In another case of admitted clinical negligence, my client (age 22) faces the prospect of further surgery and not being able to join the police. She was supposed to undergo routine surgery but that, the Trust admits, was not done to an appropriate standard. The result has been a truly torrid time for my client who had three further surgeries and can expect another, which will likely leave her with an increasing level of disability.

Aged 5 my client had been referred to a podiatrist for care of bilateral curly fourth and fifth toes. Orthotics therapy and splinting of the toes were instituted but ineffective so her GP referred her for orthopaedic opinion. Aged 17 my client’s treating surgeon diagnosed hallux valgus interphalangeus bilaterally and recommended rotational osteotomies to correct the deformity. The following year my client underwent bilateral Akin osteotomies.

An Akin osteotomy is a type of corrective surgical procedure where the bone of the great toe is manipulated in order to correct the deformity and a fix, screws in this case, are inserted in order to achieve greater alignment.

In the course of my client’s operation, a screw that was too short was inserted into the right great toe, but without adverse consequences. However, in carrying out the cuts to the left great toe, the cartilage to the proximal phalanx of the first metatarsophalangeal joint was breached, thereby giving rise to complication and subsequent degenerative change in the joint.

Unfortunately for my client, she developed a non-union on the left side. This is a known complication. For my client it meant a re-do had to be undertaken about 4 months after her initial procedure. Within 6 months her surgeon confirmed the osteotomy had united.

However, her problems including persistent pain continued and it was decided that she should undergo screw removal. That was done 6 months later but with no successful outcome. A matter in dispute between the parties is why only one and not both of the screws was removed at this time. One explanation is that the hospital realised part way through the procedure that the equipment to remove the second screw was unavailable. The Trust says there might be several reasons as to why only one screw could be removed. This however is contrary to the clear indication given to my client beforehand that both screws would come out.

A month later my client was still reporting problems with her left foot. Within the following 3 months the decision was taken to perform a minimally invasive cheilectomy (a type of bone shaving procedure) to help relieve crepitus and the associated pain. The problems persisted. The eventual outcome saw my client diagnosed with an arthritic joint (something a cheilectomy could never resolve).

It is understood that the arthritic changes now seen are consequent upon the cartilage breach at the joint, suffered at the time of the initial surgery. Given her young age, a fusion or joint replacement is not considered a solution at this stage and my client is now left to get on as best she can. When the pain becomes intolerable, one of the above-mentioned surgical interventions might help but there will be ongoing problems regardless of which she chooses.

Had the initial procedure been undertaken to an appropriate standard, my client could have enjoyed an uneventful recovery and with none of the symptoms from which she now suffers. My client had intended to pursue a career as a police officer. Left unable to run, the mandatory fitness tests are not now a possibility for her and she is left to re-consider her options.

* Disclaimer: The information on the Anthony Gold website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. It is provided without any representations or warranties, express or implied.*

The case of Caridff v Lee (Flowers) is being hailed as a key case for landlords and tenants.  But it in fact tells us nothing that a good student of the CPR couldn’t tell you.

In a frequently occurring situation a landlord obtained a suspended possession order against the tenant.  The landlord said the tenant had breached the order and requested a warrant.  The tenant denied breach and requested a stay of execution.  They lost – sadly so normal.  But then the tenant pointed out something which very few people had noticed – that the court rules had changed in 2014.

In 2014 CPR 83.2 was introduced which applies to all courts and it requires that before a warrant could be obtained in the case of suspended order (note possession or money judgement it matters not) the courts permission was required.

This timely reminder makes the case important anyway.  In fact, by the time the case got to the court of appeal this important point had been agreed between landlord and tenant.  The court of appeal confirmed the very straightforward words of CPR 83.2.

The issue for the court of appeal was what happened when permission was required to get a warrant to evict but it hadn’t been done.  Where did that leave landlord and tenant?  The tenant said the landlord had broken the rules and needed to go back to the start and ask permission.

But the landlords said that to start again was an utterly pointless waste of the court’s time.  The whole reason for permission to enforce a suspended order was required was to make sure that the order had in fact been broken.  In this case, that issue had already been comprehensively decided in the landlord’s favour.  Further the court had rejected the tenant’s request for a stay of execution.

