Oliver Chapman, specialist clinical negligence lawyer, based at Thomson Snell & Passmore’s Tunbridge Wells and Dartford (Thames Gateway) offices has secured compensation for the estate of an elderly patient who suffered a permanent deterioration in health after she was discharged from hospital prematurely.
The case concerned Mrs M who was treated by Portsmouth Hospitals NHS Trust after she developed blood in her urine. An ultrasound showed she had an irregular solid mass in her bladder wall. Whilst she was in her 90s, she was described within the medical records as being ‘fantastically well’ and it was noted that she lived completely independently and mobilised without aid. Given her good health, a procedure was planned to remove the tumour from the bladder.
In preparation for the operation, she arranged that after she left hospital she would go to a residential home for a week of convalescence.
Three days before the operation, a blood test revealed that her blood sodium level was 134 mmol per litre (the normal range is 135 mmol per litre to 145 mmol per litre). Three days later, she was admitted to St Mary’s Hospital and the procedure was performed to remove the tumour.
The following day, Mrs M appeared to be well and had stable observations. She was visited by her daughter who found her to be completely lucid, orientated and her normal self. It was planned that the catheter would be removed and that she would go home the following day provided she passed sufficient urine.
Blood tests performed that morning showed that Mrs M had a reduced sodium level of 127 mmol per litre, but no action was taken to address or to monitor the low sodium level.
By that evening, Mrs M’s condition had deteriorated. She was confused, fell on three occasions and was unable to pass urine. She did not recall falling and was noted to be distressed due to urinary retention. Following unsuccessful attempts at catheterisation overnight, a specialist registrar managed to insert a long term catheter in the morning.
Mrs M’s daughter attended the ward the following morning and was appalled at her mother’s appearance. She was dishevelled and confused and unable to stand. Mrs M did not recognise her daughter. She struggled to speak and could not articulate her words. Mrs M’s daughter expressed her concern to the doctor who explained that the confusion and sudden deterioration was due to “exhaustion.”
Notwithstanding her condition, Mrs M was discharged that morning and the discharge summary referred to ‘dementia/acute confusion’. There was no prior history of dementia or confusion and despite the suspected diagnosis no effort was made to address the cause of the acute confusion or to follow-up the low sodium level taken the previous day.
She was taken to the residential home as planned, but her confusion remained and she suffered a series of falls. A week later, she was taken to accident and emergency at the Queen Alexandra Hospital with a suspected broken hip.
Blood tests performed revealed a very low sodium level of 112 mmol per litre (hyponatraemia). Hyponatraemia causes confusion. Mrs M’s low blood sodium level was treated by giving her intravenous fluids and oral sodium supplements. Her sodium level gradually improved and the hip fracture was fixed surgically four days later. The notes reveal that the treating staff believed that the fall was due to confusion caused by low sodium levels.
Her health deteriorated over the course of the summer and after two months in hospital an occupational therapist confirmed that Mrs M would never be well enough to return to her own home. She was discharged to a nursing home. Her mood remained low and she never regained her prior physical or mental strength or state of independence. She found the experience distressing and depressing.
18 months after the original surgical procedure, she suffered a further fall and fractured her pelvis and humerus. She died two weeks later.
We were instructed by Mrs M’s son in his capacity as the executor of his mother’s estate. We obtained her medical records and a report from an independent consultant urologist. In his report, he was critical of the post-operative management that Mrs M received. There was a failure to note the low blood sodium level and a failure to react to it. She was discharged when she was not in a suitable clinical state. He believed that the standard of care that she received fell below the standard to be expected.
He believed that on the balance of probabilities, Mrs M’s low blood sodium level following surgery was the main cause of her confusion at the time of discharge. In his opinion, had Mrs M’s low blood sodium level been acted upon before discharge, it would have been corrected and the confusion, together with the subsequent falls and hip fracture, would have been avoided.
We therefore obtained a report from a consultant geriatrician who confirmed that the low sodium level was the cause of Mrs M’s delirium at the time of her discharge. Although elderly, he recognised that Mrs M was in good health and believed that had the hyponatraemia and confusion been correctly identified and treated prior to discharge, her condition would have resolved and, on the balance of probabilities, she would not have fallen and fractured her hip.
She had no previous cognitive impairment and, in the absence of the hyponatraemia and subsequent hip fracture, he believed that she would have continued to lead an independent life. She would have maintained her independence and her level of disability would not have reduced to such a degree that she would require nursing home care for the rest of her life.
A letter of claim was sent and an offer of settlement was made, but in the absence of a response, protective court proceedings were issued. The hospital trust sought to defend the case, but after a series of low offers, offered £40,000 plus payment of the claimant’s reasonable costs to settle the matter. This sum included compensation in respect of the claimant’s pain and suffering experienced before her death, but also a sum to reimburse the estate for the extensive nursing home fees incurred. The offer was accepted and the matter settled.
Oliver Chapman specialises in care of the elderly cases. If you would like to speak to Oliver about a potential case, or have a general query regarding clinical negligence, please contact him on 01892 701234 in confidence.