We acted for a client in a claim for personal injury, loss and damage as a result of a clinical negligence. He is a patient and brought this action by his wife and Litigation Friend.
Between the 11 March and 03 April 2010, our client (who was then aged 46), was under the care of the medical and nursing staff employed by the Defendant Trust at the Cheltenham General Hospital (“the Hospital”).
Summary
Our client suffered an extensive ischaemic stroke leading to global neurological impairment and right sided paralysis/paresis and it was our case that this was caused by a delayed diagnosis and treatment of a perforated colon.
A CT scan showed evidence of diverticulitis (inflammation of the colon), which we said was unappreciated sufficiently by the medical staff. He deteriorated whilst in hospital as the inflamed colon became septic, with no adequate response.
There should have been a further CT scan which would probably have revealed a perforation of the colon (which had led to the deterioration in his condition) which was only diagnosed on a later CT scan.
It was our client’s case that the undiagnosed, un-investigated and untreated inflammation, caused by the sepsis and likely blood hypercoagulability made a material contribution to the thrombo-embolic stroke and its consequential injuries.
He suffered a catastrophic injury as a consequence of the alleged negligence which impacted greatly on both his and his family’s lives.
Ischaemic Stroke Case Background
Prior to the events below, our client was a healthy man, in full-time employment as an HGV Driver.
In early March 2010, he suffered from an infection in his left calf, which had been treated with antiobiotics. He was admitted to the Hospital on the 04 March with cellulitis.
He was reviewed at the Hospital on the 10 March and discharged.
On the 11 March, he returned to the hospital with a sudden onset of abdominal pain. The pain was localised with no evidence of peritonitis. He was admitted to Hospital and monitored on a daily basis. The differential diagnosis was gallstones or peptic ulcer. He was given antibiotics and clindamycin for his cellulitis.
On the 13 March, it was noted that he had developed a fever of 39.5c and was unable to take deep breathes because of abdominal pain. A clinical diagnosis of acute cholecystitis (inflammation of the gallbladder) was made.
On the 14 March, his temperature was 39.4c and his blood pressure 84/60. A diagnosis of “severe sepsis” was made. He was given Tazocin. On the same day, he underwent a CT scan of the abdomen and pelvis. The CT report showed inflammation around the gallbladder, which contained small gallstones which were thought to be due to acute cholecystitis. It was also noted that there was some evidence of diverticular disease in the sigmoid colon with evidence of diverticulitis.
On the 15 March, he complained of a “severe band-like central abdominal pain”. A clinical examination showed the development of tenderness in the right upper quadrant.
On the 16 March, he was still in intense pain. The ITU Consultant attended and noted in his view that he was “acutely unwell and at high risk of further deterioration”. An acute pain team noted that he “continues to have abdominal pain when deep breathing/coughing. Prefers lying flat – sitting is also painful. His whole abdomen is uncomfortable”.
On the 17 march, he was found to be apyrexial, with stable observations. There was no record of any abdominal examination.
On the 18 March, his overnight temperature was noted to be 38c. There is the first entry referring to diverticulitis.
On the 22 March, a CT scan was performed and its report showed thickening of the gallbladder wall and a very thickened sigmoid colon with dramatic stranding of the adjacent pelvic fat and on the right lateral wall of the sigmoid there was a large cavity containing gas and faecal material.
On the same day, our client underwent an emergency laparotomy for perforated colon, which found a large recto-sigmoid diverticular inflammatory mass with associated multiple intraabdominal abscesses and a large inflamed gallbladder. A temporary ileostomy was fashioned.
The episode of collapse
On the 30 March, our client collapsed with loss of consciousness. A crash call was made to the cardiac arrest team. He was noted to have become unresponsive with a respiratory rate of 30, Glasgow Coma score of 6/16 and pyrexial. He was sedated, intubated and transferred to ITU.
On the 03 April, he underwent a CT scan which revealed he had suffered an ischaemic stroke. The CT imaging showed a large infarct in the territory of the left middle cerebral artery likely to be due to the occlusion of the left middle cerebral artery by an embolus. The MRI scan performed in March 2011 showed an established left middle cerebral artery stroke and showed evidence of further areas of cerebral infarction in the fright frontal lobe and the left occipital pole. These findings were due to the thrombus embolis.
Legal Case
It was our client’s case that the delay in surgery and/or changing his treatment led to the development of blood hypercoagulability, which in turn materially contributed to his ischaemic stroke.
It was alleged that the Hospital:-
- Failed to investigate adequately the unusual failure to improve from a diagnosis of cholecystitis
- Failed to appreciate the clinical emergency posed by the evidence of bacteraemia
- Failed to heed the CT findings of diverticular disease in the sigmoid colon and evidence of diverticulitis
- Failed to investigate adequately the deterioration that occurred on the 15 March and which continued into the 16 March
- Failed to arrange a CT scan on the 16 March
- Failed to diagnose the perforation of the colon and/or inflammation by no later than the 16 march
- Failed to operate on our client by either drainage of the sepsis and/or repairing his colon by no later than the 16 March
- Failed to change our client’s treatment plan to respond to his deterioration by no later than the 16 March
A further CT scan on the 16 March would have revealed a perforation of the colon and/or inflammation. He should then have undergone surgical treatment to remove the sepsis thereby avoiding its worsening and reducing the risk of a thromboembolism. This failure on the part of the hospital made a material contribution to his ischaemic stroke.
Particulars of Injury
Our client suffered permanent injuries which prevented him from working. He suffers a complex mixture of neurological, neuropsychological and neuropsychiatric disabilities. He has suffered epileptic seizures. He has cognitive impairment (reduced memory, processing speeds and impaired thought processing). He is unable to concentrate to read. He spends most of his time inside watching television. He is frustrated and moody, prone to outbursts of bad temper and irritation. There is no prospect of any improvement in this condition, it is likely that there will be further deterioration in his condition and he will require even more care and assistance. As a result of the permanent injuries he struggles with stairs, getting in and out of bed and other normal activities. He is mainly dependent upon a wheelchair for both internal and external movement.
He has been diagnosed with Parkinson’s, which is more than likely vascular Parkinsonism and attributable to the brain damage suffered: his mobility is severely impaired and he suffers multiple falls.
He will require suitable accommodation, care and case management, aids and equipment and therapy.
Litigation (Liability)
In the pre-action correspondence, the Defendant denied liability maintaining that our client had been treated appropriately and his injury/stroke could not have been avoided.
Proceedings were issued at Court in February 2016. The Defendants continued to robustly defend the case. To try to keep costs down, the parties agreed that there should be a split Trial ie. liability should be dealt with first.
The case was listed for a seven day Trial on the 04 December 2017, both parties relying on five liability experts each.
Following the exchange of expert reports and expert discussions, the parties were able to settle liability on a 50/50 basis. This settlement was approved by the Judge at an Approval hearing on the 29 September 2017.
Litigation (Quantum)
Following the liability settlement, we had to quantify our client’s claim. Both parties relied on eight experts in the following disciplines:-
- Neurology
- Accommodation
- Speech & Language
- Care/OT
- Neurological Rehabilitation
- Neuro-physiotherapy
- Assistive Technology/IT
- Court of Protection/Deputyship Costs
The case on quantum was listed for a 10 day Trial on the 03 December 2019.
Following exchange of reports and expert meetings, the parties had a roundtable meeting in August 2019 and were able to agree on a settlement of £1,650,000.00 for our client after the 50% reduction agreed on liability. This settlement was approved by the Court on the 02 December 2019.
S J Edney Solicitors obtained compensation of £1,650,000.00 for this client during 2019