How to proceed?  The landlord said the court could correct procedural error’s using CPR rule 3.10.  This was just such an error and given the background above the court could and should correct it.  In this case the court was willing to oblige.

But the court was at pains to point out that it was not erasing the requirement for permission from the rules.  The judge said landlords should not assume that the warrant would simply be retrospectively remedied.  Even if the court agreed to correct the landlords mistake it could still penalise them in costs for it.

Where this will make a big difference is where tenants have been evicted and are trying to get back in.  Previously without “oppression” the court couldn’t even consider merits of letting the tenant.    Where permission for the eviction wasn’t obtained tenants will be able to take the case right back to the pre-eviction stage and argue why they should be given extra time.  There is c

Clearly landlords must correct any failure to get permission and pre-eviction.  Prior to eviction the court will normally remedy the error.  But there are likely to be costs consequences and delay.  Post-eviction the story will be different and expect to be sent back to the start.

The court should not be tolerating serial offenders though and where this is shown, even pre-eviction stage, expect the court to refuse to remedy the error.

One thing’s for sure – we’ve not heard the last of this.

* Disclaimer: The information on the Anthony Gold website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. It is provided without any representations or warranties, express or implied.*

Reviewing some medical records in a potential claim I came across a series of clinical records which had been crossed out, times changed and  signatures or initials obliterated.  It was impossible to work out what had happened during the period in question and were it not for the nursing records it would have been difficult to prepare a chronology which was in any way accurate.  As it transpired these records may not be vital which is fortunate, but nevertheless it is worrying that such poor record keeping still occurs.

This year alone there have been two reported cases where record keeping has been highlighted as an issue. Earlier in the year FE v St George’s Hospital NHS Trust (an obstetric case with a brain damaged child) there was such a catalogue of disasters that it was hard to see how any view of the history of events could be determined. Indeed the judge, who listed a series of fundamental errors (including machines not working on the correct time and drugs not recorded), was of the view that the medical  records were wholly unreliable.  The claimant succeeded and must have been assisted by the difficulty in providing a  reliable chronology of events which could be supported by the records. It has to be assumed that both sides spent a considerable amount of time and money trying to interpret  what appears to have been a complete mess of record keeping.

Long v Western Sussex Hospitals was a case with a different problem. Part of the issue was a junior doctor making a decision to discharge when he should not have done so. The argument for the junior was that it was his usual practice that  a senior colleague would be consulted  before discharge occurred.  There was no evidence of this in the records .  As the judge pointed out  – It was “hard to accept that if he considered it important to consult ….with a senior colleague he would not have thought it equally important to  note the discussion in the notes”. The judge determined that no such consultation had taken place.

The problems of medical records are ones which present difficulties for claimant and defendant lawyers alike. They present even more difficulties for those who are not accustomed to reading and interpreting medical records such as the majority of patients.  Computerised notes such as those common in major hospitals and GP surgeries are considerably more accessible  and legible.

The health secretary Jeremy Hunt has made no secret of his desire for a digital NHS in which patients can access services and records on line. possibly reducing the need for attendances.  An idea that the NHS should be paperless by 2020 has (probably sensibly) been discarded but the desire to increase the accessibility of information is being given emphasis.

Computerised records still present challenges.  In a recent case, I dealt with, the notes of the nursing and different medical teams seemed to suggest versions of events which made no logical sense. Computer entries  seemed to contradict each other with blood pressure levels recorded at almost opposite ends of the scale.  However at least what records are there can be read.  Computerised records can still be silent about whether an activity has taken place (as in Long above) and a decision made about whether records are accurate. When entries are put into the system the timing can be checked which may be helpful but unlike handwritten records where alterations are usually obvious, material added to computerised entries can be less obvious.

With a change to computerisation, the challenges of interpreting medical records may remain, but the records themselves would be more accessible to lay individuals as well as lawyers.  This is not a panacea however. Computerised records do not solve the problem of chaotic care or failing to act appropriately.  However, they may make disputes about what the records actually mean and what they say much less time-consuming and costly.  That has to be an improvement for everyone – the NHS, medics, lawyers and most of all the patients.

