Victoria Jones, Partner in the Medical Negligence team has achieved a seven figure settlement relating to a delay in diagnosis of transverse myelitis. This Transverse Myelitis claim arose after the delay resulted in intrusive and disabling neurological symptoms as a result of permanent damage to our client’s upper cervical spinal cord. It was argued that with appropriate and prompt treatment by way of intravenous corticosteroids, our client would have made a full recovery or a recovery to the extent that any remaining symptoms would have been no more than a nuisance, not affecting his day to day activities.
Background to the case
Whilst driving home from a hiking holiday, our client noticed that he had developed pins and needles mainly in his lower left leg, specifically on the front of his left foot, but also in his upper left arm and shoulder. By the time he arrived home later that day, his symptoms had progressed: he was numb down the whole of the left side of his body with pain from his groin down his left leg, which was tingling.
When our client woke the following morning, both his legs and his left arm were numb. He also had numbness from the waist down with a constrictive feeling around his feet, calves, and thighs. When going to the toilet, his bowels opened without warning, and he was unable to urinate voluntarily but suffered overflow incontinence. He went straight to the Urgent Care Centre at the Blackpool Victoria Hospital (a GP out-of-hours service). A nurse recorded his presenting condition including his left arm symptoms. He was then examined by a doctor who examined his back and lower limbs, the only abnormal finding being subjective numbness in left leg and altered sensation around back passage despite normal tone. No examination was undertaken of our client’s upper limbs. It was considered that the cause of our client’s symptom might be cauda equina syndrome and he was referred to A&E at Blackpool Victoria Hospital where he undertook an MRI scan of his lumbar spine, although this was not suggestive of cauda equina syndrome. The doctor who then examined our client also noted our client’s complaint of numbness and tingling in the left upper arm but did not relay this to the on call neurosurgeon at Royal Preston Hospital whom he called to obtain advice. Continuation of analgesia was advised and a routine neurosurgical follow-up appointment was to be arranged. Our client was discharged from hospital.
However, upon waking the following day, our client noticed that he was suffering from weakness, numbness, unpleasant tingling, and spasticity in both legs. The unpleasant tingling was also affecting his left arm. Our client experienced urinary incontinence, difficulty in emptying his bladder, an absence of sensation in his back passage, and disturbance of genital sensation. He felt washed out. He spoke to NHS 111 and was advised to attend hospital. Our client’s wife drove him to A&E at the Royal Preston Hospital as it had a dedicated neurosciences centre. The triage and doctor assessment did not note any upper arm symptoms. Again neurosurgical advice was sought although this time arm symptoms were noted and it was thought that our client’s symptoms were more suggestive of a chronic condition such as may be seen with multiple sclerosis and that he needed an MRI scan of the whole spine in the next few days, a proper examination by the physicians and possibly both neurology and urology review. An urgent neurosurgical outpatient follow-up appointment was to be arranged and our client was discharged home with safety-netting advice. His wife had to help him into the car as he had difficulty walking due to weakness.
Our client’s condition did not improve the following day. He was exhausted by the two hospital attendances, could not physically bring himself to return, and hoped that with bedrest his condition would improve.
By the following day, our client’s symptoms continued to progress, particularly the numbness in his legs and his lack of mobility. He had not moved his bowels, and his bladder felt extremely painful. He returned to A&E at Royal Preston Hospital and was seen by an A&E nurse clinician who spoke to the neurosurgical team. They advised that there was no need for an urgent whole body MRI scan that day, but as our client was present at hospital, they would try and fit him in. The MRI scan showed a small focus of high signal within the posterior aspect of the cervical spinal cord at C3/4 and that demyelination needed to be excluded. Our client was advised that there was no need for the neurosurgeons to operate, but that that he would be referred to neurology as an outpatient, which was done via his GP after he was discharged that day.
Frustrated by his experiences at the Royal Preston Hospital, our client contacted his GP practice when he returned home that day. He asked for an urgent private neurological referral as he felt that he could not afford to wait. The GP then contacted the A&E Department at the Royal Preston Hospital. The GP spoke to Dr Haywood, A&E Consultant and then made an urgent private neurology referral to a Consultant Neurologist at the Spire Fylde Cost Hospital, Blackpool.
Over the days that followed, our client’s symptoms deteriorated still further: he was unable to move his bowels, and therefore he did not eat very much; he had further episodes of incontinence of urine; the sensory symptoms on the left side worsened, and he felt that both of his legs had turned to rubber. He did not feel he could wait more than a week for the neurology appointment and so arranged an emergency appointment at his GP Surgery. His GP telephoned the neurology team at the Royal Preston Hospital who agreed to see him that day. It was thought that the appearances were not typical of demyelination. A range of further blood tests were taken which subsequently reported as normal. An outpatient MRI scan of the brain and a lumbar puncture were also arranged. Our client was subsequently diagnosed with transverse myelitis but was only offered steroid treatment by the Walton Centre at a much later date.
Our client continues to suffer from permanent left upper limb, neck and face sensory symptoms, spasticity, bladder dysfunction, bowel dysfunction, impaired mobility, neuropathic pain, peroneal and genital numbness, all of which are distressing and disabling problems and impacted on his daily activities and ability to work.
The outcome
Although liability was denied at all times, a settlement was achieved just weeks before Trial was due to commence. The case was complicated in a number of ways. It was brought against two defendant hospital Trusts with several sets of allegations being made in respect of the care provided by the A&E, neurosurgery and neurology teams. As a result, the defendant produced an unusually high number of witness statements which all had to be considered. The claim was made more difficult by the lack of medical research into the effects of delayed steroid treatment in cases of transverse myelitis. In addition, extensive expert input was required in the fields of neurology, urology, colorectal surgery, psychiatry, pain management, spinal rehabilitation, care, physiotherapy and also from a forensic accountant to help determine the value of the claim. However, we were able to successfully analyse the medical records and weaknesses in the defendants’ witness and expert evidence and obtain a result which our client was very happy with.
Moore Barlow took over from another firm of solicitors who after two years had failed to make any headway in the claim. Victoria Jones took to the driving seat in what could be described at times as very trying conditions. Not only assembling and organising a body of experts, she addressed every pertinent aspect with clockwork precision. An excellent communicator, Victoria led me through all the complexities and when I flagged, she gave me exactly the push needed. An absolute rock, of the well polished professional diamond variety! Thank you to Moore Barlow and all of the team. You inspired confidence every step of the way. The level of service from Moore Barlow was quite exceptional.
Client comment upon settlement
I am delighted to have achieved a significant settlement for my client in this complex claim, although this was made all the more easier by our client’s sheer determination to soldier on the face of adversity. He is an inspiration.
Victoria Jones – Medical negligence partner
How Moore Barlow can help
If you have a complex clinical negligence claim, then please contact Moore Barlow who are experts in their field. We can help to secure, where possible, admissions of liability and therefore interim compensation payments pending the settlement of the claim.
