Medical Negligence

 

Brain injury acquired in childhood: when the signs of damage emerge years later

Nicola Anderson, associate - solicitor with Boyes Turner's specialist medical negligence team discusses what happens when the signs of a childhood brain injury effect adulthood.

What is acquired brain injury or ABI?

Brain injury occurring in childhood can be the result of a trauma, such as a fall or a blow to the head (a traumatic brain injury). Brain injury may also develop following an illness. Regardless of the cause, if there was a period of normal development before the brain was injured, this type of injury is called an acquired brain injury or ABI. 

Which illnesses can cause brain injury?

There are several types of illness which have the potential to cause damage to the brain. For example:

  • Meningitis (a swelling to the lining of the brain, caused by either a viral or bacterial infection);
  • A stroke (interruption to the blood supply to the brain);
  • A brain tumour;
  • Epilepsy;
  • Hypoglycaemia ( very low blood sugar levels).

Is a brain injury always obvious?

The answer is no, not always. On discharge from hospital, children may seem well in themselves and parents will be reassured that a good recovery has been made. If there are any immediate difficulties (for example fatigue, or problems with mobility), the symptoms may be subtle, or they may come and go. Alternatively, there may be no signs at all that the child has suffered a brain injury, with symptoms only becoming apparent years later as their brain develops, and the mental load placed upon them increases.

What are the symptoms of acquired brain injury?

There is no typical case. Every child, and every injury, is different. However, issues arising in childhood may include:

  • Physical problems such as reduced mobility, or difficulty with balance or coordination (for example, the child may appear clumsy);
  • Onset of epilepsy;
  • Impaired speech;
  • Hearing loss;
  • Visual disturbance;
  • Behavioural difficulties, such as defiance, or being impulsive;
  • Mental health problems, including depression and other emotional difficulties, for instance being quick to anger, or prone to anxiety;
  • Fatigue;
  • Difficulty concentrating, recalling information, planning, and learning in general;
  • Finding it difficult to make and maintain friendships.

Whilst this is only a summary of the difficulties children with acquired brain injury may experience, it highlights how diverse the symptoms can be, and how one symptom may feed in to another. For example, a child who is tired will struggle to learn. They may become frustrated by their slow progress and have frequent emotional outbursts, which may worsen during the teenage years. These outbursts will make it difficult for them to maintain relationships with others, both at home and at school, and their mental health may suffer. It is not surprising then that a child’s brain injury, caused years earlier during an acute illness, may be mistaken for other conditions, such as Attention Deficit Hyperactivity Disorder (ADHD), dyspraxia, or autism. The link with the long forgotten childhood illness may not be immediately apparent.

What should I do if I suspect my child has an acquired brain injury?

It is important to seek support early and to make others aware that your child may have an acquired brain injury. All mainstream schools will have a Special Educational Needs Coordinator (SENCO) responsible for identifying children with additional needs and they are likely to be a good first port of call, as are support organisations such as The Child Brain Injury Trust and Meningitis Now.

How can Boyes Turner help me secure support for my child within school?

The education team at Boyes Turner are experts in the law relating to Special Educational Needs (SEN). We can assist parents with matters relating to Education, Health and Care Plans (EHCP’s) and securing support within schools.

Can my child claim financial compensation for their acquired brain injury?

It may be possible to bring a claim for financial compensation if it can be established that the child’s brain injury was caused, or contributed to, by the negligence of another, such as:

  • a doctor or hospital trust failing to correctly diagnose and/or correctly treat the initial illness, therefore causing, or increasing the risk of a brain injury (a medical negligence claim);
  • the driver of a vehicle causing a road traffic accident (a claim for personal injury);
  • a local authority, individual or company failing to safely maintain an environment, for example, a playground, or public park (again, a claim for personal injury).

Please do get in touch if you think your child may have a case and our specialist claims team can advise you further.

Are there time limits for bringing a claim?

There are time limits for bringing a claim.  

A child generally has until their 21st birthday to pursue a claim (three years after turning 18),  however, in some circumstances, it may be possible to bring a claim after this. To protect your child’s right to make a claim, advice should always be sought from a brain injury specialist solicitor as soon as possible.

If you are caring for a child who has suffered an acquired brain injury and you would like to find out more about making a claim, contact us by email at claimsadvice@boyesturner.com.

Delayed diagnosis of cancer - Can I make a claim?

According to cancer charity, Cancer Research, every two minutes someone in the UK is diagnosed with cancer. The NHS deals with over 350,000 new cases of cancer each year. Around a third of those are diagnosed via the ‘two-week-wait’ referral rule, a quarter following a routine or urgent GP referral, and a fifth are diagnosed (often at an advanced stage) after presenting as an emergency.

Cancer survival has doubled in the UK over the last 40 years, with significant variation in survival between cancer types. 89% of cancer patients in England rate their care as very good or excellent. There are National Institute for Clinical Excellence (NICE) guidelines in place, designed to help doctors refer patients with suspected cancer earlier and more directly to the resources that can help them, with the aim of reducing delay between onset of symptoms, referral, diagnosis and treatment, but despite these measures, sadly, for a small minority of patients, unacceptable delays still occur with devastating consequences.

What type of cancer delays lead to compensation claims?

Some types of cancer (breast, cervical and bowel) are subject to national screening programmes which should identify abnormalities at an early stage.

Women aged 25 to 64 are invited to undergo cervical screening every three years. This is extremely valuable as abnormal cells can be detected early and then monitored or treated before these become cancerous. Early detection of potential cancers through screening saves lives. Where claims occur in these circumstances, they tend to arise when smear tests are misreported as being normal when in fact there are abnormalities, or when patients who need follow up or treatment are not notified or recalled.

All women aged 50 to 71 are also invited to undergo breast cancer screening every three years. If a woman has an increased risk of developing breast cancer, for example, due to her family history of the disease, she may be eligible for screening below the age of 50. Screening consists of an X-ray (mammogram). Mammograms can detect breast cancer early, possibly before there is a noticeable lump. Unfortunately, there have been instances of women not being invited to attend breast cancer screening, misreading of mammograms and failure to call patients who are identified as having abnormalities for treatment.

If a person starts experiencing symptoms that could be suggestive of cancer it is important that their GP recognises their potential cancer symptoms and makes the appropriate referral for investigation or treatment. The National Institute for Clinical Excellence (NICE) has produced guidelines for GPs to follow that clarify when a person should be referred to a specialist for further investigations. These are very effective, but we continue to see clients who have attended their GP on a number of occasions, sometimes over a considerable period of time, complaining of potential cancer symptoms before their concerns are acknowledged and they are finally referred, leading to delayed diagnosis and treatment of their cancer.

How is claim arising from a delay in diagnosis and treatment of cancer valued?

