Orthopaedic Claims

 Please click on the titles to read the following case reports:

N v T&S NHS Foundation Trust 

The Claimant was admitted to hospital operated by T&S NHS Foundation Trust on 23rd April 2003 with acute back pain.

In 1997, the Claimant had previously been admitted to the same hospital with what turned out to be a staphylococcus aureus spinal abscess, which resolved. The Claimant explained to the doctors who attended him in Accident & Emergency that the symptoms he was experiencing were almost identical to the back pain that he experienced in November 1997. The Claimant’s medical notes were unable to be found.
 
Notwithstanding, a junior doctor, S, suspected a possible spinal abscess (because of this previous history) as a differential diagnosis, but she was overruled by her more senior colleagues.
 
As a result, the Claimant was discharged from the hospital to the care of his GP, but his condition worsened over the weekend, and he was re-admitted as an emergency on 26th April 2005. ‘now having difficulty walking due to weakness in legs. No bladder symptoms. No perianal numbness….’
 
Thereafter, no steps were taken to confirm whether or not there was a spinal infection or control its progress between 26th April 2005 and 27th April 2005, when at 02:10hrs, the Claimant lost rectal sensation and was not passing urine. He complained of numbness in the soles of his feet. There was a delay in scanning the Claimant, because he was a war veteran with shrapnel in his skull. There was further delay due to the routine servicing of the CT scanner. No-one could perform a CT myelogram.
 
Although the Defendants then undertook emergency decompression surgery on 28th April 2005, it was too late to obtain an neurological improvement, and as a result of the delay between 23rd and 28th April 2005, the Claimant suffered a complete cauda equina lesion.

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 Mrs W v Salisbury NHS Foundation Trust (Formerly Salisbury Healthcare NHS Trust)

Out of Court settlement: 23/12/2008

The Claimant, a 50 year old woman, received £37,500 for the failure of the Defendant to diagnose a rotator cuff tear of her right shoulder.
 
Had surgery been undertaken within 7 to 10 days of review of the MRI scan then the Claimant would have gained full rotator cuff function within 12 months from surgery. The chances of success were greater the earlier the surgery was performed. The surgery would have been followed by 6 weeks immobilisation of the shoulder and 3 to 6 months of physiotherapy. Therefore, by September 2004 the Claimant would largely have recovered the function of her shoulder.
 
Instead, she is likely to require a shoulder replacement in the future and due to overuse of her left shoulder to compensate for her right shoulder she developed impingement pain in her left shoulder and had to undergo an arthroscopic subacromil decompression on the left shoulder in March 2005.
 
Claimant: female, aged 50 at the date of injury; 54 years old at the date of settlement.
 

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CW (suing as Executrix of the Estate of AFP Deceased) - v - Royal United Hospital Bath NHS Trust

AFP had suffered a number of sporting injuries to his knee during the 1970s. In 1973, both menisci in his knees were removed (a type of surgery that would be deprecated nowadays, but which was routine during the 1970’s). As a result, AFP developed very severe osteoarthritis of his left knee by 1992, and on 22nd November 1992, he was admitted to the Royal United Hospital in Bath for a left total knee replacement under the care of Mr P.

The operation took place on 24th November 1992. During the week after the operation, AFP’s recovery seemed uneventful. However, no routine anti‑coagulant therapy was prescribed, nor were any steps taken to mobilise AFP at an early stage.

Indeed, over the following weekend, 27th to 29th November 1992, AFP was actually advised to stop exercise and prescribed bed rest. His leg was immobilised in a leg-brace. There was a strong suspicion that this decision was taken because of management priorities rather than clinical priorities, because there were no Physiotherapists available at the weekend, and only a skeleton nursing staff owing to cost cutting measures undertaken at the hospital.

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H -v- Royal United Hospital Bath NHS Trust 

On 3 September 2003, the claimant, a fourteen year old at the time, sustained an injury to his right great toe while playing football at school. Due to the pain he suffered overnight, on the morning of 4 September he was taken to the Royal United Hospital (RUH) in Bath where he was given an x-ray and diagnosed as having a soft tissue injury and discharged the same day.
 
