Successful claim against GP for failure to suspect developing Cauda Equina Syndrome

We have settled a case on behalf of our client, a man in his 30s, who was left with long-term neurological damage from developing Cauda Equina Syndrome. This was compounded by failures on the part of a GP at his local practice.

Our client had a previous history of back problems including sciatica. Such symptoms indicate disc degeneration in the spine, putting an individual at risk of a slipped disc, which can compress the sensitive Cauda Equina nerves at the base of the spine controlling bladder, bowel and sexual function and sensation.

In early 2013 our client injured his back while lifting something heavy at work and suffered from back pain and some sciatic pain in his left leg for the rest of that year. In January 2014, his pain escalated significantly and he made several attendances at his GP practice, where he was recommended pain relief and physiotherapy. At this stage, his symptoms were severe but limited to back and left leg pain.

A few weeks later our client had an appointment with the defendant GP in this case. He reported that he now had pain and altered sensation in both legs and a new symptom of perineal numbness. The GP documented these symptoms and upon examination found numbness in the left side of our client’s anal area. Numbness or altered sensation in this area in the presence of back pain is a red flag symptom for the possibility of Cauda Equina compression.

Despite having noted and recorded this red flag symptom, the GP did not appear to consider Cauda Equina Syndrome or take appropriate action in terms of referring our client straight to A&E or an orthopaedic / neurosurgical team. The GP did subsequently chase up an already ordered MRI scan but did not raise with the orthopaedic team the new symptoms that our client had developed or request urgent action.

An MRI scan was carried out a few days later and the radiologist immediately identified compression of our client’s Cauda Equina nerves. Immediate steps were taken to ensure that he was admitted to hospital and our client underwent decompression surgery the next morning.

Following the surgery, our client was left with sensory disturbance in his perianal area and legs, as well as bladder and bowel functional problems. He was told about Cauda Equina Syndrome and red flag signs during his stay in hospital and therefore had concerns that he should have been referred to hospital by his GP practice at an earlier stage. He instructed Penningtons Manches to investigate whether the care he had received was appropriate.

Having taken information from our client and reviewed his records, our Cauda Equina claims team was of the view that the GP did not appear to have considered the possibility of Cauda Equina Syndrome and should have done. We instructed a GP expert who confirmed that the care provided by our client’s GP on that day fell below an acceptable standard and amounted to a breach of duty of care. We then sought input from a spinal surgeon who was of the view that the delay in investigation and diagnosis had adversely affected our client’s outcome.

We presented a case on the basis that the GP’s clinical records entry clearly documented symptoms and signs of Cauda Equina Syndrome which were present in conjunction with back pain. As soon as perianal numbness was found on the GP’s own examination, this mandated a referral to hospital. Our client also now reported symptoms in his right leg in addition to those present in his left leg. Perianal numbness and bilateral leg pain are both red flags for Cauda Equina Syndrome.

The symptoms and signs documented required emergency (same-day) MRI scanning. No responsible body of general practitioners would support the GP’s failure to refer our client to hospital for MRI scanning to confirm or exclude the diagnosis of Cauda Equina Syndrome, given these symptoms. It was therefore not acceptable for the GP simply to chase the routine MRI scan request that had already been made.

It was alleged that, but for the breach of duty by the GP, our client would have been referred to hospital that day, either directly to an orthopaedic / spinal team or via A&E. The MRI scan would have confirmed the presence of Cauda Equina compression, an urgent referral to a neurosurgeon or orthopaedic spinal surgeon would have been made and our client would have been transferred to a neurosurgical unit. He would then have had emergency decompression surgery within, at most, 24 hours of attendance at A&E.

The GP’s alleged breach of duty resulted in a seven to eight day delay in diagnosis and in our client undergoing urgent decompression surgery to prevent further damage to the Cauda Equina nerves. The evidence from the expert spinal surgeon was that our client’s bladder and bowel functional problems were as a result of the delay in diagnosis. On the balance of probabilities, had he been referred to hospital appropriately, he would have undergone surgery within, at most, 36 hours of the onset of his condition and this would have resulted in a better outcome in terms of his bladder and bowel function, which would have been normal although he might possibly have had some impaired sensation. The experts also alleged that the delay contributed to our client’s right leg sensory deficit and sexual function impairment.

Our specialist team presented the claim to the defendant GP on that basis and, after a short negotiation, the case settled in our client’s favour. 

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