patients should be seen within four hours. 

The Health watchdog, Monitor, says that this target has been breached three times in 21 months. Monitor is also investigating other issues at the trust including waiting times for cancer patients. They are concerned that these failings may indicate that there are wider governance problems at the trust.

“Patients rightly expect the highest possible standards of care, that’s why we have launched this investigation”, said regional director Paul Streat. “The investigation will determine whether the trust has breached the conditions of its licence to provide healthcare services”.

Monitor said it was also investigating the time the trust had taken to implement a new electronic patient record system, the meeting of performance targets, such as length of waiting times for cancer patients, and the number of Clostridium difficile cases.

The Trust’s Chief Executive, Ed Donald, has responded by stating that the Trust, “continues to provide high quality and safe care to its patients”.

Nicola Anderson, an experienced NHS negligence claim lawyer at Boyes Turner, commented on the breaches:

“NHS targets are in place for a reason, and that reason is patient safety. Waiting times are particularly important to those who find themselves in an A & E department, and those who require treatment for cancer. Delays can be critical. It is quite appropriate for Monitor to launch an investigation and if any underlying problems are found, potential solutions can be identified and implemented”.

Planned review of London hospital trust A&E departments

An external review has been launched in to the safety of Accident & Emergency departments run by Barking, Havering & Redbridge Hospital Trust.

The review will look into “medical staffing issues” and will include visits to the departments in question. Nationwide figures in June revealed that this Trust had the longest waiting times for treatment in London. The Chief Executive commented that, “this process will help ensure services remain safe for local people in the future”.

Nicola Anderson, an experienced A&E negligence claims lawyer, commented on the review:

“Careful assessment is extremely important. If the nature of the problem is not understood, then changes cannot be made. It is encouraging to hear that the Trust is not shying away from the issues which have emerged, but is instead embracing the opportunity to improve, thereby protecting patients”.

More than a quarter of cancer patients diagnosed in A&E

A National Cancer Intelligence Network Study indicates that a quarter of cancer patients are first diagnosed in hospital Accident & Emergency departments. The percentage is even higher for those aged over 70.

It may be that people are reluctant to visit their GP and only seek medical attention when they are very seriously unwell. However, there is also understandable concern that GPs may be failing to spot the significance of symptoms that are reported to them. This could be due to lack of training but perhaps also to a tendency to attribute symptoms to ‘normal old age’. This data is really quite concerning because it suggests that some patients are being diagnosed too late for effective treatment.

Specialist cancer negligence claim solicitor, Nicola Anderson, commented on the trend:

“It is vital that cancer is diagnosed as early as possible to achieve the best outcome for the patient. The fact that so many cancers are being diagnosed so late is of real concern as it suggests firstly that GPs in particular are missing early sign of cancer that secondly will give rise to a much worse outcome for the patient. At Boyes Turner we have experience over many years of acting for clients who have experienced a delay in diagnosis and of representing those who have suffered a poorer outcome as a result.”

A&E doctors leave boy with broken knee for 2 weeks

Accident and emergency doctors failed to diagnose a broken knee after a boy had a gymnastics accident, meaning that he had to walk on the injury for a further two weeks.

The child was taken to an accident and emergency department after sustaining the injury, but after initially being told that he had a suspected fracture below the knee and fitting a temporary cast, the doctors then removed the cast.

The boy remained in pain and could not weight bear on his right leg. The symptoms persisted at the follow up appointment but his parents were told that he would be walking in a few days and that the symptoms were just a psychological issue. The boy was discharged without a cast and without further follow up.

The parents were still concerned with the symptoms that the child was displaying as he was limping and his foot was turning out. They took him to an A&E department of a different hospital, who referred him to the GP. The GP was also concerned about the symptoms the child was exhibiting and arranged for an appointment at Darent Valley Hospital.

Once at Darent Valley Hospital, the boy underwent x-rays of the right leg and the hips. On review of the x-rays, the doctor informed the child’s parents that there was a break below the right knee. There was fortunately no permanent damage due to the delay in diagnosis.