There is no set compensation award for a claim of this type, so each case is valued according to our client’s own circumstances. It is important to understand that any injury arising from the disease itself, which the patient would still have suffered even if she had been promptly diagnosed and properly treated, will not be compensated. A successful claim will provide compensation for the additional physical and often psychological injury and financial loss that the patient suffered as a result of the negligent delay in diagnosis, the failure to treat promptly or the pain and side effects of the more radical treatment that was only required owing to the progression of the disease during the negligent delay.

How is pain and suffering compensated?

The claim includes a payment for ‘general damages’ which reflects the pain, suffering and loss of amenity caused by the GP or hospital’s negligence. This aspect of the damages award generally follows guidelines which are based on what the court has previously ruled as an appropriate level of compensation for that type and severity of injury.

Are my financial losses also compensated?

‘Special damages’ is the name given to the aspect of the award which compensates for ‘out of pocket’ expenses that the patient has actually paid or financial losses that they have suffered as a result of the delay in diagnosis.

What other types of injury or loss are commonly claimed in a delayed diagnosis or treatment of cancer case?

Discussed below are some common losses arising from delays in the diagnosis or treatment of cancer. This is not an exhaustive list and depends on the individual client’s own experience, the nature and severity of their additional injury and their financial circumstances. We work with each client to understand how the negligent delay has affected them. We may also instruct experts to comment on specific items listed below, for example which aids and equipment would be of benefit or which adaptations to property are required.

  • Additional Treatment
    The pain, injury or disability caused by additional or more radical treatment and the costs associated with it are considered when assessing this aspect of the claim.

    If there is a delay in diagnosing cancer the affected person may have experienced treatment that would not have been required if the cancer had been picked up at an earlier stage. Delays in diagnosis of cancer can lead to more intrusive and significant surgical procedures than would have been the case had it been recognised earlier.

    Early treatment for cervical cancer may consist of a cone biopsy (where tissue is removed from the cervix) and/or trachelectomy (removal of the cervix) but progression of the disease during a delay in diagnosis might mean that the patient needs a radical hysterectomy, which would otherwise not have been necessary. Not only is this a more significant procedure with more risks of complications and longer recovery time, but it results in the woman becoming infertile. In these circumstances we would consider not only the impact of more intrusive surgery, but the emotional/psychological impact and costs arising from infertility.

    Delays in diagnosis of cervical cancer can lead to a person undergoing chemoradiotherapy and brachytherapy which, again, could have been avoided if signs of the condition had been picked up at an earlier stage.

    If breast cancer is diagnosed at an early stage, treatment may consist of a lumpectomy, a breast-conserving surgical treatment in which the tumour (but not the breast) is removed. In more advanced stages, treatment may be mastectomy, which is removal of the whole breast as well as reconstruction. If delay in diagnosis has led to a mastectomy where, but for the negligence, a lumpectomy would have been offered, the impact of the more intrusive surgery will be reflected in the value of the claim.  Delays in diagnosis of breast cancer can also lead to the woman requiring chemotherapy which would not have been required if the cancer had been identified at an earlier stage.

    Not only do these more intrusive treatments have a significant impact on the person at the time, but the long-term consequences can be devastating. The claim takes into account past, ongoing, and future costs and consequences arising from additional treatment.
     
  • Loss of Earnings and Pension

    If a person has had to take time off unpaid, take a pay cut to change jobs, or cut down on hours as a result of treatment undergone as a result of the delay in diagnosis there will be a claim for net loss of earnings and pension.
     
  • Care and Assistance

    A loved one may have had to take time off work to care for someone during and/or after treatment that could have been avoided if cancer had been identified sooner. In this case there will be a claim for their time. Professional carers may also need to be employed either in the short or longer term to assist a person with care needs arising from additional injury caused by their delayed cancer diagnosis.
     
  • Medical Expenses

    These include the cost of prescriptions and also the cost of any therapies that may be of benefit, possibly including physiotherapy and/or occupational therapy.
     
  • Travel Expenses

    The costs of travel to and from medical appointments which are required as a result of the delay in diagnosis, for example, can be claimed.
     
  • Aids and Equipment

    An expert may be appointed to comment on any aids and equipment which might be of benefit.
     
  • Adaptations to Property

    The consequences of delayed diagnosis and treatment of cancer can lead to long term disability. Where our experts believe that our client’s home needs adaptation to suit our client’s disability, [for example to provide a more accessible bathroom if bowel and/or bladder function are impaired] the reasonable costs of these adaptations can be claimed. 
     
  • Psychological counselling

    Severe, life-threatening injury, fear of recurrence of the cancer and the intensely personal nature of the disability caused by delayed cancer diagnosis and treatment can be very difficult to come to terms with. In these circumstances some people need psychological help to overcome anxiety or adjustment disorders, depression and PTSD. Where our experts believe that our client would benefit from counselling we are often able to recover the costs of such treatment as part of the claim.
     
  • Loss of dependency and bereavement

    Where negligent delay has caused someone’s death, we can help the bereaved and dependent spouse and children obtain compensation for their loss of dependency and other claimable losses.

If you have suffered severe injury or have been bereaved as a result of delays in  cancer diagnosis or treatment and would like to find out more about making a claim, contact us by email at mednegclaims@boyesturner.com.

Running a fatal case with Tara Byrne

Losing a loved one is always emotionally challenging but when their death was caused by incorrect medical care it is natural that bereaved family members seek help to find out what went wrong. In some cases, particularly where the deceased left no dependants, the family may decide that seeking compensation is not their preferred way of finding answers, peace of mind or closure, but where the deceased left dependent children, a husband, wife, partner or elderly or disabled relatives for whom they provided care, a successful negligence claim can ease the financial hardship which follows a parent, breadwinner or family carer’s death.

We asked medical negligence solicitor, Tara Byrne, how she investigates and values cases arising from a death and why she believes they are so important to investigate.

What information do you need from a bereaved client who believes that negligent treatment has led to a loved one’s death?

[I/we] understand that it can be hard for bereaved relatives to talk about the upsetting events which led up to their loved one’s death. [I/we] try to guide clients supportively through our initial conversation so that [I/we] can advise them how best to proceed and whether we can help them with a claim. 

In talking to a bereaved family member, it’s really important that I understand exactly what has happened, how and when the individual died and what the family member feels went wrong.

To understand whether an investigation should take place, I need to know:

•        what symptoms the deceased experienced;

•        what diagnosis, if any, had they have been given prior to their death;

•        details about each of their visits to their GP or hospital and any advice or treatment they were given;

•        the cause of death and whether a post mortem or inquest has taken place;

•        details about the deceased’s family and work life at the time of their death.

Can anyone bring the claim on behalf of the deceased?

No. If there is a will, the executors are entitled to bring the claim. If there is more than one executor, then all of them must agree to pursue the claim. It is possible for one to deal with the claim if the others give their signed authority. Alternatively, if there is no will, then the person who wants to lead the claim will need to obtain Letters of Representation in their own name. My colleagues in Boyes Turner’s wealth protection team can help with this.

Is there a time limit for making a fatal medical negligence claim?

Yes, there is a three year deadline from the date of the death.

How are claims arising from a death funded?

