Settlement of claim for delayed diagnosis of foot fracture

We have recently settled a modest, but complicated claim for a client who suffered an injury to her foot while out with friends on a day’s sailing experience. They were packing away at the end of the day when she stumbled and fell backwards into the cockpit of the boat, a distance of two to three feet. She twisted and landed awkwardly on her left heel, which was immediately painful and quickly became swollen and discoloured.

A friend drove her home, but given her pain and symptoms, she sought medical advice and a relative drove her to her local A&E department at the North Hampshire Hospital in Basingstoke. At the hospital, our client explained what had happened. She was unable to put any weight through her foot and an X-ray was arranged. This did not, however, include her ankle area. The X-ray showed no bony injury and she was told to rest, apply ice and keep her left foot raised, then sent home.

Her pain and symptoms continued for around two weeks, by which time she was concerned she was getting no better. She explained again what had happened and the pain and reduced movement she had experienced since. A further X-ray was arranged which this time did include her ankle, but which was wrongly reported as showing no fracture. In fact, that X-ray did show evidence of a fracture. She was again sent home.

Her pain and symptoms continued, but our client relied on the hospital’s advice and believed there was only soft tissue damage. She continued to try to work, but found this extremely difficult. A couple of months later, she consulted her GP for advice, primarily because she was suffered swelling and pain. The GP referred her to an orthopaedic surgeon. He arranged an MRI, which was done a couple of weeks later and confirmed she had sustained a calcaneal fracture (heel bone), along with ligament damage in her mid-foot.

By then, the opportunity to immobilise her foot to heal in the correct position had been lost because of the time elapsed since her injury. Instead, she was told she might require surgery but in the meantime, to try to manage her symptoms conservatively. Unfortunately, she remained in pain and was therefore referred a few months later for steroid injections to her left ankle. She was then fitted with an air cast boot for two months, but still remained in pain. A CT scan eight months after the injury showed the fracture still had not fully united.

She was then referred to the pain clinic and diagnosed with Chronic Regional Pain Syndrome, which was significantly improved following a nerve block procedure, although she remains with some continuing residual pain that is unlikely to improve.

In the meantime, she also experienced problems with lower back pain.

We were instructed to investigate her claim after the hospital had already apologised to our client in connection with her care in A&E and the incorrect imaging taken when she first attended. No admissions had been made as to the damage this had caused, if any. We were therefore instructed to advise on a claim in connection with the symptoms she experienced in her foot and spinal condition.

We obtained her medical notes and records and advised that it was unlikely there was any connection between her calcaneal fracture and her spinal symptoms, or that there was any failure on the part of other hospitals she had attended in relation to acute symptoms originating from her back. We advised that expert evidence would be needed on the damage caused by the delayed diagnosis of her calcaneal fracture and proceeded to instruct an eminent consultant surgeon to report on this and to address any link between the delayed diagnosis and the wider symptoms she suffered. The expert reported that if our client’s fracture had been diagnosed at the outset, or within the first few weeks, then she should have had her foot immobilised and would have made a good recovery. His opinion was that it was not possible to link her lower back complaints to the delay in her diagnosis. While she was undoubtedly suffering ongoing chronic pain in her foot, she had not required corrective surgery so he considered any ongoing pain was more likely attributable to the injury itself than to the delay in her diagnosis. He did, however, consider her recovery had been delayed by some 12 months as a result of the negligence in her care.

We wrote a formal letter setting out the basis of the claim, relying on the hospital’s earlier admissions that there had been a failure to take correct images on our client’s first attendance in A&E and incorrect reporting when appropriate images were taken a few weeks later. Based on our expert evidence, we presented that this negligence had delayed our client’s recovery by 12 months and caused her avoidable pain and suffering in the meantime.  The hospital admitted the breaches of duty and after some negotiation a satisfactory settlement was achieved without the need to issue court proceedings.

The case highlights that legal costs can be contained in cases where a hospital trust takes a pragmatic and sensible approach. By the hospital accepting and apologising at an early stage for failings in care, we were able to contain our investigations in time and cost to evaluate the damage caused and resolve the case.

Return to case studies