Successful settlement against NHS trust following delayed diagnosis of epidural abscess

Our clinical negligence team has achieved a substantial six-figure settlement following a failure to diagnose and treat an extensive epidural abscess.

Our client attended the urgent care centre at Lewisham Hospital on 9 December 2017, reporting lower back pain which was worse when lying down. Following an assessment by a GP, she was discharged with a diagnosis of non-specific back pain, and prescribed pain relief. Two days later, an ambulance was called to attend to her due to worsening pain. On admission to A&E, by a junior doctor, she was noted to have bilateral leg weakness, and difficulty passing urine, with an abnormal post-void bladder scan. Despite these red flag findings, our client was again discharged with a diagnosis of back pain and constipation as a result of pain relief.

She returned to her GP the following day due to pain which had now progressed to her neck. She was again discharged with pain relief. She was ultimately admitted to King’s College Hospital on 13 December 2017 with reduced consciousness, hallucinations, extremely abnormal infection markers and urinary retention. 

An MRI scan was performed but was considered to be non-diagnostic due to our client’s inability to remain still due to pain. Despite this, the MRI scan was suspicious of a longitudinal epidural abscess extending from L5 to C1/2. She underwent decompression surgery on 14 December; however, this was limited to the lumbar spine. She remained critically unwell and in an induced coma until 21 December, when further imaging identified the ongoing extensive abscess in the thoracic and cervical spine. Following a second multi-level laminectomy, our client was discharged home after a month in hospital. 

She was ultimately left with mild bladder disturbance, which although did not require self-catheterisation, necessitated voiding by clock. She continued to suffer with significant back pain and extensive scarring, frozen shoulder syndrome, and numbness in her fingertips, which prevented her from returning to her job as a hairdresser and make-up artist.

Our clinical negligence specialists were instructed in 2018 and obtained extensive expert evidence from specialists in emergency medicine, general practice, spinal surgery, microbiology and neuro-radiology. The expert evidence identified multiple failures on behalf of the trust, principally the failure by the junior doctor to seek senior input, admit our client, and refer her for an emergency MRI scan. The neurosurgical evidence confirmed that had the spinal surgery been performed on the evening of 11, or the morning of 12 December 2017 at the latest, then the clinical outcome would have been significantly better. Our client would have avoided a lengthy hospital admission, as well as: 

• the pain and suffering of her advancing spinal infection, which became severe and necessitated ICU care;
• a second muti-level spinal surgery;
• any significant neurological injury to her bladder and upper limb; and 
• any, or such severe, psychiatric injury. 

Despite early pre-action admissions in respect of breach of duty, namely that our client should not have been discharged when she returned to hospital on 11 December and that she should have undergone an emergency MRI scan, causation was denied. It was the defendant’s case that earlier surgery would not have materially changed the outcome.
 
Formal court proceedings were issued and served. The defendant maintained that admission on 11 December 2017 would not have made any difference to the outcome.

Following exchange of expert evidence, the defendant admitted that an MRI scan on 11 December would have revealed an abscess limited to the lumbar spine and it would not yet have spread to the thoracic or cervical spine. The defendant’s expert evidence conceded that an earlier MRI scan would have identified an abscess limited to the lumbar spine rather than extending to the thoracic or cervical spine, but opened up arguments that there would have been microscopic spread not detectable on MRI, which would have made the second decompressive surgery inevitable.

The parties engaged in mediation in July 2023 which failed to achieve a final settlement. We continued with the court timetable and trial preparation until February 2024, when the claim ultimately reached a final conclusion after the claimant accepted the defendant’s Part 36 offer. The trial was listed for early May 2024.

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