Sita Vaghela, experienced accident and emergency negligence claim solicitor, commented on the boy’s case:

“It is vital that appropriate tests and examination are undertaken when a patient presents after an accident such as this. The effects of a delay in diagnosis or a misdiagnosed fracture can range from a few additional weeks of pain to a complete failure of the bone to heal. It is very fortunate that this child did not suffer with any long term damage from the delay in diagnosis, but many patients do suffer with permanent problems.”

Common A&E negligence claims

Unfortunately, the mix of a demanding face-paced environment, the lack of senior doctors and the extensive range of symptoms that patients present with, increases the possibility of errors being made in accident & emergency departments (though this isn’t an justification that hospital staff can make use of if mistakes are made).

Frequently the consequences of such a busy department result in inadequate record keeping, a lack of communication between staff and other mistakes such as prescription errors. Additionally, junior doctors have basic radiography training, increasing the risk of a wrong diagnosis.

Common A&E negligence claims

  • missed fractures
  • missed sub-dural haematoma
  • missed heart attack
  • failure to arrange tests and scans or properly interpret the results
  • delays in diagnosis
  • foreign objects left inside wounds

Research has been undertaken on the main complaints of medical negligence claims of substandard care in A&E departments. It found that over half of the claims related to a failure to diagnose a fracture and approximately a quarter claims related to a late or incorrect diagnosisfor an injury other than a fracture. The other claims related to alleged clinical mismanagement in the department.

Sita Vaghela, experienced A&E negligence claim solicitor at Boyes Turner, commented on the research:

“The very nature of A&E opens it up to mistakes being made, meaning that every patient does not always receive the adequate care they are entitled to. Nevertheless hospital professionals working in A&E departments should be trained specially to handle the greater demands of the job and should only work in A&E if they are able to work under those conditions.”

£30,000 compensation awarded following A&E negligence and delay in diagnosis

The man fell at home on 16 May 2007, following an epileptic seizure. He was taken to the A&E department of the defendant hospital, with acute pain in his left shoulder and arm, following the fall. An x-ray was undertaken but no fracture was diagnosed and the man was discharged home.

The man continued to suffer pain and had difficultly moving his arm/shoulder. His GP referred him back to A&E on 12 June, when further x–rays were undertaken which showed a posterior dislocation to the left shoulder.

The hospital admitted liability, and the claim was settled for £30k on the basis that, as a result of the delay in diagnosis, the man’s recovery was prolonged and he had experienced additional pain and suffering.

A&E waiting times at highest since 2004

Recent data has shown that there has been an increase in the number of patients waiting more than four hours in accident and emergency departments in England.

The statistics revealed that the number of patients waiting more than four hours has increased by more than a quarter, which is the highest level since 2004. According to the figures, 226,021 (4.2%) patients waited more than four hours in A&E during the first few months of 2012, in comparison to the 3.4% last year over the same time period.

The target is for 95% of A&E patients to be seen within four hours but it was found that nearly 50 providers failed to meet this target at the end of last year compared with 18 providers earlier in the year.

The information published implied that the increase in waiting times is due to the financial pressures hospitals are under as well as a lack of available beds for the patients.

The report did note, however, that overall the NHS were broadly achieving targets in other important areas, for example, the number of inpatients waiting in excess of 18 weeks for treatment decreased, the waiting times for outpatients were unchanged and the number of C difficile and MRSA infections dropped by 33% and 14%.

Medical negligence solicitor, Sita Vaghela, commented:

“Although hospital staff try their best to admit and treat patients as quickly as possible, the pressures on NHS hospitals can make this extremely difficult. We often see cases where a patient deteriorates whilst waiting in A&E, which only highlights that the overriding consideration must be patient safety.”

£1 million compensation after A&E misdiagnosis

A 60 year old man, was awarded £1m in medical negligence compensation after he suffered a ruptured spleen and subsequent brain injury in June 2004. He was left with permanent cognitive impairments which affected his ability to continue working as a QC and a part-time recorder.