Usually the case will be funded by a Conditional Fee Agreement (“no win no fee”) with After The Event insurance. This means that the client doesn’t have to pay any legal costs at the start of the claim and will pay nothing if the case is unsuccessful. In a successful claim the majority of the claimant’s legal fees are paid by the defendant.

I take great care in explaining the funding arrangement in detail to my clients to make sure they are entirely comfortable with the agreement. Where a claim, even if successful on its merits, is unlikely to be financially viable for the claimant, I let them know at the outset, as we would never advise a client to pursue a disproportionately expensive claim.

How do you investigate whether a GP or hospital acted negligently?

I need to establish that the negligent treatment caused or significantly contributed to the death. Each case is unique and my approach to each individual case depends on the circumstances of the death, however, the investigation always begins with gathering medical evidence. Once I have a signed authority from my client, I request the GP and hospital medical records and consider them carefully. I also take a detailed statement from my client and, if necessary, any other family members or friends, to record their recollection of what happened leading up to the death.

A successful medical negligence case depends on supportive expert evidence. Therefore, once I have the records and statements, my next step is to instruct experts in the relevant medical disciplines to comment on the care given to the deceased (to prove breach of duty), and the impact of that care and whether it caused or contributed to the death (to prove causation). My choice of experts depends on the type of treatment the deceased received, so for example, if the A&E care is a concern, I will instruct an A&E expert. If the concerns relate to treatment from a GP, then I instruct a GP expert. The type of causation expert depends on the cause of the death, so for example, if the deceased died from sepsis, I usually instruct an expert who specialises in critical care to comment on whether earlier or more appropriate treatment would have avoided the death. If, however, the deceased died of cancer then I would instruct an expert in oncology.

How do you calculate the level of compensation in a case where someone has died?

As with all medical negligence cases, the valuation is tailored to the individual client, so every case is different.

The law relating to compensation claims in fatal cases – who can claim and what can be claimed - is set out in The Law Reform (Miscellaneous Provisions) Act 1934 and the Fatal Accidents Act 1976.

The following losses can be claimed on behalf of the deceased’s estate:

  • ‘general damages’ for pain, suffering and loss of amenity - the pain, suffering and disability arising from the negligence which was suffered by the deceased up to their death;
  • ‘special damages’ - any financial losses, including lost earnings, care and services, whether provided by paid professionals or freely by family or friends before the death;
  • reasonable funeral expenses which were paid for by the estate.

Family and dependants of the deceased can claim:

  • the statutory bereavement award - a fixed sum, presently set at £12,890, which is only payable to selected people, including the deceased’s spouse or civil partner or the parents of a deceased child under 18 years old at the time of death;
  • a claim for loss of dependency – often the largest item of loss, which compensates the deceased’s dependants for the loss of the deceased’s income or services, such as childcare, housework, home maintenance and gardening etc;
  • funeral expenses if paid by the dependants rather than the deceased’s estate. 

Why do you think it’s important for negligently caused fatal cases to be investigated?

Losing a loved one is difficult in any circumstances but at Boyes Turner we often see the increased pain that bereaved families feel if they think that the death could have been avoided. An investigation provides the family with insight into the circumstances of their family member’s death, the treatment provided and whether there were any failings in care. The claims process also enables the NHS and individual medical professionals to learn from mistakes, so that steps are taken to avoid further harm to other patients in the future.

Dependant families are often left struggling financially where the person who has died was the primary income provider, a parent to young children or family carer. In these circumstances, a successful claim can provide compensation to ease their financial concerns at what is already a very distressing time. 

If you are concerned about the treatment your family member or friend has received, or are caring for bereaved, dependent children as a result of medical negligence,  please contact our specialist solicitors on mednegclaims@boyesturner.com.

Can I claim surrogacy costs after negligent cervical cancer?

Delays in diagnosis and treatment of cervical cancer can be fatal or can result in the need for radical treatment with ongoing side-effects such as pain, premature menopause, impaired bowel and urinary function, painful sexual intercourse, fear of recurrence and psychological damage.

What side-effects from late-treated cervical cancer can be compensated?

We can usually help clients recover compensation for these aspects of their injury but we know from our clients that one of the consequences of late-treated cervical cancer that they find most difficult to come to terms with is loss of their fertility, particularly in younger women who were hoping to have their first or further children in the future. Whilst fertility treatment options are available, such as IVF treatment, some women are not suitable for such treatment and, if they are to have a child of their own, need to have a surrogate.

Until recently, whilst it was possible to recover compensation for many aspects of a late-treated cervical cancer injury, it was not possible under English law to claim for the costs of surrogacy which was needed owing to infertility caused by the delay in treatment for cervical cancer. This left many seriously injured women without an effective remedy for one of the  most distressing consequences of their injury.

How has the law changed to compensate for surrogacy costs?

In 2018 there was a development in the law which opened the way for surrogacy costs to be successfully claimed where a woman has been left infertile as a result of a delay in diagnosing cervical cancer.

The medical negligence case of XX v Whittington Hospital NHS Trust concerned a young woman of 29 whose diagnosis of cervical cancer was negligently delayed by four years. As a result of the delay, she needed more radical treatment than she would have had if her condition had been properly managed. She underwent chemo-radiotherapy which caused irreparable damage to her uterus and ovaries. The woman and her partner wished to have their own biological children using a surrogate. To do this they wanted to go to the USA for surrogacy treatment and, therefore, wished to claim the costs of this.

When the case first came to court, the injured woman was awarded the costs of UK-based surrogacy for two pregnancies but was refused the additional costs associated with surrogacy in the USA. She successfully appealed the court’s decision and was awarded the costs of undergoing surrogacy in the USA.

Boyes Turner’s medical negligence specialists have helped many severely injured women and bereaved families recover compensation following misdiagnosed, delayed or incorrectly treated cervical cancer. We understand the emotional, psychological and physical damage that these injuries cause to the women and their families and welcome this recent development in the law which we hope will open the way for more women in this situation to begin to rebuild their lives by being able to have a child.

If you have suffered serious injury or family bereavement as a result of negligent diagnosis or treatment of cervical cancer and would like to find out more about making a claim, contact us by email at mednegclaims@boyesturner.com.

Inquests into Stillbirths

According to Tommy’s, the largest charity which funds research into the causes of miscarriage, stillbirth and premature birth, there are, sadly, nine stillbirths every day in the UK. That adds up to too many families each year affected by the tragic loss of an expected baby, often with no clear explanation as to what caused their baby’s death.

What is stillbirth?

The NHS defines stillbirth as a baby that is born dead after 24 completed weeks of pregnancy. If the unborn baby dies before 24 completed weeks, this is known as a miscarriage or ‘late fetal loss’.

The cause of the stillbirth may be unexplained. Stillbirth may be caused by problems with the placenta or the mother’s health. In a baby that was known to be healthy immediately before birth, it can also have been caused by negligent management of the delivery. Unfortunately, many bereaved families are left not knowing why their baby was stillborn.

