Successful claim against Kingston Hospital for negligent delay in diagnosis of Cauda Equina Syndrome

We secured a substantial settlement for a man who has been left with long-term bladder, bowel and sexual dysfunction after his local A&E department failed to recognise and respond to signs of Cauda Equina Syndrome. This rare but very significant condition occurs when a prolapsed disc in the spine causes progressive damage to a very sensitive group of nerves at the base of the spine.

Our client had a history of intermittent back problems which flared up and resulted in several attendances at his GP, and while he initially suffered from pain in his back and right leg only, it was getting steadily worse, resulting in an A&E attendance and increased painkillers.

A few days later, our client noticed that his right leg was starting to feel numb and that he was also suffering some numbness in his left leg and around his anal and buttock area. Bilateral leg numbness or weakness and any altered sensation in the genital / anal / buttock area against a background of back pain are red flag signs for the possibility of Cauda Equina compression. The condition requires an emergency operation to relieve the nerve compression, otherwise a patient will end up with long-term damage and disability.

On calling his local out of hours service, our client was advised that he go straight to his local A&E department at Kingston Hospital, which he did. There are no clinical records for this attendance at the hospital (the hospital having lost them) other than a discharge summary confirming a diagnosis of sciatica. Our client had however explained his symptoms which included right hip pain progressing to his lower back and now into both legs and that he had developed numbness in his groin, genitals and buttocks, as well as numbness and pins and needles in both legs. Despite these warning signs, a full neurological examination was not carried out and no consideration appears to have been given to the possibility of Cauda Equina Syndrome. He was discharged with pain relief.

Our client’s condition worsened and three days later he suffered an episode of urinary incontinence followed by problems passing urine. The following day he went back to A&E and this time the likelihood of Cauda Equina Syndrome was noted and actioned. He underwent an MRI scan and was transferred to a neurosurgical team for surgery. He has been left with bladder and bowel dysfunction in the form of both urgency and frequency, as well as sexual dysfunction, and his day to day quality of life and activities are significantly affected. It was alleged that these symptoms would have been avoided with appropriate care.

After reading reports of a similar case that we had dealt with, he approached Philippa Luscombe who leads the Cauda Equina specialist team. She advised that there were likely failings on the part of the Kingston A&E team and that there were good grounds to investigate the case. We carried out full investigations and, based on expert evidence, a claim was submitted to the hospital alleging that on his first attendance the A&E team had failed to advise him of the red flag symptoms of Cauda Equina Syndrome and to return to hospital immediately if he experienced any of them. It was alleged that during his second attendance, the team had failed to act upon his symptoms of Cauda Equina Syndrome, in particular, numbness around the anus / buttocks and in both legs, to record any or any adequate history of his complaint and developing condition, to carry out a detailed neurological examination, to order an MRI scan of his spine and to refer him to the orthopaedic team and / or the neurosurgeons.

It was alleged that, had the hospital considered and acted upon the possibility of Cauda Equina Syndrome and not simply considered the sciatica (which is a symptom not a diagnosis), he would have undergone an MRI scan and surgery at a stage where it would have been early enough for him to have retained normal or near normal bladder and bowel function. Instead the negligent delay resulted in permanent neurological damage. The trust initially denied any negligence (despite not having records for our client), but after we issued and served court proceedings, it made a full admission and the parties entered negotiations resulting in a substantial settlement.

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