Clinical Negligence

£82,500 recovered for estate of patient whose Grade IV sacral pressure sore prevented neuro-rehabilitation following brain injury

We initially acted for Mr P who suffered a low velocity focal trauma, sustaining bilateral subdural and subarachnoid haemorrhages, when he fell down a set of stairs. Whilst he suffered a severe brain injury, our medical expert advised that crucially it was focal in nature rather than diffuse, meaning his prognosis – if he survived the initial trauma – was more positive.

He spent almost six weeks in King’s College Hospital before being transferred to Maidstone and Tunbridge Wells NHS Trust. After a period of recovery, he was considered by West Kent Neuro-rehabilitation Unit to be a suitable candidate for their inpatient programme.

When he was transferred from Maidstone and Tunbridge Wells NHS Trust to West Kent Neuro-rehabilitation Unit two months after his initial accident, he was found to have a Grade 4 sacral pressure sore which required treatment. As a result, the majority of his care whilst in the unit was nurse led and he could not participate in any meaningful sense with the planned neuro-rehabilitation.

After two weeks his stay on the unit was cut short and he returned to Maidstone and Tunbridge Wells NHS Trust in order to have the sacral sore adequately managed.

Two months later he was discharged to a nursing home where he required further management of the sacral sore. By that point, he was no longer considered a suitable candidate for neuro-rehabilitation; the window of opportunity had been missed.

Maidstone and Tunbridge Wells NHS Trust promptly admitted that Mr P’s treatment had fallen below an acceptable standard, and was negligent, resulting in the development of a Grade 4 sacral sore. The sore took about four months to heal.

The trust did not, however, admit our argument that the most catastrophic impact of the sacral sore was on Mr P’s recovery from his brain injury.

We argued that, but for the development of the sacral sore, Mr P would have spent up to nine months in neuro-rehabilitation, initially intensive (in the inpatient rehabilitation unit), then in a step-down rehabilitation unit, and finally in the community.

On the balance of probabilities, he would have made his most rapid gains within the multi-disciplinary specialist neuro-rehabilitation unit. At all states of rehabilitation he would have been provided with specialist input consisting of a multi-disciplinary team, under a consultant in rehabilitation medicine, incorporating physiotherapy, occupational therapy, speech and language therapy, psychology and other services as required.

On the balance of probabilities, had Mr P been able to engage with the neuro-rehabilitation programme, commencing 2.5 months after the initial brain injury:

1. He would have continued to make rapid gains. We argued that, given he was accepted for admission to an acute neuro-rehabilitation centre (it is difficult to secure a place) on the basis of their assessment (primarily of his potential to benefit from their programme), confirmed the opinion of those treating him that Mr P would have benefitted significantly from neuro-rehabilitation.

2. He would have enjoyed a good recovery in all of the domains of commonly used rehabilitation outcome scales.

3. He would have been mostly independent and, being mostly independent, he would have returned to live in his family home.

The development of the sacral sore denied Mr P the benefits of neuro-rehabilitation in the crucial few months following his brain injury. Instead, during the four months that it took for his sacral sore to heal, he was laid in the foetal position and repositioned from side to side. Flexion within his lower limbs became restricted and he could not transfer, stand or walk.

His physical and cognitive condition deteriorated and he spent the rest of his life in a nursing home environment.

During the course of the case Mr P died and we were instructed to continue to act for the benefit of his estate by his widow and administratrix.

The defendant admitted that had Mr P undergone inpatient rehabilitation he would have been able to achieve some independent eating earlier than he did and would have been capable of spending more time in a wheelchair. He would also have had less pain and contractures in his upper and lower limbs, but it was denied that he would have made other gains. It was denied that he would have returned to live in his family home and, on the balance of probabilities, he would have required care in a nursing home, with provision for 24 hour care, in any event due to the severity of his underlying brain injury.

We subsequently negotiated a settlement of £82,500 prior to issuing court proceedings.

Oliver Chapman specialises in clinical negligence cases. If you would like to discuss any clinical negligence case with him, please contact him on 01892 701234 to discuss your potential case in confidence.

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