What is a Coroner’s inquest?

An inquest is a judicial inquiry led by a coroner. The purpose of an inquest and the coroner’s role is to find out what caused a person’s death. Unlike a clinical negligence claim, a professional disciplinary hearing or criminal proceedings, the coroner’s role is not to blame anyone but to consider the facts surrounding a person’s death.

As the purpose of an inquest is specifically not to attribute blame, it is hoped that witnesses will tend to be more open and transparent with the coroner than they might be in other judicial circumstances, which can make the process easier for a family to go through. The witnesses can include any clinicians involved in the person’s care prior to their death, and the inquest gives families an opportunity to ask the clinicians involved any questions they might have about the circumstances of their loved one’s death.

Will there be a Coroner’s inquest after stillbirth?

Under current law, in certain circumstances, the coroner has a duty to open an inquest into deaths of adults, children and babies who were born alive. If it is not clear whether the baby showed signs of life at the time of birth, then a coroner may investigate that, but the coroner has no power to investigate stillbirths.

Where the unborn baby appeared healthy during the pregnancy but the baby was stillborn, the hospital or Healthcare Safety Investigation Branch (HSIB) may carry out its own investigation into the stillbirth but the Coroner has no power to do so. This means that significant numbers of families each year are left with unanswered questions relating to the circumstances leading up to the stillbirth of their previously healthy child. This only adds to the emotional and psychological impact of the stillbirth, making it even more difficult to come to terms with what has happened and causing stress and anxiety in future pregnancies.

What is the government doing about stillbirth?

The government has pledged to halve the number of stillbirths in England by 2025. The Maternity Safety Strategy aims to make pregnancy safer by improving maternity care and learning from mistakes so that fewer people will experience the tragedy of losing a child.

The government recognises that many parents have raised concerns about the inconsistency of maternity investigations and have called for a more transparent and independent system to investigate when things go wrong.

As part of the government’s wider plans to help prevent future stillbirths and improve maternity care they are considering giving coroners new powers to investigate stillbirths.

What will the proposed changes allowing inquests for stillbirths do?

If the proposed changes to coroners’ inquests for stillbirths go through:

  • coroners will have powers to investigate all full-term stillbirths (from 37 weeks of pregnancy);
  • the coroner will consider whether any lessons can be learned which could prevent stillbirths in future;
  • coroners will have an independent right to investigate stillbirths – they won’t need consent or permission from anyone else;
  • coroners’ investigations will not replace any of the investigations which are currently undertaken by hospitals or NHS agencies (such as HSIB) in stillbirth cases;
  • any reviews carried out by other organisations, such as HSIB, may form part of the coroner’s investigation into a stillbirth;
  • coroners’ inquests and investigations into stillbirths will follow the same rules that apply to other types of inquest, allowing them to:
    • compel witnesses to give evidence;
    • call for disclosure of documents;
    • order relevant medical examinations, such as post mortems, of the stillborn baby and placenta;
    • retain legal custody of the stillborn baby’s body whilst needed for the investigation.
  • The proposals would apply in England and Wales.

The government’s Consultation into Coronial Investigations (i.e. Inquests) of Stillbirths

The Ministry of Justice and the Department for Health and Social Care have issued a joint consultation seeking views from a wide range of people, including bereaved parents, support and advice organisations, researchers, health professionals and healthcare providers, about whether coroners should be given powers to investigate stillbirths.

What benefits could a coroner’s inquest give to a family bereaved by stillbirth?

Boyes Turner’s clinical negligence specialists have helped many families who have been affected by stillbirth. We know how deeply upsetting these heart-breaking events can be for families and understand the severity of the related psychological injury that is often suffered by the mother of a stillborn child.

Where there are grounds for a medical negligence claim, a successful claim leading to an admission of liability can be helpful to a grieving family, as it may provide an explanation as to what has happened, but depending on the circumstances of the stillbirth, admissions can often come too late, at the end of a long and emotionally challenging journey for a family.

In the majority of stillbirth cases which do not involve additional injury to the mother, the level of compensation that the law provides for the loss of the baby alone appears insultingly low considering the tragic circumstances involved. Many bereaved parents in these circumstances find compensation to be of little comfort and a clinical negligence claim is often financially unviable.

In such circumstances, an independent inquest can help families to understand what has happened, providing parents with vital information about what went wrong and why, which they might not have access to from any other source. Bereaved parents would be able to have their voices heard in the investigation, ask questions of witnesses and take some comfort in being involved in the process which identifies lessons to be learnt as set out in the coroner’s recommendations, thereby playing a part in the prevention of future stillbirths.

The Consultation into Coronial Investigations of Stillbirths closes on 18th June 2019 and can be accessed on the government’s website here.

Claims against GPs: a new scheme which may speed up the process

The NHS is changing the way in which it responds to negligence claims against GPs. From 1st April 2019, new claims against GPs and other providers of healthcare within GP surgeries will be handled and paid for by NHS Resolution, the same organisation that defends, resolves and pays for claims against hospital doctors and nurses in NHS Trusts. So, how will the new scheme affect doctors and their patients?

What is a GP?

GP stands for ‘General Practitioner’ – the local doctor who provides everyday medical advice and services to people who are registered with their practice or ‘GP surgery’. In the UK there are around 7,000 GP surgeries, with each surgery generally employing a mixture of permanent doctors (some of whom may be partners, others who are salaried) and locums who are employed on a temporary or flexible basis.

GPs now work in a wide range of different settings. They may be employed in a single practice or as part of a multi-site surgery, as part of a federation, or attached to hospitals. It is also possible for a GP to hold more than one NHS contract. Therefore, they can have additional positions outside of their main practice, such as in the armed forces, or in academic institutions.

Claims for medical negligence

It is estimated that in England there are over 300 million patient/GP consultations each year, leading NHS England to describe general practice as “the bedrock of the NHS”. Whilst patients are generally satisfied with the care provided by their GP, given the high numbers of patients that GPs see each year, it is not surprising to learn that the Medical Defence Union estimate that on average, a GP is sued once every 10 years in their professional career, or four times in their working life. Mistakes happen which can sometimes have serious consequences for the patient who is then entitled to claim compensation by bringing a claim.

What is indemnity cover?

Given the high probability of being sued at some point during their career, GPs need insurance in place to protect them. This ‘indemnity cover’ or insurance will cover their legal costs arising from a negligence claim and also any compensation due to the patient. Until recently, GP doctors have purchased this cover from various medical defence organisations, such as the Medical Protection Society (MPS) or the Medical Defence Union (MDU).

What is the Clinical Negligence Scheme for General Practice (CNSGP)?

A new government-backed scheme has now been introduced in England, known as the Clinical Negligence scheme for General Practice (CNSGP). It covers claims "arising from the care, diagnosis and treatment of a patient as part of the NHS in England following incidents which happen on or after 1 April 2019". Enrolment in the scheme is automatic and covers all GPs and staff providing primary medical services, including both salaried and locum GPs, nurses and other health professionals. The scheme is administered by NHS Resolution for the Department of Health and Social Care, in the same way that NHS Resolution handles claims against hospital doctors working in NHS trusts.

