Settlement for patient who suffered loss of sight following hospital’s failure to diagnose and treat giant cell arteritis

We have secured a considerable financial settlement for our elderly client who suffered permanent loss of sight from both eyes as a result of admitted negligence at the Birmingham and Midland Eye Centre in April 2016.

In late 2016 and early 2017 our client, aged 73, began experiencing new symptoms of double vision and headaches.

In January 2017 she attended the emergency hospital at Sandwell General Hospital. She was examined by a junior doctor who conducted an examination and arranged blood tests. The blood tests were recorded as normal. In fact, they indicated that our client’s CRP (an indicator for inflammation, and a sign of possible giant cell arteritis (GCA)), was abnormal. The doctor concluded that our client’s symptoms were due to age related deterioration, but she was advised to return to hospital if she had worsening symptoms.

Our client’s symptoms persisted. In April 2016 she attended her GP with double vision and two days later, on 19 April 2016, she attended the eye emergency unit due to her double vision which had persisted. She underwent an ophthalmological examination, which was normal. It was observed that she was not suffering any GCA, although her recent on-set headache was noted, and it was also noted (erroneously) that her CRP in January was normal. Our client was advised that further blood tests were required to investigate the cause of her symptoms. She was discharged and advised to visit her GP for those blood tests.

Our client did attend her GP for blood tests on 25 April but had not been informed that she needed to fast beforehand, and so the blood tests could not be performed and would be re-scheduled.

In May 2016 our client visited her daughter in Bristol. On 7 May 2016 she awoke and was unable to see from either eye. Her daughter took her to Bristol Eye Hospital. Upon a detailed examination of her history, it was noted that she had been complaining of blurred vision, had experienced jaw pain and weight loss, and had suffered from headaches. All of these symptoms are consistent with a diagnosis of GCA. Urgent blood tests were arranged, and our client was started on a course of steroid treatment for her probable GCA diagnosis.

Due to the high dosage of steroid treatment, our client suffered a psychotic response and was detained under the Mental Health Act. She was eventually discharged into her daughter’s care in September 2016. The steroid treatment did assist in restoring some of our client’s sight to the extent that she was able to see the blurred outline of shapes, but her overall vision was poor, and her sight loss was expected to be permanent.

Owing to our client’s sight loss, she required considerable help and assistance with all aspects of her day to day life, while living with her daughter. She was, after six months, able to move into her own single level apartment, but continued to require extra help; she was visited daily by her daughter to help with domestic tasks and chores, grocery shopping, her medication, and with meal preparation and cooking. She was also visited once per week by a paid carer.

The deterioration in our client’s function was complicated by a pre-existing and progressing dementia. This ultimately caused our client to need to enter residential care, as she required support for her increasing level of needs.

We were approached by our client’s daughter (our client’s litigation friend) to accept instructions approximately 18 months after the events. Our client’s daughter had complained to the trust, but her concerns about the failure to diagnose and treat our client’s GCA had been dismissed. She had been told that our client had not been exhibiting symptoms of GCA and it was reasonable to discharge her to her GP for further blood tests.

Our client’s daughter was not satisfied with this response, and we agreed to accept instructions to investigate the claim. After obtaining and reviewing our client’s medical records, it seemed to us that a negligent mistake may have been made in failing to suspect GCA as a possible cause for the symptoms in April 2016.

Accordingly, we instructed a medical expert to review our client’s medical records and provide their expert opinion on whether the management our client had received in the eye emergency unit in April 2016 had fallen below the acceptable standard of care.

The expert provided a report in which he stated that, given our client’s presenting signs of double vision and her history of recent onset headaches and a raised CRP in January, the doctor in A&E should not have discharged our client to her GP. The expert stated that the doctor should have arranged for blood tests to be performed in hospital, on the day of our client’s attendance. Those blood test results would likely have been available within a few hours, and they would have probably demonstrated raised/abnormal inflammatory markers and GCA would have been suspected as a possible diagnosis.

The expert stated that GCA is a medical emergency and, had it not been for the negligent failure, our client would have been treated with steroid therapy on an urgent basis, while further tests were performed to confirm the diagnosis. The expert was of the opinion that, had our client been treated with steroid therapy for possible GCA in April 2016, she would not have suffered any sight loss and would have retained good, functional vision in the long term.

Following receipt of the expert’s evidence, we advised our client’s daughter and sent a letter to the NHS trust alleging negligence in our client’s care.

In the hospital’s formal response, contrary to what our client’s daughter had been told when she had earlier complained to the hospital, it was admitted that the doctor should have arranged blood tests on the day of our client’s attendance in April 2016, and that those blood tests would have been abnormal. A diagnosis of GCA would have been made and our client would have been treated for that condition. It was admitted that our client would not have suffered injury to her sight and would have retained functional vision from both eyes.

Following receipt of the response, we set upon valuing the claim for compensation. We instructed our ophthalmic expert to consider further our client’s condition at that time, and to report on her probable future prognosis – what would her sight be like in the future, and would that give rise to any additional needs?

With that evidence, we were then able to quantify her care needs. By this point, our client had moved into a care home on a permanent basis because of her dementia. We needed to explore the extent to which her past and future care needs were attributable to her sight loss, and we therefore instructed an expert to assess those care needs. The care expert report enabled us to present a document setting out the additional help, support and assistance our client had needed because of her sight loss as a result of the negligence. It was considered that her ongoing and future care needs arose because of her dementia, and her sight loss did not add to those needs.

We advised our client’s daughter on those expert reports and on our assessment of the value of the claim. We then advised our client on making an opening offer to settle the claim, following which we commenced settlement negotiations with the defendant. Ultimately the defendant took a pragmatic approach to the claim, and settlement was agreed in the amount of £91,000.

The injury sustained by our client to her sight was significant and has substantially impacted her remaining years of life. Even though she was elderly, prior to the negligence she lived on her own and was active in her community. The negligence meant that she had to move home and to an unfamiliar community, away from her friends.

The negligence has had far reaching consequences not just for our client, but also for her daughter, who has had to spend considerable time during the final few remaining years with her mother acting as a carer, rather than a daughter, which has caused considerable upset.

We are ultimately pleased to have achieved compensation for our client for her avoidable injury. While it will not give her back the sight she has lost, it will at least enable her to live her remaining years comfortably.

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