Cauda Equina Syndrome involves catastrophic injuries to clients that change their whole lives. Negligent treatment has left them with urinary incontinence, bowel incontinence, loss of sexual feeling and immobility.
Cauda Equina Syndrome Claims
A timeline must be established of all the relevant treatment of the claimant’s “slipped disc”. Medical records must be obtained from the GP and all treating hospitals.
A detailed statement must be taken from the Claimant and particular attention must be given to the dates and times when “red flag” symptoms first occur. Also, to when urinary incontinence, bowel incontinence and immobility first occur.
Cauda Equina Syndrome cases often involve delay in diagnosis and treatment. Other causes include poor operation technique and failure to recognise a post operative haematoma.
Cauda Equina Syndrome Claims & Proving Breach Of Duty
Proving breach of duty gets easier, but proving causation more difficult, later in the timeline.
Proving breach of duty gets easier because the Claimant’s CES evolves into a stage where more of the classic “red flag” symptoms manifest themselves.
Examples of significant red flags are perineal numbness and changes in sensation whilst urinating such as difficulty in starting to pee and poor stream during peeing. These are symptoms at a stage where the Claimant can be treated to avoid progression to incontinence.
The symptoms should prompt an urgent referral to hospital as time is of the essence. At hospital there should be an urgent MRI scan, even if it is out of normal hours. If this shows compression of the cauda equina nerves, there should be an urgent decompression operation. Usually this is a discectomy and/or a laminectomy.
Best results are achieved by operating as soon as possible after of onset of CES symptoms.
The Bolam & Bolitho Tests
Breach of duty in CES claims is established by either the Bolam or Bolitho tests. The medical expert effectively needs to say the Defendant doctor’s treatment of the Claimant was “beyond the pale”. In other words, no reasonable body of doctors would have treated the Claimant in that way. However, usually the Defendant will be able to field their own expert to say the treatment was reasonable.
The Bolam test involves getting a report from a medical expert on a “like for like” basis. The Claimant’s expert will be of the same medical discipline as the Defendant’s doctor. Often there are multiple Defendants of varying disciplines so multiple Claimant experts on breach of duty are required. For example, a mistake by a GP may be followed by mistakes by an A & E doctor and by a physiotherapist.
Choosing the right medical experts to report on the case can make or break a Cauda Equina Syndrome case as experts’ opinions do tend to vary considerably. Usually, experts are instructed who have reported positively in other CES legal actions.
Cauda Equina Syndrome Timelines
Proving causation becomes more difficult later in the timeline as more neurological damage has already happened by then, and possibly too much. For it is necessary to prove that at least some of the neurological damage could have been avoided had correct, timely treatment been received at the time of the breach of duty.
Operating over 48 hours after onset of perineal numbness and changes in sensation whilst urinating will usually not achieve this, unless the Claimant is incredibly lucky. Proof of causation is on a balance of probabilities i.e. 51%.
Establishing causation usually involves initially obtaining a report from a neurosurgeon. Preferably a neurosurgeon who specialises in CES. They will hopefully state in their report that all or at least some of the Claimant’s injuries could have been avoided with more timely treatment.
Afterwards, they will also need to examine the Claimant and report on condition and prognosis. Travel to their consulting rooms and examination may be traumatic for the Claimant but is a “necessary evil”.
Usually, it will also be necessary to obtain a report from a urologist. This will firstly be on causation to confirm the neurosurgeon’s view that urological damage to the Claimant was not caused by anything other than CES and that it could have been totally avoided or mitigated. The neurosurgeon will defer to the urologist in this regard, so unity is required for a successful claim. The urologist will then go on to produce a report on condition and prognosis.
Sometimes it is also necessary to obtain a report from a colorectal surgeon, if there is any doubt over the causation of the Claimant’s bowel incontinence.
It will also be necessary to obtain quantum reports from a care expert and an accommodation expert.
Claimant Support
Often the Claimant’s incontinence and loss of mobility will mean that carers are required to assist him or her with activities of daily living, together with specialised equipment to assist him or her. The medical experts will set out what the Claimant can no longer do unassisted and whether his or her present accommodation is unsuitable.
The care expert, who often is an occupational therapist, will be able to advise what assistance and equipment is required and to cost this out.
The housing expert will usually report on level accommodation being more suitable together with how much this will cost.
With these quantum reports a Schedule of Loss can be drafted by the Claimant’s solicitor. He will also draft a protocol letter of claim to send with the Schedule to the Defendant’s solicitor. The letter sets out the Claimant’s case on breach of duty, causation, and details the Claimant’s injuries.
Within four months of the date of the letter the Defendant must send their Letter of Response.
Sometimes, however, a claim will be immediately commenced in the courts to try to avoid a Defence that the time limit for commencing an action set out in the Limitation Act has expired.
Either way, more likely than not, the action will be stoutly defended as Cauda Equina Syndrome claims are high value.
The case may be defended on limitation, breach of duty, causation, and quantum.
More trauma for the Claimant is being examined by the Defendant’s experts, often at a considerable distance away.
Why Choose A Specialised & Experienced Legal Expert
It may take two or three years of litigation for the cauda equina syndrome case to come to a trial or a settlement. A Cauda Equina Syndrome claim is a war of attrition for both client and solicitor.
To be successful cases need to be pursued by a highly specialised, experienced solicitor.
Clients must receive both sympathy and understanding.
Often around £500k is awarded but each case is different.
How We Can Help
Clinical Negligence Solicitor, David Dickie, has specialised in CES claims for over 30 year. For further advice, please contact David on freephone 0800 011 6666 or by email at legal@timms-law.com.