* Disclaimer: The information on the Anthony Gold website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. It is provided without any representations or warranties, express or implied.*

In a recent piece of health news, it has been noted that allergy hospital admissions have increased by a third.

The article states that, according to NHS Digital statistics, there were 29,544 hospital admissions in 2015-16 for allergic reactions, as compared to 22,206 admissions in 2011-12; an increase of almost exactly 33%.  This is thought to be due to the fact that we now live in a cleaner society, which lowers our resistance to various allergens including dust and pollen.  Three of the top five hospitals recording allergy-related admissions are in London, although this just may reflect the local population size.  It is also notable that the rise in anaphylactic shock admissions has been less significant, but it has still risen some 19%.

Understanding anaphylaxis is extremely important, as it can be a life-threatening condition.  Typical features of an anaphylactic reaction, which will often occur within seconds or minutes of being exposed to the offending allergen, include:

• widespread flushing and itching of the skin
• a raised, red rash resembling a nettle rash (also known as “hives” or “urticaria”)
• swelling of the skin (angioedema), lips, hands and feet
• swelling of the mouth, tongue and throat, which can lead to breathing difficulties
• wheezing, tightness in the chest, shortness of breath and asthma
• abdominal pain, nausea and vomiting, and diarrhoea
• dizziness, collapse (often due to a drop in blood pressure) and unconsciousness.

In mild cases, there may be nothing more than some tingling or itching in the lips or mouth, or a small rash, which will either disappear on its own or can be treated with antihistamines.  In more severe cases, cardiorespiratory arrest and possibly death may occur if emergency treatment is not sufficiently quick: there are about 20 deaths per year in the UK from anaphylactic shock.  Fatal cases related to food allergy tend to lead to death within 25-35 minutes of the exposure to the allergen, which is longer than that for drugs which are between about 5-15 minutes.  Asthma is a risk factor for fatal anaphylaxis, as is delayed treatment.

Food allergy from common allergens, including peanuts, tree nuts (walnuts, almonds, brazil and cashew nuts), celery, egg and shellfish, are only part of the story; other allergens include wasp, bee and hornet stings, natural latex (rubber), certain drugs, including penicillin, and even exercise.  An excellent website on anaphylaxis describing the above  which is the website of the Anaphylaxis Campaign, an organising which supports those with severe allergies.

Allergens trigger an over-reactive immune response mediated by a chemical known as Immunoglobulin E, which causes the release of other chemicals, such as histamine, which cause the symptoms described above.  One of the mainstays of treatment of those prone to severe allergies is adrenaline, which can be administered in an emergency situation by use of an adrenaline pen (Emerade®, EpiPen® and Jext®).  A panel of experts in Europe (Muraro et al 2014) has recommended that adrenaline should be prescribed to people in three main circumstances: (a) previous anaphylaxis triggered by food, latex, allergens in the air or exercise, or if the cause is unknown; (b) unstable or moderate to severe persistent asthma in combination with a food allergy; and (c) an insect sting allergy where allergic reactions have been moderate or severe.

People with allergies should, therefore, be extra vigilant about what they eat or are exposed to, and anyone with a significant allergic reaction may wish to consider seeking specialist advice from an immunologist or allergy expert.  It is notable that a large number of people who go on to develop anaphylaxis have a previous history of atopy e.g. allergic rhinitis, asthma, atopic dermatitis: in the Rochester Epidemiology Project in the US, 53% of the patients with anaphylaxis had a history of atopic diseases.

In the clinical negligence setting, probably one of the most important anaphylactic reactions are those of drug reactions, even to common drugs such as penicillin and the cephalosporins such as cefuroxime, as such reactions need to be identified and treated rapidly, as failure to do so can result in a catastrophic anaphylactic reaction which, in the worst case scenarios and when the reaction is not recognised sufficiently quickly, can lead to severe brain injury or death.  In the primary care setting, though, it is important that GPs, in particular, are aware of the risk factors and at-risk individuals and prescribe adrenaline pens appropriately, and it is also important for paramedics and those in A&E to be able to recognise the tell-tale features of anaphylaxis and react quickly.  It is, therefore, of some note that allergy admissions to hospital have increased by a third in four years.