CNSGP currently applies only to claims for treatment from 1st April 2019, but the Department of Health and Social Care (DHSC) and the Medical Protection Society (MPS) are already discussing the terms of a possible similar scheme which would allow NHS Resolution to cover claims arising out of treatment which took place before 1st April 2019. 

What level of cover does the CNSGP provide?

Under the new scheme, indemnity is unlimited (i.e. payments out are not capped). There is also no excess to be paid and, if the claim falls within the scheme, GPs will not be at risk of having to meet part of the claim themselves.

What does the CNSGP not cover?

As with the indemnity offered by the defence organisations, the cover will remain discretionary. This means that NHS Resolution will have discretion as to which cases they will pay out for, and which they will defend. So, if a GP wants to settle a claim but NHS Resolution wants to fight it (for example on principle to discourage other similar claims, or to test how the courts will interpret the law in similar circumstances), NHS Resolution may override the GPs wishes and insist that the claim is defended. Alternatively, a GP who wishes to defend their claim, may not be able to do so if NHS Resolution believes the case should be settled.

There are also other limits to the cover. For instance, CNSGP will not cover:

  • Claims arising out of non-NHS work, e.g. private treatment;
  • Complaints where there is no likelihood of a claim arising;
  • General Medical Council (GMC) inquiries;
  • Care Quality Commission (CQC) investigation;
  • Representation at inquests;
  • Disciplinary proceedings against GPs or other members of staff;
  • A range of other legal issues.

GPs will have to keep up membership of a medical defence organisation to assist with these matters.

What are the advantages of the CNSGP scheme for GPs?

The main advantage to GPs is that it should save them time and money. They do not need to pay for this cover as it is automatic under their NHS contract. This will save them the increasingly high costs of annual idemnity cover subscriptions and the administrative work required to keep their claims cover in place. Future costs will now be paid for by NHS England and government. The Minister of State for Care has said that this will allow GPs to “focus on continuing to provide excellent care to patients, knowing they have comprehensive cover in place”.

Many GPs are disappointed that NHS Resolution will decide when a case should be settled or defended, as the new scheme will be discretionary. Some are concerned that they will not be able to protect their reputation if they are forced to admit liability for a mistake or settle (or may only be able to defend the claim at increased personal financial risk).

What are the advantages of the CNSGP scheme for the government?

By introducing this scheme, the government will be able to have more control and oversight of claims and the costs involved. They also hope to attract more doctors to the profession by providing automatic indemnity cover for GPs at greatly reduced cost.

What are the advantages of the CNSGP scheme for the patient?

The advantages to the patient are yet to be seen. However, at Boyes Turner we hope that from now on NHS Resolution will make the process of pursing a claim against a GP much smoother and settlements will be reached more quickly. For claims against GPs arising on or after 1st April 2019, it will no longer be necessary for us to track down the indemnity insurer and negotiations can potentially start sooner.

We are also hopeful that in cases of clear negligence where there are multiple GP defendants (for example, when the patient has seen different doctors within the GP surgery over a period of time, as is often the case), NHS Resolution will prioritise early resolution and settlement for the injured patient, with less time spent arguing over apportionment of blame between GP defendants, resulting in savings in time and costs.

If you have suffered serious injury as a result of negligent GP care and would like to find out more about bringing a claim, contact us by email at claimsadvice@boyesturner.com.

Valproate and birth defects: were you told the facts?

The anti-convulsant drug, sodium valproate, is used to treat epilepsy. It is also used as a mood stabiliser for people with bipolar disorder. Valproate is also known by various trade names, including Epilim and Epival.

Valproate is very effective at reducing fits or seizures in epileptics. For some people it is the only effective way to manage their disabling epileptic condition. However, use of valproate during pregnancy is known to carry a high risk of serious injury to the unborn baby. Prescription of valproate to women of childbearing potential has now been banned for all except those women for whom no other equivalent drug works, and even then, only on the condition that they are using contraception under a pregnancy prevention programme (PPP).

How does sodium valproate affect babies in pregnancy?

1. 10% risk of birth defects or physical disabilities

Babies who are exposed in pregnancy, via their mother, to valproate, are known to be at increased risk of serious birth defects (physical disabilities) and long-term developmental problems.

The risk of physical disabilities is approximately 10%. That means one in ten valproate babies are born with these disabilities. These include:

  • minor malformations, such as small fingers and toes;
  • major malformations:
    • of the spine, such as spina bifida;
    • of the face and skull, such as cleft palate;
    • of the limbs;
    • of the organs, such as the heart, kidneys and sexual organs.

2. 40% risk of developmental or learning difficulties

There is also a 40% risk of persistent learning and developmental issues. That’s four of every ten babies. These learning and developmental problems are sometimes known as fetal valproate syndrome, fetal anti-convulsant syndrome (FACS), or fetal valproate spectrum disorder.

What is fetal anti-convulsant syndrome (FACS)?

Fetal anti-convulsant syndrome describes the developmental or learning difficulties suffered by babies who were exposed to valproate during pregnancy. Unlike physical birth defects which are often apparent at birth, developmental issues may not be noticeable until the child grows older and struggles to meet developmental milestones. Learning and developmental problems caused by fetal anti-convulsant syndrome include:

  • delayed walking and talking;
  • impaired speech and language;
  • problems with memory;
  • lower intelligence than other children of the same age;
  • valproate-affected babies are also more likely to be on the autistic spectrum.

How long has it been known that sodium valproate is not safe to take in pregnancy?

When valproate was first marketed in the 1970s, animal studies had already shown that it carried serious risks of birth defects in the unborn baby if used by the mother in pregnancy.

Campaigners have also identified evidence that in 1973 the Committee on the Safety of Medicines decided it was best not to mention the risk of birth defects in the information supplied with the medicine. Instead, doctors were informed of the risks and were expected to weigh up the benefits and risks of prescribing the drug and use their discretion in informing the patient about the side effects.

As more evidence became available of other risks to the unborn baby, firstly of developmental delay and later of autism, further warnings were repeatedly issued to prescribers over the next 40 years. By 2013, long-term follow up of affected children had provided clear evidence of the extent of the risks to babies in valproate pregnancies.

The Medicines and Healthcare products Regulatory Agency (MHRA) then began a Europe-wide safety review of valproate in pregnancy which concluded, in November 2014, that the benefits of valproate to women of childbearing potential could only be justified against the risks where no other drugs were effective in treating their epilepsy or bipolar disorder.

In March 2016, MHRA developed a valproate toolkit, containing information presented in various forms to help healthcare professionals, including GPs and pharmacists, share information with patients about the risks of valproate in pregnancy. However, despite coordinated efforts by the government and the MHRA to promote the use of the toolkit to encourage healthcare practitioners to raise awareness amongst patients, a survey by INFACT, the National Valproate Campaign, later discovered that 80% of patients had not received the toolkit booklet and 90% had not received the toolkit pharmacy card. In many cases GPs had not even been given the booklets to distribute but had been left to download them from the manufacturer’s website and the information was not reaching potentially vulnerable women.

