Boyes Turner’s cauda equina syndrome (CES) solicitors secured a £350,000 settlement for a woman in her fifties who was left with permanent CES disability as a result of hospital delays in diagnosis and referral for urgent spinal decompression surgery when she presented with red flag signs and symptoms of cauda equina nerve root compression.
A&E attendance with early cauda equina symptoms
Our client had a medical history of lower back pain. She developed sciatica, extending down her right leg to her foot, and increased back pain, which coincided with investigations for psoriatic arthritis. She was referred by her rheumatologist for an MRI scan, which revealed nerve compression in her lumbar spine.
A few days after the MRI scan, she experienced a sudden worsening of her back pain with searing pain across her pelvis as she turned over in bed. By the early hours of morning, she could not feel herself pass urine but could feel that her bladder was full. Her groin, right buttock and thigh were numb and she had pins and needles in her right foot. She contacted her GP, who told her to call 999 as her symptoms could indicate CES.
She was taken by ambulance to the defendant hospital’s A&E, where an ED doctor noted her altered bladder function, reduced sensation and reflexes in her right leg, but normal anal tone on examination. The doctor queried a diagnosis of cauda equina. Our client had an MRI scan the same day and was told that she had sciatica from a prolapsed disc. She was discharged from hospital with safety-netting advice to return to hospital if her symptoms worsened or she experienced any incontinence.
Saddle numbness and emerging bladder symptoms
Overnight our client noticed that the numbness had spread to her buttocks and the backs of her thighs. She called 999 and was taken by ambulance back to the hospital, where possible diagnoses of sciatica and cauda equina were considered. An opinion was sought from a neurosurgeon who advised that her recent MRI scan showed no cauda equina compression, merely a minor nerve prolapse at L5/S1, which could gradually resolve. Her emerging urinary difficulties were investigated with a bladder scan, which ruled out urinary retention. She was given antibiotics for urinary tract infection. She was discharged with advice to avoid bending or heavy lifting, to seek a spinal referral if her sciatica continued, and to call 999 if she had new symptoms of urinary or bowel incontinence or leg weakness.
Two days later, she lost control of her bladder and was unable to open her bowels. She assumed this was due to her medication. By the next day, however, she contacted her GP as she was unable to pass urine, with no urge, and her abdomen was swollen. She had also had no sensation when opening her bowels the previous day. The worsening urinary dysfunction was a new red flag symptom for CES, but she told the GP she had put off going back to A&E so soon after her recent attendances and MRI.
ED consultant’s inadequate examination and response to red flags for CES
A further two days later, our client attended A&E. She was seen by an ED consultant who noted her recent history of saddle area numbness, her concerns about lost perineal sensation, her worsening bladder dysfunction and recent bladder scans, the previous MRI evidence of disc prolapse with disc fragments compressing her S1 nerve root and the recent neurosurgeon’s advice. He noted her ability to walk into A&E as evidence of normal neurology and discharged her without testing for perineal sensation or rectal examination.
GP intervention leads to reassessment and eventual surgical decompression
Over the next few days, our client experienced bowel and bladder incontinence. She called her GP, who called the ED duty doctor who commented that the ED consultant hadn’t noted any deterioration since her previous MRI scan. The ED doctor agreed to reassess her in A&E, and consider another MRI scan. She attended A&E and was told to return the next morning for an MRI scan.
After the MRI scan, a referral was made to the neurosurgeons at another hospital. They reviewed her history and scans and told the A&E staff to call her back in for an MRI scan, which took place after she called 999 and was taken in by ambulance the next day. She was then contacted by a neurosurgeon at the other hospital, and told to go straight to their hospital for surgery early next morning. She attended A&E and was transferred the next day to the care of the neurosurgeons at the other hospital, where she finally underwent surgical L5/S1 decompression.
Delayed diagnosis and surgical decompression cause CES disability
As a result of the delays in her diagnosis and surgical treatment, our client was left with permanent CES disability, including bowel and bladder dysfunction, numbness in her buttocks, and loss of sensation and weakness in her right leg and foot. She has required ongoing medical and surgical treatment, including nerve blocks and further spinal surgery.
Cauda equina syndrome (CES) claim leads to £350,000 settlement
We helped our client pursue a cauda equina syndrome (CES) claim against the defendant hospital. The claim was based on our independent medical experts’ opinions that the consultant’s negligent reliance on previous assessments as having ruled out cauda equina nerve compression and inadequate examination of our client, given her new red flag symptoms, resulted in delayed diagnosis, MRI scanning and referral for neurosurgical decompression, causing or contributing to our client’s irreversible CES disability.
NHS Resolution vigorously denied liability on behalf of the defendant hospital in response to our letter of claim. They maintained their defensive stance throughout the court proceedings until a few days before the scheduled exchange of experts’ reports, when they made a sudden, unexpected offer to settle the claim for £250,000. We entered into settlement negotiations and achieved a £350,000 compensation settlement for our client.
Julie was professional and supportive. It’s an emotional rollercoaster pursuing justice for a life-changing injury and all the staff at Boyes Turner completely understand and support you throughout the journey. Julie fought hard to keep the claim moving forward even when it looked doubtful at times. I couldn’t have done this without Boyes Turner and without Julie at the helm. I am eternally grateful.
If you or a family member has experienced a delay in diagnosis of cauda equina syndrome and you would like to find out more about making a claim for compensation, you can talk to one of our experienced solicitors, free and confidentially, by contacting us.
Written by
Julie Marsh
Julie is a partner within Boyes Turner’s outstanding medical negligence team. She specialises in high value and complex claims for clients whose lives have been changed by cauda equina (CES) and spinal cord injury (SCI), amputation, brain injury and disability caused by infections such as meningitis, sepsis and tuberculosis (TB).
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