The Claimant, now aged 51, was an artist and designer who was also able to turn his hand and skills to general building work and landscape garden design. He had a 10 year history of back pain, prior to the negligence, with several periods of exacerbation following which he was always able to return to work.
In November 2004 when 45 years of age the Claimant noticed a sudden deterioration in his back pain and within a few days developed pain in his left lower limb reaching to the ankle with pins and needles in the buttock area and some numb patches in the perineum (around the testis and anus). The Claimant attended on his General Practitioner who, recognising the seriousness of the Claimant's condition, immediately arranged for hospital admission that day.
The Claimant was admitted to Dorset County Hospital in Dorchester under the care of the Orthopaedic Department and was thoroughly examined in relation to a potential Cauda Equina lesion. An MRI scan was carried out the following day which confirmed a significant disc protrusion at L5/S1. In view of the MRI findings Wessex Neurological Centre, Southampton (to whom he had been referred by Dorset County Hospital) advised that surgery should be performed and arrangements were made for the Claimant to be transferred by ambulance to Southampton.
The Claimant's case was discussed with the Consultant Neurosurgeon with overall responsibility for neurosurgery at the Defendant's NHS Trust. Surgery was delegated to a more junior surgeon who, it was subsequently discovered, initially commenced surgery without supervision. He experienced difficulties very early on during the procedure and assistance was provided by a surgical registrar, who also, it was subsequently discovered, had limited experience of the type of disc prolapse and presentation experienced by the Claimant.
On recovery from the anaesthetic, following the operation, the Claimant was aware of a new sensory loss around his left foot. The surgeon explained to the Claimant that following surgery a nerve root had been accidentally damaged; he apologised to the Claimant in that he had been a bit "gung-ho" and indicated that he had detached a nerve when carrying out the surgery.
The Claimant went on to develop weakness of the left foot and unrelenting pain of a burning nature in the left leg. The Claimant continues to suffer extremely severe pain in his left lower limb and has restricted mobility. He tried to address the issues with the Defendant by writing to the Consultant in charge and expressing his concern about the comments in relation to the "gung-ho" attitude and asking for an explanation.
In response it was confirmed that the S1 nerve root had been damaged during the operation and in a letter to the GP the Trust advised that the Claimant had a complete S1 neuropathy on the left and residual sensory disturbance affecting the left L5 nerve with impaired sensation on the left S2 to S4. The letter also confirmed that the Claimant was having difficulty walking because of the neuropathic pain relating to the S1 damage and that he had residual problems with his bladder, bowel and sexual function and required multi-disciplinary rehabilitation.
The Claimant eventually pursued a clinical negligence claim against the Defendant Trust.
The main issue in relation to the Claimant's case, and the only evidence available at the start of the investigation was the reference to the "gung-ho" attitude. On considering the medical notes and records and the MRI scan it became clear that the scan showed a type of presentation that, according to the Claimant's solicitor, and subsequently according to medical evidence, should have been known to the Defendant's Surgeons. The surgeons would have been familiar with this presentation if they had possessed the relevant experience and expertise. Presentation was such that the Claimant's left S1 nerve root was displaced laterally by the protruding disc material which meant that, without adequate expertise and knowledge, it was possible for the surgeon to mistakenly identify the anatomy which is what occurred in this case.
The Claimant's solicitors pursued the claim on a Conditional Fee Agreement (CFA) on the basis that it appeared from the evidence in the medical records that the surgeons were inexperienced and should not have been performing such complex surgery without supervision.
Because of his mobility difficulties and constant pain the Claimant had care needs. At the time of injury the Claimant had been keen to progress his business development in the art and design field but because of the nature of his work and the fact that much of this had been carried out on a part-time basis, prior to his having a family to support, evidence in respect of his loss of earnings was limited and this presented a problem to the Claimant's solicitor.
The Claimant's claim has been settled for a significant six figure sum which will enable him to address his accommodation needs and compensate him, to some extent, for his future inability to work in any full-time capacity.
The Claimant's solicitor, Angie Maxwell, has a background in the NHS, having been a Senior Physiotherapist with a particular interest in neurology and spinal injury and was therefore ideally suited to manage this claim. As damage to surrounding nerves is a known risk of spinal surgery, particularly spinal surgery involving the Cauda Equina this case presented with particular difficulties.
Having a knowledge of the anatomy and an understanding of the devastating consequences of a spinal injury, and the need to use the appropriate experts in such cases, can make all the difference between success and failure and can significantly contribute to the amount of damages received. As in this case, Cauda Equina injuries are often difficult because proving causation, the link between the substandard management of the surgery and the damage suffered by the patient, is dependent on a clear understanding of the symptoms and signs experienced by a Claimant up to and before surgical intervention.
If you have suffered a spinal injury or if you have concerns over spinal surgery you have undergone in the last 3 to 5 years please contact Angie Maxwell in Michelmores LLP Clinical Negligence Department on 01392 687613.