Concerns about the limited impact of the toolkit in raising awareness in the UK led to a further EU safety review which strengthened the rules relating to safe prescription of valproate in potentially childbearing women. These new rules came into force in the UK in April 2018 when the MHRA changed the licensing rules controlling the prescription of valproate. The new rules banned the use of the drug for women of childbearing potential (whether or not they are currently sexually active) unless other drugs were not effective and they were using highly effective, (preferably user-independent) contraception via a pregnancy prevention programme (PPP). The regulations also required patients to have been told about and understand the risks of pregnancy, to be reviewed by their specialist at least once a year and to have signed a risk acknowledgement form.

Valproate campaign group, INFACT, carried out a further survey from December 2018 to February 2019. This revealed that despite the stringent requirements laid down by MHRA in April 2018, high percentages of women taking valproate were still not receiving information about the risk of pregnancy from their GPs and pharmacists. 40% had never discussed a pregnancy prevention programme with their doctor and more than 60% not been asked to sign an acknowledgement of risk form. This survey highlighted the ongoing failure by valproate prescribers and healthcare professionals, such as GPs and pharmacists, to comply with their obligations to inform and safeguard their patients against the risks of valproate-affected pregnancy.

What is being done to reduce harm to babies from valproate in pregnancy?

  • Repeated warnings and drug safety updates to GPs and pharmacists

The MHRA continues to issue warnings and drug safety updates to pharmacists and doctors reminding them of their responsibilities towards patients and that they must comply with the new valproate licensing regulations.

  • NICE easy reference summary guideline

In March 2019, the National Institute for Health and Care Excellence (NICE) issued a new summary guideline which brings together in one short, easy-reference, visual summary all the key information and advice on safe prescribing of valproate from various sources, including MHRA safety alerts, BNF (British National Formulary – a pharmaceutical reference book containing drug information used by GPs) and NICE’s own amended guideline following the April 2018 licensing changes.

  • Valproate compliance now incentivised through GP contracts

NHS England’s General Practitioner (GP) contract framework – the GP contract – now includes a quality indicator for safe valproate prescribing to incentivise GPs to comply with their obligations.

  • CQC inspections include valproate compliance

The Care Quality Commission now includes valproate compliance in its inspections.

  • Studies into possible risks from paternal valproate

Studies are also being undertaken into the risks to the unborn baby caused by the father taking valproate following possible associations between birth defects and developmental disorders and paternal valproate use at the time of conception.

  • Independent Medicines and Medical Devices Safety Review

In February 2018, following patient-led campaigns, the Department of Health and Social Care set up The Independent Medicines and Medical Devices Safety (IMMDS) Review to look into how the NHS handled complaints and emerging awareness of problems with three NHS treatments, one of which is sodium valproate. The review is led by Baroness Julia Cumberlege and is independent from government, the NHS, regulatory or public bodies, and the pharmaceutical industry.

The IMMDS review will assess the evidence surrounding the use of valproate, including:

  • what was known about valproate;
  • the decisions and actions taken by the manufacturers, regulators, clinicians and policy makers;
  • whether proper consent (based on clear information) was taken from patients;
  • whether the response to safety concerns raised by patients and others has been satisfactory;
  • the licensing and treatment of women of childbearing age with valproate given the evidence of its teratogenicity (harmfulness to the unborn baby or fetus);
  • how the knowledge of the drug’s potential effect on the fetus was or should have been communicated between manufacturers, regulators, healthcare practitioners and patients and acted upon.

In addition, the review will:

  • clarify the characteristics of fetal valproate spectrum disorders and the implications of this condition so that those affected receive a proper diagnosis and assessment of their needs;
  • make recommendations about what action is now required and who must take it.

It will publish its report later this year. 

Will the IMMDS review give compensation to children affected by valproate in pregnancy?

No. The aim of the review is to help the healthcare system learn and improve. The review won’t allocate compensation to any individual but it may make recommendations if it concludes that there is a moral, social or ethical responsibility to consider a system of compensation if avoidable harm has been suffered.

If your child has suffered serious physical or developmental injuries as a result of negligent medical prescription of sodium valproate during pregnancy and you would like to find out more about bringing a claim, contact Boyes Turner’s birth injury experts by email at mednegclaims@boyesturner.com.

Sepsis - NHS guidance enforces one hour response time

The UK Sepsis Trust report that there are around 250,000 cases of sepsis a year in the UK and around 52,000 (around 20%) of those people die as a result.

NHS England has issued new guidance to NHS Trusts aimed at improving diagnosis times and commencement of treatment for patients arriving in accident and emergency departments with symptoms of sepsis. Under the new guidance, hospital staff must alert senior doctors if patients with suspected sepsis do not respond to treatment within an hour.

Sepsis – what is it?

The NHS website describes sepsis as “a serious complication of an infection” which without quick treatment can lead to multiple organ failure and death.

There are varying degrees of sepsis but, if left untreated, severe sepsis (affecting the organs or reducing the blood and oxygen supply to the tissues) and septic shock (in which the blood pressure drops to a dangerously low level) may develop. Both are medical emergencies.

How do you get sepsis?

Sepsis can arise from an infection in any part of the body; the most common sites of infection are the lungs, urinary tract, abdomen and pelvis.

Anyone can develop sepsis but if diagnosed at an early stage, it can be treated with antibiotics at home. In most cases, people generally go on to make a full recovery without lasting consequences.

Why is sepsis so dangerous?

Sepsis is difficult to diagnose. There isn’t any one investigation or obvious symptom for it, which means that signs can be missed and often treatment starts too late. Additionally, symptoms present differently in adults and children, which can cause confusion.

If left untreated, sepsis can progress into the vital organs which can result in organ failure. This is a medical emergency and can lead to serious consequences such as amputation or death.

How is sepsis treated?

Sepsis is usually treated by antibiotics. The type of antibiotic may vary depending on where the infection originated but they are generally of a high strength dose and administered intravenously. Treatment should be started promptly as every minute counts in stopping the spread of sepsis. Ideally, treatment should start within an hour of diagnosis/development of symptoms.

What is the NHS doing to reduce delays in treatment of sepsis?

Delays in diagnosis and treatment of sepsis should not happen, but unfortunately they do. 

The NHS recognises that delays in diagnosis and treatment of sepsis can have catastrophic consequences. Public awareness has also increased following recent media attention on the devastating injuries suffered by patients as a result of delayed diagnosis and treatment of this dangerous condition. In response to these concerns, NHS England has issued new guidance requiring NHS Trusts to prioritise patients with suspected sepsis for diagnosis and treatment in one hour.

