Amputation following failure to act on patient’s critical limb ischaemia

Our client has been awarded damages for negligent treatment provided to her late father which led to him requiring amputations of his left lower leg and right big toe. He had a known history of peripheral vascular disease (PVD) – a condition which causes reduced blood flow to the extremities (limb ischaemia). Despite characteristic signs of critical limb ischaemia (the most advanced form of PVD), timely treatment was not provided.

On 2 July 2015, our client’s father fell and fractured his left hip. He was admitted to John Radcliffe Hospital in Oxford where he underwent a surgical repair. In the weeks following surgery whilst he was recovering in hospital, he showed increasingly severe signs characteristic of critical limb ischaemia. He complained of painful, cold feet which felt like lead, and he would hang them off the bed to help alleviate the discomfort. He developed ulcers to both heels, which indicated a lack of blood flow to his feet. He was given pressure-relieving boots but found these too painful to wear as they worsened the pain and discomfort in his feet. Despite explaining this to the nursing staff, the cause of his pain and discomfort was not investigated. At no point was he reviewed by the vascular surgery team despite clear signs of deteriorating critical limb ischaemia. He was finally discharged on 3 August 2015 with a recommendation for his GP to arrange a review and assessment of blood flow in his feet.

Our client’s father rapidly deteriorated following discharge. The ulceration to his heels worsened and he developed a new area of ulceration to the top of his left foot which quickly became necrotic. There was a delay in arranging a referral to the hospital’s vascular surgery team and his daughter eventually had to contact the Patient Liaison Service (PALS), which prompted an emergency appointment for urgent consultant review. He was eventually admitted for surgery to restore blood flow to his legs but, sadly, it was too late and his left lower leg could not be saved. He underwent a left below knee amputation and, following a deterioration to his right leg, his right big toe also had to be amputated.

Our client’s father, who had recently been widowed, suffered a huge setback to his independence. He was fitted with a prosthetic leg, though he struggled with mobility and suffered from phantom limb pain.

We initially investigated a claim against the hospital trust and our client’s father’s GP and put our allegations to the defendants. Despite the hospital trust’s findings of failures in the treatment provided within its own internal investigation into the incident, the defendants filed a defence denying liability in full.

Very sadly, whilst the claim was ongoing, our client’s father passed away from a cardiac arrest aged 86. His daughter, our client, continued to investigate on his behalf. We managed to secure a settlement from the defendant hospital trust in respect of the allegedly negligent treatment provided.

Rosie Nelson, associate in the clinical negligence team at Penningtons Manches Cooper, said: “This sad case demonstrates the importance of rapid diagnosis and treatment where a patient is showing signs of critical limb ischaemia. Not only can delays lead to amputation of the affected limb, but a failure to act in time can also result in sepsis and death. We are currently investigating another case with facts similar to these, where the outcome was sadly fatal. We hope that by investigating these cases and raising awareness of the issues, lessons may be learnt and lives may be saved.”

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