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  • Overview

    James Cahan, specialist clinical negligence lawyer based at Thomson Snell & Passmore’s Tunbridge Wells and Dartford (Thames Gateway) offices, has secured £145,000 compensation for a young man whose GP failed to properly examine him when he presented with the classic symptoms of a slipped upper femoral epiphysis (SUFE) leading to a more significant slip of the fracture and the necessity of having hip replacement surgery at age 22 and every 12 -15 years thereafter.

    The claimant in this clinical negligence claim was a young boy living in Kent who was aged 13 when he attended the A&E Department of the West Middlesex Hospital complaining of a four month history of right knee pain behind the knee after playing football. A clinical examination revealed that the claimant was obese and a chronic soft tissue problem was diagnosed and follow up by the GP suggested. The claimant’s GP was sent copies of this paediatric attendance two days later.

    Three months later the claimant attended his GP who recorded minimal notes of the consultation, no physical examination was carried out and no further action was taken.

    Six weeks later the claimant went again to the same GP with pain in his right knee. Again minimal notes were recorded buy the GP, no physical examination was carried out and no referral was made.

    Some three months later the claimant twice attended the Teddington Hospital walk-in centre complaining of increased right knee pain. On the second occasion he was referred directly to West Middlesex Hospital where an MRI scan showed evidence of an extensive slip of the right upper femoral epiphysis (where the ball at the upper end of the femur slips off in a backward direction due to weakness of the growth plate.)

    Four days later the claimant was admitted to the West Middlesex Hospital to have the slipped upper femoral epiphysis pinned in situ.

    James Cahan, acting for the claimant, sent a letter of claim to the GP which set out the many breaches of duty alleged against him, which included a failure to take a clinical history, to record an adequate note of the consultations with the claimant, to carry out an examination either visually or physically of his knee, to consider the possibility of SUFE or to refer the claimant. In addition he failed to appreciate that the claimant fulfilled all of the classic signs of slipped upper femoral epiphysis, such as his age, gender, the fact that he was obese and the fact that his knee displayed no abnormal clinical signs. It is well recognised that pain in the knee may well be referred pain from the hip. It is also well recognised that when SUFE is considered on a differential diagnosis it is mandatory to exclude SUFE and examine the hip in an attempt to identify any pain and compare movements between each side of the patient’s hip.

    It was contended that had the GP examined the claimant’s knee on either of the two consultations he would have found that there were no clinical abnormalities of redness or swelling and this should have led the GP to conclude that the claimant’s symptoms may be referred pain from the hip which should have alerted him to the possibility of SUFE, making a hip examination mandatory.

    It was also contended that had the hip examinations been adequately carried out on either of these two consultations then this would have led to a consideration of a slipped upper femoral epiphysis. It was contended that on the earlier diagnosis would have avoided the slip occurring and would have greatly reduced the impact that this injury had on the claimant.

    In fact he suffered significant levels of pain and a much more significant fracture than would otherwise have been the case. This led to rapid onset arthritis at the age of 20 and the need for a total hip replacement at age 22 with hip revision throughout his life every 15 years.

    James was able to negotiate an out-of-court settlement in the sum of £145,000, to compensate him for the pain and suffering endured by the delay in diagnosis, the early onset of arthritis, and the trauma of having to undergo a hip replacement and further hip revision procedures.

    This settlement included the costs of additional hip revision procedures that would otherwise have been avoided. The claim also took into consideration the increased risks that are associated with multiple revision procedures as the risk of complete failure of the hip revision increases significantly by the stage of the third and fourth revision. These risk factors had to be carefully considered before settlement could be finalised.

    James Cahan specialises in clinical negligence cases. If you would like to ask James a question about a potential case, or if you have a general query about any clinical negligence, contact James on 01892 701289 in confidence.

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