Meanwhile, some clinicians have expressed reservations about the consequences of the guidance, as they are concerned that the focus will be on meeting targets rather than improving service and that patients with suspected sepsis will be moved onto short-staffed acute medicine units rather than receiving proper diagnosis and treatment on accident and emergency wards. Against a background of stretched NHS resources, concerns have also been raised about the potentially poorer and slower treatment that other patients on A&E might receive.

Boyes Turner’s medical negligence team have helped secure compensation for many clients with devastating injuries arising from delayed diagnosis and treatment of sepsis. We welcome the new guidance and all genuine efforts to raise awareness within the NHS of the importance of early recognition and treatment of sepsis. We hope that by improving standards for diagnosis and treatment the number of lives affected by this dangerous condition will be greatly reduced. 

If you have suffered serious disability as a result of late diagnosis and treatment of sepsis and would like to find out more about making a claim, contact us by email at mednegclaims@boyesturner.com.

Jan's amputation story: Little victories; lots of frustrations

When 58-year-old nurse, Jan, went into hospital to have her colostomy reversed, she could never have imagined how much her life was about to change.

Jan had lived with the colostomy for a year after a bowel resection for diverticulitis and the reversal operation should have been the final stage towards recovery. She awoke after the surgery in excruciating pain and was given an epidural for pain relief. Over the next two days, her condition was allowed to deteriorate, developing into sepsis. She was treated with ineffective antibiotics and when she was finally taken back to the operating theatre, investigative surgery revealed a leak from her perforated bowel. Despite her continued post-operative deterioration, signs of sepsis and necrotising fasciitis were mistaken for post-surgical bruising and her ineffective antibiotic treatment regime continued.

A change of shift finally brought a nurse who had experience of nursing necrotising fasciitis. The nurse “smelled rotting flesh” and, recognising the signs, called the surgeon to review Jan’s condition. Jan was taken back to theatre for extensive debridement of her right flank, lower back and thigh. “It was huge,” says Jan, “like a shark bite,” and left deep scarring that she still finds upsetting whenever she looks in the mirror.

The infection raged on and Jan underwent multiple further debridement procedures. She became increasingly unwell with septic shock, ending up on the ITU suffering from multi-system organ failure, ischaemia, brachial thrombosis and extensive peripheral vascular compromise, causing gangrene in her hands and feet.

Jan has no recollection of these events throughout which she was semi-conscious from the strong pain medication. Jan’s first recollection is of waking up ten weeks after the original resection operation, completely unaware of her condition. “When I eventually came to, I remember looking at my hand. I couldn’t comprehend it at all.” She struggled to come to terms with the fact that she was potentially facing amputations. It was only months later, whilst sitting in a café with her daughter, that Jan asked to be told what had happened.

Jan was transferred to the Royal Free for the next stage of her treatment; “They did a skin graft on my thigh, removed my left hand and half my fingers [on the right hand], my toes on my left foot and half of my right foot. That was the most awful time for me, probably the worst time ever in my eleven months in hospital.”

Left in a closed room, isolated from the rest of the ward, with multiple recent amputations and the physical and emotional after-effects of her life-threatening illness, Jan received no counselling or psychological support. “I was very lonely. I was away from the nurses’ station and I was scared. I remember the physios trying to get me up walking. They took me down to the gym and I collapsed. I don’t think they believed how much pain I was in.”

The loss of the right leg came in stages. Initially, Jan had a mid-tarsal amputation leaving her with half a foot which never healed, despite five or six operations. 

“I was in so much pain from the sinus wound in the foot, especially when I had the dressings done. They gave me such strong painkillers that I was actually nodding off when I was eating. I remember the wound nurse from Hillingdon coming to see the wound on my foot and I said, ‘I’ve had enough. Let’s just take it off’. When I woke up after the below-knee amputation, it was fantastic. I didn’t have the pain. I was sore but I didn’t have the pain that I had before. When the physio came to see me and told me that he had come to help me with transferring to a wheelchair, I said, ‘What, like this?’ and I got up and did it. Little victories.”

Given her extensive disabilities, Jan understood that it was inevitable that she should lose her job as a nurse, but that didn’t make the news any easier to take. “I had been nursing since I was 17 and worked right up until the day before this all started. My manager and the HR came to see me while I was in hospital. That was very upsetting. I knew I wouldn’t be able to go back to work but when they actually came in to see me and told me…it was very upsetting.”

Going home was tough, bringing Jan face to face with the devastating impact that her sepsis, multiple amputations and consequent disability has had on her previously contented life.

“Three days before I came home the occupational therapist took me home [to see how she would cope]. I remember walking in there and looking at the pictures on the wall of our wedding two years earlier and bursting into tears.” Turning to her husband, Martin, Jan says; “Our relationship is very different. You’re still my husband but you are my carer.”

Ever-supportive, Martin, responds philosophically; “I’ve got another role as a carer and that takes precedence over all the other feelings. What’s happened has happened and we’ve just got to accept it.”

Martin was still working when Jan was discharged from hospital and in the absence of adequate provision for her safety and care, he did what he could to enable her to cope at home. “We had a big meeting towards the end of my time in hospital with the OT, the doctors and the physios,” recalls Jan, “They said I didn’t need a stair-lift. Apparently, you don’t need a stairlift if you can’t manage the stairs - you either have a room upstairs with everything in it or a commode downstairs.” Undeterred, Martin installed a stairlift before Jan came home. Without it, she wouldn’t have been able to cope. 

Martin also extended his daily routine to give him time to help Jan with her personal hygiene before he set off for work. Jan recalls; “I was given an ileostomy, which they tried to get me to manage. An ileostomy is not like a colostomy - it will work when it wants to work - so, all I remember about when I got home is being in the back bedroom, covered in pooh all around me, because it had leaked. Martin had to get up for work at half past two every morning, but he used to do me first before he went to work. Then the carer would come in later and it would be everywhere again. At first, they were giving me bed baths, but when I was able to move onto the commode, they would wheel me through into the bathroom and I would have to sit on the toilet to be washed. That was awful. I hated it. We had a bath but I couldn’t get into the bath. We had to fight with the council to have a walk-in shower put in.”

Given the almost complete loss of her hands and feet, Jan found the inadequacy of her NHS prosthetic provision, and the lack of compassion which accompanied it, particularly upsetting; “When we were at the Royal Free, the OT just handed me a catalogue of all the implements I could use without hands, and said, ‘All we will give you is cosmetic, you’ll get nothing else’. At Stanmore, the cosmetic arm they gave me fell off and the thing they gave me for my foot had a calliper on it. It was just awful.” Later, at the John Radcliffe, Oxford, she was offered a hook. “That was more of a hindrance than a help.” 

Jan and Martin are gradually adapting their lives and environment to meet Jan’s extensive needs. They have moved to a one-level home with a bigger bathroom and a walk-in shower, with further adaptations underway, but Jan has no intention of spending her days sitting waiting for Martin to come home.

