Clinical negligence
cases and experience.

Case example

Fertility treatment negligence

Four-and-a-half years of inappropriate fertility treatment.

Scott acted for a couple following negligent fertility treatment which resulted in approximately four and a half years being spent pursuing the wrong treatment pathway.

Before fertility treatment is commenced, appropriate investigations are important so that clinicians can identify possible causes of infertility and recommend suitable treatment. In this case, necessary investigations were not undertaken before treatment commenced.

Had appropriate investigations been carried out, Scott's clients should have been referred for IVF considerably earlier. Instead, they underwent years of treatment which was inappropriate for their circumstances.

For a couple experiencing fertility difficulties, a delay of this length can be devastating. Fertility treatment can be physically and emotionally demanding, and the passage of time itself may be highly significant when attempting to conceive.

Scott investigated the treatment provided and obtained an admission of negligence from the Defendant. The claim subsequently concluded with a favourable financial settlement for the Claimant.

Although Scott's practice includes substantial injury litigation, he also considers lower-value clinical negligence claims where it is appropriate to do so. The financial value of a claim does not necessarily reflect the importance of what has happened to the person concerned.

Experience

Birth injuries and cerebral palsy claims

Claims involving lifelong neurological disability.

Birth injury cases are amongst the most serious and complex claims encountered in clinical negligence.

Scott has experience of birth injury and cerebral palsy claims involving serious neurological injury, cognitive impairment and functional disability. These cases often require detailed consideration of the injured person's lifelong needs.

Where negligent treatment during pregnancy, labour, delivery or the neonatal period results in permanent brain injury, the consequences may remain with the injured person throughout life. Some claimants may never be capable of living independently and may require substantial assistance with personal care, mobility, communication, education and everyday activities throughout childhood and adulthood.

The lifetime consequences of a serious birth injury

Depending on the evidence and individual circumstances, a substantial birth injury claim may need to consider:

• professional carers and support workers, potentially providing 24-hour care
• substantial care already provided by parents and family members
• professional case management
• physiotherapy, occupational therapy, speech and language therapy
• neuropsychological and psychological support
• specialist education and educational support
• suitable accommodation or substantial adaptations
• wheelchairs, hoists, specialist beds and seating systems
• communication aids and assistive technology
• adapted vehicles and transport requirements
• medical treatment, future surgery and rehabilitation
• social and recreational support
• loss of earnings and pension where applicable
• Court of Protection and professional deputyship costs where applicable

In catastrophic cases, these requirements may continue for many decades. The resulting claims can be very substantial because they must address the injured person's reasonable lifetime needs.

The objective is not simply to achieve a headline compensation figure. A properly prepared catastrophic injury claim should identify the injured person's needs and seek appropriate financial provision for care, accommodation, therapies, equipment, support and financial security.

Case example

Grade 4 pressure ulcer claim

A severe pressure injury with devastating consequences.

Pressure ulcers, also commonly described as pressure sores or bed sores, are sometimes wrongly regarded as relatively minor wounds. Serious pressure damage can be anything but minor.

Scott acted for a family following a severe Grade 4 pressure injury suffered by an elderly patient whilst receiving treatment in hospital.

A Grade 4 pressure ulcer represents the most severe category of pressure injury. It involves full-thickness loss of skin and tissue. Deeper structures such as fascia, muscle, tendon, cartilage or bone may be exposed or directly palpable, and the wound can involve undermining or tunnelling.

These injuries can be extraordinarily painful and difficult to treat.

In this case, the patient's pressure injury took years to heal. His condition became so severe that he spent approximately six months confined to bed. Following his return home, he required daily nursing input together with specialist tissue viability nursing oversight.

He suffered substantial pain and required referral to a specialist pain consultant. He also needed specialist equipment to manage the consequences of the injury, and considerable assistance was provided by his wife.

Scott pursued a claim which included not simply compensation for the injury itself, but the wider financial consequences of what had occurred. This included the value of relevant care and assistance provided by the patient's wife and the specialist equipment required as a consequence of the injury.

The case concluded for a sum in excess of six figures.

Case example

Fatal medication negligence

Pulmonary fibrosis following long-term nitrofurantoin treatment.

Scott assisted a family following the premature death of an elderly relative who had received nitrofurantoin over a prolonged period for recurrent urinary tract infections.

Nitrofurantoin is an antibiotic commonly used to treat urinary tract infections. In appropriate circumstances, it can also be prescribed prophylactically to reduce recurrent infections. It is an effective and widely used medication. However, prolonged treatment is associated with recognised risks, including potentially serious pulmonary and hepatic adverse reactions.

The fact that a medication was appropriate when originally prescribed does not necessarily mean that it should continue indefinitely without appropriate clinical review.

In this case, nitrofurantoin had been repeatedly prescribed over a period of years. Concerns arose regarding the adequacy of the monitoring and review undertaken while the patient continued to receive long-term treatment.

The patient subsequently developed severe pulmonary fibrosis associated with the medication. Pulmonary fibrosis involves scarring and damage within the lungs. As the condition progresses, the lungs become less effective at transferring oxygen and the affected person can experience substantial breathlessness, reduced exercise tolerance and increasing disability.

The patient's respiratory health deteriorated significantly. Increasing disability resulted in greater dependency upon family members, who provided substantial care and assistance. Ultimately, the lung disease contributed to the patient's premature death.

Investigating long-term medication negligence

Scott investigated the circumstances surrounding the repeated prescribing of nitrofurantoin and the monitoring and review of the patient's treatment.

As with many medication negligence cases, the investigation required consideration of two separate questions. First, whether the management, prescribing and monitoring of the long-term medication fell below an appropriate standard. Secondly, causation: what would probably have happened had appropriate monitoring and review taken place, including whether the medication would have been discontinued or changed sufficiently early to avoid the severe pulmonary injury and premature death.

Scott pursued the clinical negligence claim on behalf of the patient's Estate and investigated the wider financial consequences of the injury and subsequent death, including the substantial care and assistance provided by family members as the patient's condition deteriorated.

The case resulted in a significant award of damages.

Clinical negligence claims are about people, not simply damages

Scott's experience includes catastrophic clinical negligence claims involving serious injury, lifelong disability and substantial care needs.

However, the financial value of a claim is not the only measure of its importance. An avoidable injury which attracts a relatively modest award of damages can still have a profound effect upon the person who suffered it.

Scott considers cases according to their individual circumstances and merits rather than concentrating exclusively upon claims of the highest financial value.

Whether a case concerns catastrophic brain injury, negligent fertility treatment, a severe pressure ulcer, medication negligence or another avoidable medical injury, the starting point is understanding what happened, whether the treatment was negligent, what difference that negligence made and what can now be done to address its consequences.