Case overview
I recently acted for Simon Small in relation to a medical negligence claim arising from alleged delays in diagnosing and treating a serious spinal infection and the neurological injuries which then followed. Dr James Piers and Simon discuss the case in the video below:
Full transcript of the video can be found here.
How Simon’s symptoms began
Following a long weekend of gardening, Simon awoke one morning with a sore neck and upper back. He felt that he had simply overdone it in the garden and pulled a muscle.
He had just landed what he felt was his dream job and naturally was very reluctant to take any time off work. He battled on for a couple of days, but his neck and upper back pain became progressively worse and he started to develop feverish symptoms and sweating.
First GP consultation
Eventually, the pain became so severe that he could not go into work and he arranged to see his GP.
At a consultation later that afternoon, he reported his symptoms to his GP. The GP advised Simon that he had probably pulled a muscle and that he would improve over the next few days with some simple painkillers.
Second opinion at a walk-in centre
However, Simon did not improve. His condition became worse and two days later he felt he had to seek further medical advice. Following a call to the 111 service, he was advised to see a GP at a walk-in centre at a local hospital. Notwithstanding that Simon was getting worse rather than better, the second GP also concluded that he had a simple muscle sprain that would get better with time. That GP prescribed him even stronger painkillers and advised him to see his own GP the following day.
Third consultation and warning signs
As instructed, Simon saw his own GP the following afternoon. By that time, he had started to feel unsteady on his feet. The third GP also reassured Simon and warned him that he should get back in contact if he were to lose control of his bladder.
Having been reassured, Simon returned home expecting that his condition would gradually improve.
Collapse and emergency hospital admission
Unfortunately, that evening he collapsed whilst going up the stairs and had to be helped to bed by his wife. When he woke in the morning, he found that he had lost feeling in his legs and had lost control of his bladder.
An ambulance took him to a local hospital who then transferred him to a neurosurgical centre for further investigation and treatment.
Diagnosis: spinal epidural abscess
An MRI scan identified that Simon had a spinal epidural abscess in his neck.
A spinal abscess is a collection of pus from an infection which can cause injury to the spinal cord by compression as it enlarges and because of local inflammation from the infection.
Simon underwent emergency surgery to decompress and wash out his spine.
Surgery and rehabilitation
Following surgery, Simon spent many weeks in hospital. He required further repeat surgery to his neck over the following weeks and eventually he was transferred to the London Spinal Cord Injury Centre at the Royal National Orthopaedic Hospital in Stanmore. It was there where he underwent intensive rehabilitation.
Through his hard work with the therapists at the Spinal Cord Injury Centre, he gradually became able to walk again and, from a mobility perspective, improved considerably.
Some months later when he was finally discharged from the Spinal Cord Injury Centre, he was able to walk slowly and with a stick.
Understanding spinal cord injuries
With spinal cord injury, it is all too easy to focus on the consequences on a patient’s mobility and to lose sight of the many other consequences of damage to the spinal cord.
The spinal cord carries nerve impulses from the brain to the rest of the body allowing muscles to function and for various body systems to operate. It also carries sensory information from the body up to the brain to enable the body to react to its environment. All of this important information is carried by the spinal cord, and when the cord is damaged the range of body systems that can be affected is broad.
Although Simon’s mobility recovered reasonably well, he was left with other, not so obvious but profound life-changing problems.
Bladder and bowel dysfunction
Perhaps most sensitively, spinal cord injury frequently leads to loss of normal control of bladder and bowel function. It is these injuries “below the belt” that are often embarrassing and which many people do not wish to discuss. However, they can be life-changing. Unfortunately for Simon, he was left with significant impairment of bladder and bowel function which often manifest as unpredictability as to when either system might choose to work.
Neuropathic pain
Damage to the sensory pathways can also often lead to long standing, highly unpleasant neuropathic pain. Again, this can be life-changing as it can be unpredictable in severity and completely prevent a sufferer from going about their normal daily business. Simon has described his pain as if he is being beaten in the back of the leg with an iron bar and having a cheese grater taken to the soles of his feet.
Impact on Simon’s life and livelihood
For a gentleman in his early 50s who had just obtained his dream job and for whom the future could not have looked better, the consequences of his injuries were devastating, life-changing and were clearly going to be permanent. He had to adjust to a new normal which in itself is often psychologically very challenging.
He lost his job and his livelihood as he would simply not have been able to fulfil the duties required of him. His main lasting problems of bladder and bowel dysfunction and severe unpredictable pain makes him a poor prospect for future employment and the economic stress that this placed upon him and his family was considerable.
Establishing negligence
Following a careful investigation of the circumstances of the care provided to Simon, it appeared that there had been delays by the various GPs in identifying serious clinical symptoms and signs that ought to have raised alarm.
A spinal cord abscess is a rare condition and one which a GP might reasonably not be expected to diagnose; however, whilst the underlying diagnosis may not be identified, the features with which Simon presented to the GP were such that further urgent investigation ought to have been advised.
The GPs denied liability and indicated that their recollections of the consultations differed from Simon’s. In the circumstances, they considered that they had acted properly.
Settlement
Following a careful and in-depth investigation not only of the events at the time, but also into the broad range of consequences of Simon’s injuries, the parties were able to negotiate a fair settlement without the need for a lengthy trial in the High Court.
Whilst the compensation clearly cannot turn back the clock and remove Simon’s permanent neurological injuries, I do hope that it will allow him to recover some of the independence that he has lost and help address the life-changing consequences of losing his livelihood.
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