 “At home I was very isolated. To begin with, I couldn’t drive, so I couldn’t go anywhere. I was housebound.” Jan is delighted that they have addressed the problem of her isolation with an adapted car which, at last, restores some of her independence. “I’m back driving, which is fantastic. My car’s been adapted. I use my left foot to drive with, so the accelerator is now on the left side. That took some getting used to. Martin can still use it because the left accelerator goes up and the right one comes down. It’s automatic and I have a ball on the steering wheel. I love driving, just my little dog, Molly, and me.”

For all Jan’s enthusiasm, Martin can’t help worrying; “I hate her driving. It’s good, but I still don’t like her driving.”

Having watched Jan’s struggles, it’s only natural that Martin worries, but Jan has learned to celebrate every little step towards her independence. Jan explains, “I would rather try and do things on my own, so I do, and he gets cross with me. I get very, very frustrated. We went out for a meal two weeks ago and I said to the waiter, ‘Would you ask the chef to cut my meat up for me please?’ The waiter asked whether that was all I wanted cut up, but I knew I could manage the rest. That was excellent.”

Little victories. Lots of frustrations. Little things we take for granted that Jan can no longer do.

“I still have tears, but the tears now are really frustration. It’s so hard. I was taking things out of the tumble dryer yesterday and trying to fold them up. I can just about manage to cook but I have to ask Martin to take things out of the oven for me. I can’t peel an apple…”

That’s no hardship,” Martin intervenes. He’s always happy to help.

“I know it’s no hardship to ask you,” says Jan, “but I’d rather do it myself.”

Jan would also rather do her own shopping; “I don’t like Martin going to do the shopping all the time. I like to go, but you’ve got to plan ahead all the time. I drive up to Tesco but it’s no good using my wheelchair because all I can do is put a basket on my lap and I can’t put much in there. So, I go in with my stick and ask for an electric wheelchair, but [when she last went] there were none left. So, I managed by pushing a trolley around. By the end of it they were very sweet. They could obviously see me struggling and they came over and offered me a staff member to push me around in a wheelchair and do my shopping with me, which was brilliant. When I went in again yesterday to do some shopping, they had got some new scooters.”

Jan approached Boyes Turner after her previous solicitors left it until a month before her limitation deadline expired to tell her they couldn’t pursue her claim. “I thought it was finished and I was broken hearted.” However, Boyes Turner were able to overcome these difficulties and obtained a substantial settlement for Jan, bringing to a satisfactory conclusion this highly complex and strongly contested claim.

With the legal case behind her and the security of knowing that she has financial provision for her needs now and in the future, we asked Jan to reflect on the claim; “The biggest relief is that it’s finished. There is no more fighting for anything. They still haven’t said, ‘Sorry, we made a mistake,’ but I suppose they don’t just write out a cheque without some acceptance that they were to blame.”

If you or a loved one have suffered or are expected to undergo amputation as a result of medical negligence and you would like to find out more about making a claim, contact us by email at claimsadvice@boyesturner.com.

Meningitis and its long-term effects

What is meningitis?

Meningitis is a serious illness in which infection causes inflammation of the membranes that surround the brain and spinal cord.

If not treated immediately, meningitis can be deadly. Survivors can experience a number of long-term effects, including brain injury, hearing loss, vision loss and limb loss or amputation.

Our medical negligence lawyers have obtained compensation for adults and children who have suffered brain injury after meningitis and may be suffering from many of the following long-term, disabilities. 

What are the physical effects of brain injury caused by meningitis?

Physically, the individual may have impaired movement and coordination affecting their mobility, balance and independence. Long-term movement difficulties are more common with children. They may be linked to hearing loss.

Individuals may also experience seizures (also known as fits or convulsions) and suffer from epilepsy, which may need to be controlled by medication. Headaches and fatigue are also commonly experienced after meningitis.

How does meningitis cause limb loss or amputation?

Meningitis and septicaemia often happen together. Septicaemia occurs when meningococcal bacteria enters the blood stream, causing damage to blood vessels and reducing the flow of oxygen to major organs, such as the heart, brain, lungs, liver and kidneys. As the body prioritises sending blood to the vital organs, the blood supply to the peripheries – legs, arms, fingers and toes – is reduced. Without enough oxygenated blood, the hands and feet start to die and amputation may be needed.

Amputation can be devastating, affecting the amputee’s mobility, independence, ability to care for themselves or their children and their ability to work. Without proper support and prosthetic provision, amputees can become isolated and suffer from psychological symptoms, such as post- traumatic stress and depression.

If you have experienced limb loss following meningitis there are some great charities that we work with, such as PACE, which may be able to help you.

What are the subtle or invisible after-effects of meningitis?

In addition to the physical consequences of brain injury, meningitis survivors can also suffer from subtle or invisible after-effects which have a huge impact on their daily life but can be misunderstood by people around them as they are less obvious than a physical disability.

Meningitis charity, Meningitis Now’s helpful fact sheets set out the many ways in which brain injury from meningitis can cause difficulty with aspects of brain function that we take for granted, such as memory, perception and ‘executive skills’, such as organisation and understanding the consequences of our behaviour. Injury to the brain from meningitis can cause unpleasant changes in behaviour, such as:

  • withdrawal
  • being impulsive
  • aggression
  • lack of inhibition
  • loss of confidence
  • mood swings
  • depression
  • anxiety

Some people also experience problems with language following a brain injury.

How can meningitis cause hearing loss?

According to Meningitis Now, approximately 8% of survivors will experience some degree of permanent hearing loss. This is caused by damage to the hair cells of the cochlea or nerve fibres inside the ear. Cochlear damage is sometimes treated with cochlear implants but long-term hearing loss can still remain. The severity of hearing loss can fluctuate over time and needs long-term monitoring.

Meningitis treatment delay: How can Boyes Turner help obtain compensation?

Each meningitis survivor’s experience is unique, depending on the way in which their brain and body were affected by the disease. At Boyes Turner we can help those affected by negligently delayed treatment for meningitis get support that is personalised to meet their individual needs. We have helped clients obtain:

  • care
  • special educational support
  • prosthetics
  • assistive technology
  • specialist equipment
  • therapies
  • adapted vehicles
  • adapted accommodation
  • counselling
  • compensation for loss of earnings

Our brain injury and amputation specialists have successfully claimed millions of pounds in settlements for meningitis survivors. In cases where admissions of liability have been made, we secure interim payments to get rehabilitation underway, to ease financial hardship which arises from the individual’s loss of earnings, and to fund bespoke prosthetics, therapy, assistance with personal care, education, accessibility and adapted accommodation, often long before the claim is finally settled.

What our clients say:

“I’m back driving, which is fantastic. My car’s been adapted. I use my left foot to drive with, so the accelerator is now on the left side.”

Jan McFadden

“Now we’ve come to the end of this and I think, oh my God! I could have missed out on all this help.”

If you are caring for someone who has suffered amputation or brain injury from negligent medical care and would like to find out more about bringing a claim, contact us by email at mednegclaims@boyesturner.com.

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Boyes Turner client

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