Settlement for patient who suffered loss of sight following hospital’s failure to report orbital X-ray correctly

We have secured settlement for a client who pursued a clinical negligence claim against Royal Surrey County Hospital. The claim arose following a negligent delay in diagnosing and removing an object retained within our client’s left eye, which caused our client to suffer a severe infection and led to complete loss of sight from his left eye.

Our client works as a farmer. On 4 July 2015 he was working on his farm and hammering a metal nut out of a metal oil drum. A shard of metal sheared off and struck his left eye. The following morning his left eye was bloodshot and painful. He attended the A&E unit at the hospital where he was examined by an A&E doctor. After the initial examination our client was sent for an X-ray of his left eye.

The X-ray was reported by a hospital radiologist, who did not see any evidence of an object in our client’s left eye. He did however record the presence on the X-ray of an object in our client’s right eye. Our client was not complaining of any symptoms from his right eye and he was advised that his left eye was clear. He was given eye drops and discharged.

Our client’s eye continued to be very painful. The following morning he was unable to see anything from his left eye other than the blurred outline of objects. He returned to the A&E department at the hospital that morning and saw a consultant ophthalmic surgeon who was very concerned by our client’s deterioration. An urgent CT scan was requested, which confirmed the presence of an object in his left eye. Our client was advised to attend the specialist vitreo-retinal unit at Moorfields Eye Hospital in London.

At Moorfields the following day, our client underwent further investigations and subsequent surgery to remove the object. By this point infection had developed and our client was treated with antibiotic medication. Regrettably, the infection was not controlled and progressed. Our client underwent further operative procedures over the course of the next 18 months but, in May 2017, was advised that he had suffered permanent and total loss of sight from his left eye.

Our client complained to Royal Surrey County Hospital and was informed in response that the X-ray taken when he first visited in July 2015 had been incorrectly reported: the object seen within our client’s right eye was actually within his left eye – the X-ray had been read the wrong way round.

Our client was concerned that, had the orbital X-ray been correctly reported on 5 July 2015, he would have had surgery to remove the object straight away and would not have suffered any long-term injury to his eyesight. He approached us to investigate a potential medical negligence claim against Royal Surrey NHS Foundation Trust.

After obtaining and reviewing our client’s medical records, and the hospital’s response to our client’s complaint, it seemed clear to us that a negligent mistake had been made during our client’s treatment. The orbital X-ray was not labelled correctly, which led to the radiologist’s confusion, but this was a mistake that should never have happened.

The more complicated issue that needed investigating was whether, even had the negligence not occurred, his outcome would have been any better.

We instructed an expert ophthalmic surgeon to review our client’s medical records and provide his expert opinion on whether, but for the negligence, our client would have avoided the severe infection that caused the loss of his eyesight. Our expert was critical of the hospital’s failures and unequivocal that, had the object been identified when our client first attended A&E, which it should have been, he would have had surgery on the same day and would not have suffered any injury to his eyesight at all.

We advised our client to pursue a clinical negligence claim against the hospital and sent a letter of claim to the hospital alleging negligence in our client’s care.

The hospital admitted that it was negligent in failing to correctly read our client’s orbital X-ray but did not set out its case on what would have happened had the object been identified, or what our client’s outcome would have been. This is known as causation and is often disputed between parties in a medical negligence claim.

In the absence of knowing the defendant’s case, but with strong expert evidence on causation, we began valuing (also known as quantifying) the claim. This involved arranging for our client to be examined by our expert so that he was able to report on our client’s condition and future prognosis. Our expert’s view was that our client would never recover sight in his left eye and he would live the rest of his life with permanent visual impairment. The expert’s evidence enabled us to quantify the value of our client’s claim for his pain, suffering and loss of amenity (known as his general damages).

The more complicated factor in quantifying this claim related to our client’s financial losses (also known as his special damages). Our client works as a tenant farmer. He lives on a large farm, in a large farmhouse, but does not receive a large (or regular) income. Despite not receiving a formal income, we considered that there was a financial value to the benefits he derived from living on the farm: all of his day-to-day costs and expenses were paid for by the farm. We then set about investigating what those benefits were worth.

We instructed a forensic accountant who assessed the benefits that our client received from living on the farm property. The expert forensic accountant, by analysing average statistics, provided his evidence on the value of those benefits to our client, thus enabling us to assess our client’s effective annual net earnings.

Our client’s injury to his sight meant that he was unlikely to be able to continue managing the farm as he had done up to the point of the defendant’s negligence. In light of that, we needed to explore with our client how he intended to earn a living in the future. Our client’s evidence was that he would remain in the farming industry but that he would need to take a junior farm assistant position, which had less responsibility, due to the injury to his sight. The average net annual earnings of a farmer’s assistant were less than the value of our client’s effective annual net earnings on his own farm and we were able to present a calculation that demonstrated our client suffering a loss of earnings over his lifetime.

After quantifying the claim, we entered into negotiations to explore settlement on our client’s behalf. The solicitor for the hospital was sensible. In response to our opening offer she responded with a reasonable opening offer. That offer was rejected, but the solicitor for the hospital was amenable and open to discussions about quantum and, after some negotiations, offered to settle our client’s claim for £225,000. This was acceptable to our client and settlement was agreed.

The injury sustained by our client to his sight was entirely avoidable. It is a significant injury, not only in coming to terms with the partial loss of one of a person’s major senses, but also in relation to the consequences and impact it may have on our client for the rest of his life.

Return to case studies