Compensation for negligently fitted pacemaker resulting in stroke

I recently acted for Mrs C who in 2013 elected to have a permanent pacemaker implanted in her chest to correct an irregular heart rhythm which had been troubling her intermittently since 2004. Mrs C was due to undergo transvenous implantation of her pacemaker which is the most common method of fitting a pacemaker in the UK.  Essentially, this involves guiding the pacemaker lead through the cephalic vein into the heart.  The lead is then lodged in the tissue of the lower right chamber of the heart (the right ventricle).  The other end of the lead is connected to the pacemaker, which is fitted into a small pocket between the skin of the upper chest and the chest muscle.

Two weeks after her operation Mrs C started to suffer headaches and disturbed vision with zigzag lines and blind spots.  She attended her GP who referred her immediately to hospital where she was diagnosed with a mini stroke. 

Following further investigations at hospital, it transpired that the pacemaker lead was lying in the wrong blood vessel.  Mrs C needed further surgery to remove the lead and reposition it correctly.  She was in hospital for 6 days following this second procedure. 

So what went wrong?  I applied for Mrs C’s medical notes and on review, although the operation notes stated that the pacemaker was implanted via the cephalic vein into the right ventricle (as with all transvenous implantations), during the revision surgery, the lead was in fact found to have been placed in another blood vessel next to the cephalic vein.  A chest x-ray taken after the initial procedure clearly showed the pacing lead passing via the main artery into the heart (the aorta), through the aortic valve into the left ventricle rather than through the venous system into the right ventricle.

I instructed an expert in cardiology to prepare a report on the two branches of establishing a negligence claim.  Firstly, the hospital clearly had a duty of care to Mrs C.  Was the care provided so far below the expected standard of care that it could be determined to be a breach of duty of that care? (Although from the notes it appeared fairly straightforward, an opinion from a specialist medical expert is necessary to establish breach of duty in clinical negligence cases).  Secondly, did this breach of duty result in injury? In this case, did it result in Mrs C’s stroke and need for revision surgery?  

In the expert’s opinion, both positioning the pacemaker lead via the arterial system into the left ventricle rather than the right ventricle, and failing to notice the error on the following day’s chest x-ray represented seriously substandard care and were clear breaches of the duty of care.  Further, in the expert’s opinion, placing the pacemaker lead in the left ventricle is a well-recognised cause of embolic stroke and it was, on the balance of probabilities, the cause of Mrs C’s stroke. 

I sent a letter of claim to the hospital who admitted responsibility for Mrs C’s injury fairly quickly.  The next stage was to work out how much compensation Mrs C should receive. 

Luckily, Mrs C felt she had not suffered any long lasting effects of her stroke and in her words was “back to normal within a few months”. Even so, it was necessary to obtain a report from an expert neurologist to determine whether there were perhaps more subtle consequences or any risk of future complications developing.

The expert confirmed that the stroke did not cause any long-term complications.  However, because of her stroke, Mrs C now had mildly increased chance of developing epilepsy (a 2% chance, rather than the 1% chance that the general population face).  If this did develop, there was an 80% chance that it would be fully controlled with medication. I took this into account when assessing how much compensation Mrs C should receive for her injuries. 

Although Mrs C was 72 at the time of her stroke, she had for a number of years been running her own modest catering business.  After the stroke, she couldn’t drive for a few months and lost custom because of this.  I obtained her full business accounts which demonstrated a loss in the year after the stroke although her business had since recovered as she had worked to rebuild her reputation.  This past loss was of course included in her claim as a direct financial loss stemming from the injury. 

I made an offer to the hospital and following negotiations, Mrs C’s claim settled for just under £25,000.  This took account of the short term effects and mild long term risks of the stroke, the need for further surgery and the loss of business Mrs C experienced as a result of her injury.

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