Seven figure settlement in High Court clinical negligence case arising from negligent failure to diagnose cauda equina syndrome

14/11/2023

Lionel Stride (instructed by Emma Doughty and Joanne Warren of Slater & Gordon), represented a claimant who suffered severe injuries as a result of a negligent failure to diagnose cauda equina syndrome at A&E on 2 February 2015. She had presented with a host of red flag indications to her GP, including reduced sensation around her saddle area and loss of sensation when opening her bowels, and had been advised to attend hospital immediately. On arrival, however, the SHO specifically ruled out cauda equina syndrome without conducting an MRI scan and in the teeth of a letter from the GP highlighting his own concerns. Consequently, the Claimant was not diagnosed until returning to A&E and undergoing emergency surgery on 10 February 2015.

Regrettably, intervention came too late and the Claimant was left with permanent bladder and bowel dysfunction, as well as severe spinal pain, even after follow-up surgery (including fusion).   

Given that expert reports were required in multiple disciplines (to address breach, causation, condition, prognosis and quantum), the evidence took a long time to gather and the parties agreed extensions of time for limitation, service of the pleadings and medical evidence on the basis that the Defendant’s experts were also afforded the opportunity to examine the Claimant pre-service.

It was the Claimant’s primary case that: –

• The SHO had been negligent in, amongst other things, ignoring the examination findings of the GP and failing to undertake an MRI scan (which would have led to the correct diagnosis) and/or conducting a negligent examination (with specific criticism pleaded);

• The alleged negligence led to a delay in surgery of 7 days, during which time there was ongoing compression and permanent damage to the neural structures of her spine; and,

• Although she would still have been left with some saddle numbness, loss of sensation and back pain, she would have avoided the extensive urinary and bowel dysfunction, as well as disabling levels of spinal pain, that she continued to experience.

In its Defence, the Defendant ultimately admitted breach of duty in light of the fully pleaded allegations (8 years after the events) but challenged causation on grounds that: –

• She already had significant cauda equine symptoms on 2 February 2015;

• There was no material deterioration between 2 and 10 February 2015, such that the outcome would have been the same even with earlier surgery;

• The Claimant recovered well from initial surgery in any event but suffered unrelated decline in her spinal condition thereafter due to pre-existing spinal issues/a pain reaction that she would have experienced no matter the timing of surgery; and/or

• She would have developed similar levels of disability within a few years as a result of further disc herniation or prolapse and/or the development of unrelated chronic pain.

After exchange of evidence (some without prejudice), the case ultimately settled at a JSM for a seven figure sum that reflected the balance of evidence and risk on these issues; the settlement was consistent with the Claimant succeeding on her primary case but with reductions for the risk that she might lose on one or more of the causation issues and/or that any award would be discounted to reflect her medical history and increased need for care in future in any event.

Settlement was only possible because the case had been fully pleaded at the time of service, including a detailed chronology of the critical medical entries (evidencing deterioration); and both sides had been able to make a comprehensive assessment of the litigation risk after conferences with their experts and service of medical evidence (even if only on a without prejudice basis).

The case demonstrates the benefit of a collegiate approach to gathering evidence in complex cases, as well as the value of pleadings in narrowing the issues between the parties (in this instance leading directly to a late admission of breach of duty, allowing the parties to focus on causation and quantum). The constructive engagement over several years was to the credit of both sides.