Admission of liability over failure to perform MRI scan on patient with Cauda Equina Syndrome

We have secured an admission of breach of duty and causation from St Albans Hospital that it failed to properly assess a patient and perform an MRI scan. This led to a delay in diagnosis of Cauda Equina Syndrome (CES).

Our client had elective spinal decompression surgery in November 2017 at St Albans Hospital for spinal stenosis to L4/5. They had been suffering with some back pain but remained independent and mobile.

Following the operation, whilst an inpatient, our client complained of numbness to their buttock area. A full neurological examination was apparently carried out, where normal anal sphincter tone was noted. However, this assessment did not appear to be properly documented in the records.

The client had a catheter in situ due to acute urinary retention following surgery. When they attempted to remove this, during a trial without catheter (TWOC), this was unsuccessful. As the client was unable to urinate when the catheter was removed, they were discharged home with the catheter in situ.

Our client reported that they had not opened their bowels since surgery and that the nurses were aware of this at the time of discharge, being four days post-op. Despite this, the client was discharged home.

Following ongoing numbness and having an episode of faecal incontinence at home, the client was examined by a duty doctor who confirmed that the rectal (PR) examination showed no anal tone. The client was taken by ambulance to A&E at Watford General Hospital. In light of the ongoing symptoms and PR examination, it was confirmed that the findings were consistent with CES. 

Our client underwent an urgent MRI scan which showed that they had been decompressed at L3/4 instead of L4/5, and they remained severely stenotic at L4/5. CES was diagnosed and emergency surgery was performed. However, our client has been left with permanent neurological symptoms affecting their mobility, as well as suffering from double incontinence.

The defendant has admitted that there were failures in the care it provided to our client, but has not gone so far as to admit all the allegations posed against it, ie that performing decompression surgery at L3/4 amounts to a breach of duty of care. The main points of admission are:

• It has admitted that it failed to respond to the symptoms while the client was an inpatient and accordingly it failed to arrange for them to undergo an MRI scan before being sent  
• Had the client undergone the MRI scan after developing buttock numbness and before discharge, the defendant would have identified that the wrong level had been decompressed during surgery to decompress levels L4/5 as originally planned and further surgery would have been offered.
• Had the client undergone this surgery, the bowel and bladder function and neuropathic pain would have been materially better than it is now, and the need for intermittent self-catheterisation would have been avoided.

A letter of apology has been provided by the defendant to our client. 

We are now proceeding to value our client’s claim and to assess the significant impact the negligence has had on our client’s long-term health and mobility.

Return to case studies