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From the TS&P casebook - missed DVT

Miss L was referred by her general practitioner to a consultant vascular surgeon at the local DGH. He made a diagnosis of mild lymphoedema and subsequently confirmed the use of the combined oral contraceptive pill was not contraindicated. About a year later she started to suffer from symptoms of a grossly swollen leg with a purple veiny appearance and severe cramping and tightness causing her difficulty in walking. She saw her general practitioner who immediately referred her to A & E, at the same hospital, with a covering letter explaining her symptoms and suggesting that he suspected DVT. At A & E it was noted that she was on the contraceptive pill and her mother, who accompanied her to the appointment, specifically raised the concern that she might have DVT. The medical records noted that she was suffering from an ache all over the thigh and was in considerable pain despite taking pain killers. She eventually saw a registrar who diagnosed the problem as lymphoedema. She was advised to elevate the leg and wear a support stocking but otherwise had to learn to cope with this lifelong condition. She was discharged and not advised to see her GP or make any follow up appointments.

By the time she returned to the hospital 11 days later Miss L was in such a bad state that she could walk only a couple of paces and was in tears most of the time as pain killers were ineffective. The consultant immediately took a duplex venous scan which revealed that both the popliteal and femoral veins were occluded. She was admitted and the DVT treated with warfarin and thereafter heparin. We instructed an expert general/vascular surgeon to report. He reported that the hospital was negligent in failing to properly investigate the possibility of DVT but the delay had not made a difference to the eventual outcome as the damage was already done. The best treatment would have involved the use of a more powerful anticoagulant such as streptokinase which may have avoided long term damage to the leg altogether. However, he recognised that such treatment would not necessarily have been given by all responsible practitioners and the omission did not therefore constitute negligence.

A letter of claim was sent setting out the claimant’s case on breach of duty and causation and also pointing out that it was likely that the claimant had suffered a psychiatric reaction as a result of being told in A&E that she would suffer from acute pain for life and then following the correct diagnosis appreciating that she might have narrowly missed a fatal pulmonary embolism. Breach of duty was admitted but the defendant refused to accept the claimant could have suffered a psychiatric injury and therefore offered only £800.00 in respect of her pain and suffering during the period of delay. It was likely that the cost of taking the matter to trial would very substantially outweigh damages and the claimant’s legal aid would, therefore, have been discharged. As the claimant wished to put the matter behind her she accepted a revised offer of£1,000 and costs. The case indicates the difficulty claimants have in pursuing cases of modest value. It is not the first time we have seen the NHSLA take an unreasonably sceptical view of psychiatric injury. We have yet to see how the proposed Redress scheme will work in practice but we doubt that it would provide patients such as Miss L with the reassurance that their case had been fully independently investigated.

For further enquiries please contact Graham Bell (view full profile) on 01892 701358 or email graham.bell@ts-p.co.uk.

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