Accident and emergency negligence

On 16 June 2004 the man attended the A&E department of the defendant hospital, after falling about 12 feet from a 1st floor window. He was diagnosed as having sprained his ankle and was discharged home. Over the following few hours the man’s condition deteriorated and he returned to the hospital with a raised pulse and falling blood pressure. He was admitted and monitored and it was planned that an abdominal ultrasound would be performed the next morning. However, his condition further deteriorated overnight, his blood pressure dropped and he suffered prolonged hypoxia. He was resuscitated and taken urgently to theatre where 6 litres of blood were removed from his abdomen and he underwent a splenectomy (removal of the spleen). He recovered from surgery but suffered cognitive impairments.

Mis-diagnosis negligence claim

A claim was brought against the hospital, alleging that it was negligent in failing to consider and diagnose intra-abdominal trauma on both occasions when the man attended. It was alleged that if the man had been properly investigated an urgent abdominal CT scan would have been undertaken, which would have shown that his spleen had ruptured. An urgent splenectomy would then have been carried out and he would not have suffered a profound hypotensive episode which it was alleged had caused the man to suffer a hypoxic ischaemic brain injury.

The hospital admitted liability.

Will the planned A&E closures lead to more mistakes?

Doctors working in accident and emergency say plans to downgrade some services are based on flawed evidence.

The College of Emergency medicine says it’s wrong to assume that most patients coming to A&E can be seen elsewhere and that investment in separate walk-in and urgent care centres is misguided and wasteful.

Campaigners who have protested against the replacement of A&E departments with clinics for minor injuries welcomed the report. The future of many A&E units is coming under scrutiny as health trusts seek to concentrate some highly specialised care in fewer hospitals.

The College of Emergency Medicine says many plans are based on an assumption that’s “simply untrue” – namely that 60% of people coming to A&E have relatively minor problems that could be sorted out elsewhere – for example in minor injuries units or polyclinics.

The college’s president, Dr John Heyworth, says the 60% figure is ‘fiction’, “it is a mantra which has driven strategy for a number of years, but our evidence from the college of emergency medicine and other evidence from recent research has confirmed that it’s nowhere near 60%”.

A report earlier this month by the Primary Care Foundation said the true figure was between 10% and 30%. Dr Heyworth says this proves that most patients going in to A&E need the expertise and resources that can only be offered by a hospital emergency department. Surely if that department is not available, with the correct staff on hand, more mistakes will happen. He said, “we need to strengthen our emergency departments and if we want to consider different strategies they must only be on the basis of robust, reliable clinically-led evidence – and at the moment that’s not applying in many places”.

The college is issuing a manifesto, calling for a substantial increase in the number of emergency medicine consultants. It wants to bring their staffing levels up to 10 for an average-sized A&E unit, so they can provide cover at evenings and at weekends. It says this would help save money for the NHS by reducing inappropriate hospital admissions and unnecessary investigations.

Health campaigners fighting plans to scale down or close A&E units have welcomed the manifesto.

John Lister from Health Emergency said ministers should heed the advice of the “real experts” in emergency medicine. He said, “for far too long policies have been driven not by these clinicians but by evidence-free assertions by health service bureaucrats or management consultants who have claimed that up to 60% of A&E case load could be switched to primary care”, adding that, “policies based on false assumptions have wasted management time and diverted attention away from the proper ways to improve A&E departments, resulting in more errors and patients not receiving the right treatment”.

He called for an inquiry into where the 60% figure came from in the first place.

Dr Andrew Hobart, from the British Medical Association’s Emergency Medicine Committee, agreed that assumptions behind the re-organisation of urgent and emergency care were ‘fundamentally flawed’. But he said there was still a case for some re-organisation. “In some metropolitan areas it may be better to have slightly fewer all-singing-and-dancing emergency departments rather than more that are not so good”, he said.

A Department of Health spokesperson said, “it is for the NHS locally to decide on ways of meeting patients’ urgent and emergency care needs that deliver integrated, convenient, accessible, quality and safe care which is value for money. There is a wide choice of services available for people with an urgent care need, including urgent care centres, GP led health centres, walk-in centres and minor injury units. A&E services are part of the wider urgent and emergency care system. The NHS locally will ensure resources and clinical expertise are used efficiently and effectively across the system for the benefit of patients”.

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