Following his discharge, the Claimant continued to be in considerable pain and had a high temperature. He therefore attended A&E again on the 6 September and was told he had sprained his right big toe and sent home. However, the pain did not ease and the Claimant returned to A&E on 9 September. He underwent tests for a full blood count, C-reactive protein, urea and electrolytes. He was also referred for an orthopaedic opinion. An x-ray was taken and a small fracture was noted. The Claimant was provided with a plaster boot and discharged with an appointment to attend the fracture clinic.
 
The Claimant’s condition continued to deteriorate and he re-attended A&E on 11 September 2003. The medical notes noted no signs of a septic joint and the Claimant was sent home. He returned on 12 September and was seen by a Consultant orthopaedic Surgeon who subsequently referred the Claimant to the paediatricians. The Claimant underwent a paediatric review and was given a below knee plaster, prescribed paracetamol and discharged.
 
The Claimant noticed no improvement and was seen by his GP on 18 September 2003. He was diagnosed with acute osteomyelitis of the right foot and immediately admitted to hospital. He subsequently underwent 4 separate surgically invasive procedures between 21 September and 1 October to deal with the progression of his osteomyelitis. He was eventually discharged on 10 October and remained in plaster until April 2004. He sustained permanent damage to his metatarsal and it is likely he will require further surgery in the future.
 
The Claimant alleged that the Defendant was negligent in failing to admit the Claimant for further investigation between the 9 and 12 September and contended that given the symptoms, osteomyelitis should have been diagnosed on 12 September when he was reviewed by the orthopaedic department and antibiotics commenced. The failure to do so resulted in septic arthritis, 4 surgically invasive procedures and permanent damage to the metatarsal of his right toe.
 
Expert reports were obtained which stated that the Defendant was negligent in diagnose osteomyelitis and commence antibiotics on 12 September and a letter of claim was sent to the Defendant. The defendant denied liability and proceedings were issued.  

The Claimant was awarded total damages of £22,500.00 in full and final settlement of her claim.

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B - v - Royal United Hospital Bath NHS Trust

On 21 December 1997 B fell from her horse and was taken to Accident and Emergency where she was diagnosed with bad bruising. Further to considerable pain, B returned to the hospital the following day but was told there was no fracture and again diagnosed with bad bruising.

On 23 December 1997 B had a fall. This caused her considerable pain and on 26 December 1997 she went to hospital where a fracture of the neck of the femur was diagnosed.

B’s parents were told that pinning the hip at this late stage could cause further damage to the growth plates and blood supply and there was a possibility that the blood supply to the hip might have been damaged. They were informed that had the fracture been detected within 24 hours of the accident, the bone could have been operated on and the damaged blood vessels repaired.

Court proceedings were issued and expert reports obtained. It was the opinion of experts that the delay in the diagnosis of the fracture which was present on 21 December 1997 provoked the displacement caused by the fall on 23 December 1997. The outcome following this delay had been a 1 cm shortening of the leg and a torsion abnormality. The NHS Trust denied liability and maintained that the original diagnosis of soft tissue damage was not negligent.

B was awarded damages in the sum of £9,000.00 in full and final settlement of her claim.

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AJM (By Her Litigation Friend RM) v Bath & North East Somerset Primary Care Trust (Formerly Bath & West Community NHS Trust)

Paediatrician Negligence – Dysplastic Dislocation Of The Hip – Failure To Adequately Assess And Recognise Congenital Hip Dislocation – Adverse Long Term Sequelae For Child
The infant Claimant AJM (born 17th January 1996) was at all material times in the medical care of the Defendant. The Infant was born in a breech position. The Midwife noted “hips √√”. Two days later she was reviewed by Dr H, Paediatric SHO, who made no note of a hip examination.

Following discharge, AJM was examined by a Community Midwife, but, despite the fact that the mother was concerned about the way the child’s leg hung out of the cot, the Health Visitor assured her that there was no problem. The General Practitioner on the six week check purported to carry out an Ortolani-Barlow examination and found nothing abnormal. At the 9 month check, the General Practitioner again marked that the hips were “satisfactory”. Given the subsequent history, this must have been inaccurate.

