Delay in diagnosis of cauda equina - £98,000 compensation awarded

On 7 November 2008 Nigel, aged 50, was required to move heavy boxes at work.  Whilst doing so, he experienced discomfort in his back, and it developed into significant pain.  Later he developed weakness in his right leg and strange sensations in the saddle area with the feeling that he wanted to go to the toilet all of the time.  However when Nigel tried to pass urine, it was difficult to do so.

Nigel’s symptoms persisted throughout that evening and the pain increased, and he was advised that he was to be assessed on an emergency basis. An ambulance was arranged to attend his home address. Correctly, the NHS Direct operator suspected a cauda equina injury because of the problems passing urine.

The ambulance crew arrived to find Nigel lying on the floor. He was unable to sit up. He was taken to a hospital of North West London Hospitals NHS Trust, and assessed by a triage nurse.

Nigel was subsequently assessed by a junior doctor who requested an x-ray. This was performed at 15:25, 2½ hours after his arrival at hospital. It was reported as normal. The junior doctor advised Nigel that there was no evidence of a cord compression, and he was ready to be discharged. He was advised to return if his symptoms did not improve, but was given no additional advice.

On 9 November, Nigel was sent home, and his symptoms persisted throughout the day.

When Nigel woke on the morning of 10 November, the pain was more intense, his right leg and foot were much weaker, and he had no sensation of his bowel and bladder.  He called an ambulance, and arrived at hospital at 11am.  An MRI scan was undertaken at 16:00 and reported a disc prolapsedat L4-L5, which was causing a severe compression of the cauda equina nerve.

The hospital was unable to operate on Nigel on an emergency basis, and he was transferred to another hospital where he underwent disc decompression surgery the next day.

Nigel alleged that the first hospital was negligent in failing to suspect cauda equina syndrome when he presented on 8 November, and failing to undertake appropriate investigations to investigate a disc prolapsed.

The hospital trust admitted liability and confirmed that, had Nigel undergone surgical decompression of his cauda equina on either 8 or 9 November, he would have had normal bladder, bowel and sexual function, together with normal neurological function.

Nigel was affected significantly, both physically and psychologically. He relied on walking sticks when mobilising out of the house, and generally moved in a slow and stiff manner. Moving or changing position triggered Nigel’s pain.

Nigel has continued to experience numbness in the saddle area, down the back of his legs and on the side of his feet and heels. He also had shooting pain in his saddle area and hypersensitivity in his left foot.

Nigel has permanent bladder, bowel and sexual dysfunction. He was unable to pass urine or empty his bladder normally. He is dependent on self intermittent catheterisation which he performs four times a day.

Nigel suffered from a loss of sensation in his penis and erectile dysfunction.  He lost the ability to perceive the need to open his bowels, and suffered faecal incontinence.

Nigel experienced a major depressive episode of between 2-3½ years after the injury. He was a risk of future depressive episodes.

The claim was settled on the basis of an award for £98,000 for his pain, suffering and loss of amenity.  He was afforded future accommodation costs to allow him to move to a more suitable property, in the sum of £390,000.  He was also awarded a sum of £120,000 for future care costs, £10,000 for future transport costs, and £27,000 for future therapy costs. In addition, he received a future loss of earnings award at £17,780, a future aids and equipment award at £28,500, and additional future medical treatment costs at £33,000. His past losses totalled £42,000.

The service was personal, professional and considered. I was treated so kindly and in the end I knew that not only had I found the right organisation but also the right person.

Boyes Turner client

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