Cauda Equina Syndrome (CES) is a rare but well-known condition where the lower nerves in the back are suddenly compressed. The only treatment for this serious medical emergency is rapid surgery.
Clinical Negligence partner Hugh Johnson reports on the settlement of a long-running case brought against multiple defendants after his client, BL, developed CES after spinal surgery for a separate medical issue.
Background to BL’s medical treatment and CES injury
BL was 53 years old at the time of his injury.
He had a long history of back pain and had been receiving treatment under his surgeon for several years. He had undergone back surgery before, which had been successful in alleviating his pain for a short period. In late 2017, it was identified that BL needed further spinal surgery, namely, a decompressive laminectomy. As BL had private medical cover, he was able to organise the surgery at a private hospital close to his home.
Immediately after the surgery, BL was in great pain, much worse than he had experienced with previous back surgeries. Over the next three days, he began to have difficulty urinating and struggled to walk due to his continuous pain. BL had developed Cauda Equina Syndrome (CES). The surgery undertaken had not created the space anticipated and likely caused CES to develop. The onset of this new condition was a neurosurgical emergency and required an urgent MRI scan and revision surgery.
It is widely accepted that patients experiencing CES must undergo surgery within 24-48 hours of onset if there is to be a good medical outcome. Unfortunately, the CES diagnosis was not made in BL’s case despite the medical records clearly recording “red flag” medical symptoms, such as numbness and pins and needles in the saddle area. Instead, BL was discharged from his private hospital without further investigation. On leaving hospital, BL went home but continued to make calls to his surgeon and his GP as he continued to experience significant pain, numbness and pins and needles. He struggled to walk.
Ultimately, BL was asked by his private neurosurgeon to attend his local NHS hospital for a new scan. There was a further delay at that stage, with the NHS hospital failing to recognise the urgency of BL’s condition.
BL underwent further surgery four days after the initial surgery, having sustained CES for that period. Unfortunately, he has never recovered full neurological function. While BL can walk, he is less able to walk long distances and is more prone to tripping. He has impaired bladder, bowel and sexual function. BL was still able to work at the time of the settlement but had to scale back his working days and is expected to need to stop working earlier than he would have done.
Instruction of Stewarts
Stewarts brought claims against three separate defendants.
- The neurosurgeon
- The private hospital where BL had received his treatment, and
- The NHS hospital that performed the remedial surgery (after a period of delay).
The need to bring claims against multiple defendants arose because BL’s medical care was provided in the private sector where, unlike NHS care, the surgeon is self-employed and insured separately from the treating hospital.
BL deteriorated following his surgery. Although the medical records suggested that the nurses at the private hospital had contacted the defendant surgeon to make him aware, the surgeon denied that. He alleged there was a failure to inform him. In addition to analysis of the medical records and input from experts, investigations needed to include an interrogation of other records. These included a review of itemised phone bills (to ascertain whether the nurses had contacted the surgeon), hospital referral contracts and scanner logs (both to ascertain where and when MRI scanning could have been performed earlier).
While the NHS hospital had admitted a delay in treatment, the other two defendants refused to accept any liability. All three defendants denied that BL’s injury could have been avoided. Multiple experts were retained to advise on neurosurgery, nursing and physiotherapy liability issues. The number of defendants meant there was evidence from four separate neurosurgeons.
At mediation in September 2022, the defendant parties reluctantly agreed to apportion liability for BL’s injuries wholly between them. This meant investigations could progress to a valuation of the claim without the need for a trial. It was also agreed at this point that the defendants would pay BL an interim payment of £600,000. Those funds were essential to enable him to look for a new property and begin meeting his rehabilitation needs.
Subsequently, Stewarts retained a team of experts addressing care, occupational therapy, accommodation, physiotherapy, psychology, urology, pain management and spinal injury rehabilitation needs. Witness evidence was obtained from family members and the claimant’s employer regarding his earnings and future earnings potential had he not been restricted by his injury.
Hugh Johnson, instructing Grahame Aldous KC and Linda Nelson of Deka Chambers, secured a damages settlement totalling £2.5m at a settlement meeting in April 2024. The level of award recovered for BL reflects the life-changing nature of his condition. The settlement award is sufficient to meet the costs of BL’s accommodation needs, fund physiotherapy and pay for support workers to assist him with tasks that have become physically more difficult now and in the future.
Life after injury
With the damages settlement and the large interim payment made available to him, BL has been able to sell his pre-injury townhouse and purchase a new home before the litigation concluded. The property is ‘future-proofed to meet his needs. BL’s new home is largely level-access and has better bathroom facilities. He no longer needs to negotiate steep and narrow stairs, which puts him at risk of falling. Importantly, all the rooms also have wide open-plan spaces, which means he will be able to use a wheelchair or walking aids within the home should that become necessary as he ages with his disability.
Hugh Johnson comments: “This was a fiercely contested piece of litigation. For some time, the defendants were willing to blame one another but unwilling to accept any individual responsibility for the injuries caused to BL despite it being clear he had been discharged from hospital inappropriately. BL’s injuries have had both a physical and psychological impact. He had been concerned about how much longer he could continue working. The settlement award provides BL and his family with financial security. Having moved home, he now has the space to organise therapies and support.”
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