By 3rd February 1997, the Health Visitor noted that the child was still “crawling, pulls to stand, will stand unsupported briefly”. Again, there was no examination of the hips recorded.

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B - v - East Sussex Hospitals NHS Trust

B, aged 39 years at date of alleged negligence and 44 years at date of settlement, ruptured the tendon controlling her right middle finger as a result of an assault.

There was a 12 day delay in diagnosing and repairing the break in the tendon. As a result, when B was assaulted again 1 month later, the tendon repair weakened when it would not have done so if there had been no delay in the original repair. The tendon repair went on to re-break, leaving the Claimant with ongoing disabilities in relation to her right hand.

This claim was eventually negotiated to a settlement in the sum of £21,500.

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P - v - United Bristol Healthcare NHS Trust (2004)

Out of Court Settlement 16/4/2004

The claimant, a 23-year-old man, received £40,000 for the right scaphoid fracture sustained following an incident at a nightclub and subsequent treatment at the defendant's hospital. The claimant underwent hand surgery, during which internal screw fixation and bone grafting took place, however it was not successful and his scaphoid did not heal. There was therefore a 95 per cent chance that he would develop degenerative arthritis within fifteen years.

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X –v-Swindon & Marlborough NHS Trust 

Orthopaedic Negligence – Total Knee Replacement
Popliteal Artery severed and unrecognised - Neurological impairment loss of earnings

In 1991, X was diagnosed as suffering from osteoarthritis in both knees. He was recommended to go bilateral knee replacement surgery, and because of delays in arranging surgery, it was decided to operate on both knees sequentially under the same anaesthetic on 27th July 2000.

Following the operation, X suffered from excessive bleeding within the left leg. There were no problems with X's right knee, and the outcome of that athroplasty was very satisfactory with pre-operative arthritic pain relieved, the tissues healing well and the prosthesis functioning with an excellent range of movement with no operative or post-operative complications.

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B - v- G NHS Trust 

Orthopaedic Negligence – Infection Control – Failure to control infection leading to unacceptable total knee replacement result

The Claimant was admitted to a hospital operated by G NHS Trust in 1999 for a first right total knee replacement.

Later in 1999, the Claimant was admitted for a second left total knee replacement. Following the first total knee replacement, the Claimant contracted a hospital acquired infection, but this was controlled and she suffered no significant effects, and she had a good result from the right total knee replacement.

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H–v-East Somerset NHS Trust

H began to suffer pain in his right thigh in February 1998, as a result of which he attended his GP, x-rays were undertaken and he was then sent to an orthopaedic surgeon at Yeovil District Hospital in or around May 1998. A bone scan was carried out showing an abnormality in the right thigh, but H was diagnosed as suffering from a non-malignant condition.

H returned to his doctor for review in early 1999, when further x-rays were taken and H was again reassured that he had a non-malignant condition despite increasing pain in his right thigh. H returned to his doctor earlier than planned in July 1999 as a result of ongoing pain, at which time yet more x-rays were taken, and he was again reassured that he was suffering from a non-malignant condition.

Unfortunately, in August 1999 H suffered a fracture to his right thigh at which time it was diagnosed that this was caused by an aggressive bone tumour in his right thigh. Despite prompt surgery, the delay in diagnosis and treatment of the cancer with the subsequent fracture, had allowed the cancer cells to escape into the surrounding tissue and the cancer returned and then spread to H’s lungs and brain, causing significant ongoing disabilities, and his eventual death in May 2005.

Unfortunately, despite the best endeavours of the firm, it was not possible to settle the case prior to H’s death as a result of the complexities of the case. The case continued on behalf of H’s estate, and was eventually settled for the sum of £127,500.

This case was dealt with by Paul Rumley, an Associate Solicitor in our Swindon/Marlborough offices, a member of the Law Society’s Clinical Negligence Panel and head of the firm’s Fatal Claims Unit. 

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