Our client, KH, presented to his local hospital in 2017 with red flag symptoms of cauda equina syndrome. He was refused an MRI and sent home without any further investigations. Five days later, he reattended with worsening symptoms, and an MRI confirmed a ruptured disc compressing his cauda equina nerves.

KH brought a claim against the hospital trust, leading to a successful settlement for a seven-figure sum. Nadia Krueger-Young, who acted for KH with Nathan Tavares KC, reviews the case.

 

The background

In October 2017, KH began suffering from lower back pain. On 21 December 2017, the pain changed in severity, and KH was suddenly in agony and struggling to walk. He lost sensation and was numb from his knees down. He attended A&E, and red flag symptoms of cauda equina were elicited. Despite this, an X-ray was ordered rather than an MRI scan. The X-ray was normal, and KH was told he did not have cauda equina syndrome (CES). He was told to go home and wait for physiotherapy, which would not be available until after the Christmas period.

For the next five days, KH could not walk and was crawling on his hands and knees. He was crawling up and down the stairs to get to his bedroom and to use the toilet. He had to lift his knees up onto each stair using his hands to do this. His knees were cut and sore.

After a friend called 111 for advice, he went back to A&E. He was referred to an orthopaedic doctor, who sent him for an MRI scan. KH was in excruciating pain and could not tolerate lying down for the length of time required for the MRI, even though he was desperate for the scan.

He requested further pain relief, and to his shock, when he got back to the ward, he was shouted at by the orthopaedic doctor, who accused him of delaying the MRI. No doubt, by this point, KH’s records had been reviewed and it was clear he should have been given an MRI when he first attended before Christmas. KH spoke to a friend who came to be with him at the hospital to help him with a PALS (Patient Advice and Liaison Service) complaint and to be the go-between between KH and the doctor.

After being given adequate pain relief, an MRI scan was carried out, and KH was sent to Ipswich Hospital. He wasn’t told what was going on, only that he needed emergency surgery. When he arrived at Ipswich Hospital, it was revealed that a disc in his lumbar spine had ruptured. The disc’s material had spread onto the cauda equina nerves, causing severe compression. KH underwent emergency surgery for decompression.

KH was left with neuropathic pain, leg weakness, right foot drop and lack of proprioception, sexual dysfunction and an overactive bladder. His injury had a significant impact on his physical and mental wellbeing and increased his isolation. His injury made it more difficult for him to see family and friends and carry out the hobbies he used to enjoy.

 

National Suspected Cauda Equina Pathway

In 2019, the Getting it Right First Time (GIRFT) National Specialty Report for Spinal Services reviewed 127 spinal units and found that many patients with suspected CES were not being referred for onward care in line with agreed treatment protocols.

The failures outlined in this report were similar to those in KH’s case. The report confirmed that for cases of suspected CES, an MRI should be carried out within four hours of the request, and surgery should be carried out as quickly as possible as an emergency.

The report recognised that CES is a serious spinal presentation, which, if not diagnosed and treated swiftly, can result in life-changing injury. Twenty-three per cent of litigated claims for spinal surgery in England relate to CES (based on GIRFT’s assessment of litigated claims in England between 2013/15 -15/16).

National-Suspected-Cauda-Equina-Pathway-Updated-July-2024.pdf (gettingitrightfirsttime.co.uk) 

 

The legal case

KH instructed Stewarts’ Nadia Krueger-Young to act on his behalf. Initially, he wanted to investigate a case against the orthopaedic doctor who had intimidated him. Stewarts agreed to help KH with a specific complaint about the doctor as well as a claim against East Suffolk & North Essex NHS Foundation Trust for its delay in diagnosing and treating KH’s ruptured disc, which caused cauda equina compression. Nathan Tavares KC of Outer Temple was instructed as counsel.

Although breach of duty was admitted early on, the defendant tried to argue causation was only limited to a one-year period of loss. The defendant sought to argue that KH had several comorbidities, such as peripheral neuropathy and autistic spectrum condition, which they argued would lead him to require care and assistance in any event. However, the defendant failed to serve any neurology or psychiatry expert evidence to support its position.

Stewarts and Nathan Tavares KC robustly held KH’s position and the claim settled for a seven-figure sum.

 

The future

KH is now looking forward to following his ambitions of going back into education and completing a bio acoustics degree. He also wants to build a sustainable home which will accommodate his needs as he ages, as well allowing him to live in an environmentally friendly, low-impact home.

 


 

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