Failure to diagnose and treat: BM -V- Norfolk and Norwich University Hospitals NHS FT

C a male, aged 73 at time of instruction, 75 at age of settlement,  instructed Mr Andrew Taylor, a Solicitor and Partner at Birchall Blackburn Law to investigate a Clinical Negligence Claim on a No win, No fee basis.

The basis of the Claim was that in January 2014 C began to experience chest pain on exertion and his GP referred him to the D’s Cardiology Department. On 10th March 2014 C was examined with a diagnosis of non-cardiac chest pain,  noting that the Claimant’s ECG was unremarkable with no further investigations necessary, albeit the electronic ECG printout stated abnormal ECG-probably anteroseptal infarct recent. A systolic murmur was noted and so for completeness an echocardiogram was arranged. This took place on 24th April 2014 after which the Doctor reported that the Claimant’s heart muscle was in excellent condition with only one significant abnormality, namely a mildly dilated aorta which was leading to a slight leak in his aortic valve. This was left to be controlled by the Claimant’s GP.

On 11th March 2015 C’s GP again urgently referred him to D Trust due to worsening symptoms including shortness of breath and swollen ankles and finding it difficult to lie down to sleep due to shortness of breath. C was seen by an SpR in Cardiology on 23rd March 2015 when a further ECG and a transthoracic echocardiogram were undertaken.  Unfortunately, the ECG results were not commented upon. Reporting on the echocardiogram, it was concluded that C had orthopnoea and basal crepitations consistent with fluid overload. However, he thought it unlikely that this was related to his valvular heart disease, his echocardiogram showing mild left ventricular systolic dysfunction only. The echocardiogram recorded on 23rd March 2015 reported showing hypertrophied dilated, mildly impaired left ventricle, mild aortic, mitral, and tricuspid regurgitation, moderately dilated left atrium, raised right ventricular pressure.

On the 21st April 2015 C re-attended his GP who noted that his breathlessness had improved with a change in medication but had not resolved. C again attended on 29th April 2015 complaining of continuing breathlessness and on-going swollen legs. His GP advised him to increase his dose of furosemide and there would be a review in 1 month. In the interim it was confirmed that C was well enough to fly to Barcelona to go on a planned cruise.

On 2nd May 2015 C flew to Barcelona. Unfortunately, his breathlessness continued and then deteriorated. On 11th May 2015 he woke at 2am complaining of dyspnoea which progressively worsened. At 7:30 hours he consulted the ship’s physician complaining of chest pain and on examination he was found to have difficulty breathing. The chest x-ray showed signs of pulmonary oedema. A copy of the ECG taken at that time was abnormal but showed the same changes that were present on his review on 23rd March 2015.  The Claimant had suffered an avoidable myocardial infarction or heart attack.

C was transferred to hospital in Italy. On arrival he was noted to be in acute pulmonary oedema with severe hypoxia. A further ECG was described as showing sinus rhythm, heart rate 90 bpm. It was averred by C that the changes in leads V1, V2 and V3 represented evidence of acute cardiac damage.

Following a period of stabilisation, C underwent coronary angiography which demonstrated 2 critical stenosis in the medium and distal left inter ventricular descending artery which were successfully treated with 2 stents. Thereafter, the C’s recovery was complicated by multiple organ failure, but after intensive care and hospitalisation for 2 weeks, C was flown back to England.

It was the C’s case that had Defendant Trust correctly analysed the ECG’s and/or echocardiogram, C would have been admitted immediately and further appropriate investigations, including a coronary angiography, conducted. Thereafter, an urgent revascularisation of the left anterior descending coronary artery by stenting is likely to have been conducted. On the balance of probabilities, this would have prevented the Claimant’s subsequent further myocardial infarction in May 2015 which left him with residual left ventricular damage/scarring and impaired systolic function.

C continued to suffer with significant breathlessness with acute hospitalisations, as well as swollen legs and consequent loss of mobility, pain, suffering and loss of amenity.

In order to begin investigations, the C’s medical records were requested in July 2015 and D was advised as to the potential claim details. Andrew Taylor then took instructions and drafted the Claimant’s witness statement. The Defendant acknowledged the claim on 7th August 2015 and requested further information.

A Consultant Cardiologist instructed for C, opined that the ECG recorded on the 10th March 2014 was abnormal, and that the ECG of the 19th March 2015 was in keeping with a diagnosis of anteroseptal myocardial infarction of indeterminate date. There was a breach of duty in failing to recognise the true significance of the changes on the ECG on the 10th March 2014. Thereafter Mr Taylor approached a Care Expert, who was instructed on 26th April 2016 and arrangements were made for C to be examined.

A Letter of Claim was served on D in May 2016. The Letter of Claim was acknowledged on 7th June.  On 3rd June 2016 an update was received that C had suffered a stroke and had been admitted to Hospital. Matters were left in abeyance whilst C recovered. In September 2016 D requested an extension of time to serve their Letter of Response, and a 14 day extension was agreed. The Letter of Response was served in October 2016 in which many of the allegations of negligence and causation were admitted. However, liability was denied for the breach of duty identified in March 2014.

A Care Report was received in November 2016 who identified issues in respect of the Claimant’s accommodation and identified adaptations and equipment that would be beneficial to the Claimant. Mr Taylor then proposed a Joint Settlement Meeting between the parties

Instructions were obtained from C and the Medical Evidence obtained to date was disclosed together with the Schedule of Special Damages and a Part 36 Offer in the sum of £180,000.00 on 28th September 2017.

In assessing General Damages, C was assisted by JC Guidelines 13th Edition Section 6(A)(b) Injuries to Internal Organs – Chest Injuries – Traumatic injury to chest, lung(s) and/or heart causing permanent damage, impaired function, disability and reduction of life expectancy. General damages between £55,000 and £84,150.

The C’s Cardiologist identified a reduction of life expectancy of half, as a consequence of the negligence, and as such there was some urgency required to attempt settlement without significant court proceedings.

C’s claim for Special Damages included, adaptions to accommodation, level access showers, compression stockings for life, powered scooter with maintenance, cover and hoist, loss of enjoyment of holiday, increased Travel insurance, , treatment, aids and therapy.

On 6th February 2018 D put forward a Part 36 Offer in the sum of £110,000.00 gross of CRU. It was the Defendant’s case that C would have required care in any event following surgical intervention, and that he would also have required assistance as he advanced in age. On 26th February 2018 D put forward a revised Part 36 Offer of £145,000.00., which was accepted, and matters were concluded on that basis.

Head of the Healthcare & Clinical Risk Team

Partner at Birchall Blackburn Law