* Disclaimer: The information on the Anthony Gold website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. It is provided without any representations or warranties, express or implied.*

In the recent case of Smith v Lancashire Teaching Hospitals NHS Trust and another [2016] EWHC 2208 (QB) the court found that whilst a failure by the Fatal Accidents Act 1979 to award bereavement damages to couples who live together, but are not married, does not directly engage Article 8 (right to family life and privacy), as a point of principle this distinction could not be justified and Parliament should consider reforming the law.

The case

The claimant had been in a relationship, living with the deceased between March 2000 and the date of his death on 12 October 2011. Liability was not in dispute as the defendants had admitted that the death was caused by their negligence.

The claimant sought a declaration that the bereavement damages provision in section 1A of the Fatal Accidents Act 1976 should be interpreted to allow her compensation; alternatively, she applied for a declaration that the provision was incompatible with the Human Rights Act 1998. Her justification for this was that her entitlement stemmed from her right to respect for her private and family life (Article 8) and that a failure to recognise this would amount to discrimination under Article 14 on the grounds of her “other status” as an unmarried partner.

Justification

The court held that in order for Article 8 to be directly engaged the claimant needed to show a direct and immediate link between the restriction and her private and family life. It was noted that the just because the family life had ended did not mean that Article 8 could not be engaged. However, the court felt that it would extend the reach of Article 8 too far to hold that the payment of bereavement damages fell within its ambit.

In coming to this decision the judge considered the legislative history of the Fatal Accidents Act in some detail. He noted that when the amendment was made to extend dependency claims to cohabiting couples, Parliament did not consider the distinction between dependency and bereavement damages.  Therefore, for reasons not explained by Parliament, cohabiting couples were treated differently under section 1 and section 1A.

When the courts interpret statutory provisions, they try and reason out Parliament’s intention and look for the meaning behind the law. In this case, the court opined that the distinction must flow from Parliament’s desire to construe bereavement damages more narrowly than dependency, so as to avoid an overly intrusive enquiry into the relationship between the parties. Such an enquiry may be appropriate in the case of dependency claims which are purely financial, but bereavement damages are meant to compensate for the grief and suffering for the loss of a loved one. The court had to conclude that the distinction was made for a reason and there was no intention to imply that the denial of the award meant that grief felt by cohabitees is any less valued by the State in comparison to married couples.

Some thoughts of my own

When a loved one passes away it is always a difficult time. Compensation is often not a priority, but if there is a case the last thing you expect to be told is that you are not entitled to a certain form of damages just because you were not married to your partner.

In law cohabiting couples have often received a raw deal simply because our legislature cannot keep up with changes in social convention. What makes this case particularly interesting is that the Fatal Accidents Act does recognise a cohabiting couple’s right to bring a claim for dependency damages, but then makes an arguably arbitrary distinction when it comes to bereavement damages. Although it was held that Articles 8 and 14 were not engaged, the judge went on to reflect on the arguments put forward by the Secretary of State when justifying the distinction. The judge concluded that “If I am wrong about the engagement of Articles 8 and 14, I do not believe that the Secretary of State has established that the difference in treatment between the claimant and a widow in her position is justified” [paragraph 109 of the judgment]. So, whilst it may not have been the underlying intention of Parliament to create the impression that cohabitees are less valued, they have done exactly that.

With such a powerful statement by Mr Justice Edis, and with the House of Commons debating the emotional effect that the loss of a child can have on family members, perhaps it is time for a rethink on bereavement damages as a whole so the issues surrounding the amount and who can claim are brought into the 21st century.

* Disclaimer: The information on the Anthony Gold website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. It is provided without any representations or warranties, express or implied.*

Despite  guidance from NICE and a commitment to improving awareness of sepsis too many people are still dying unnecessarily from the condition or living with lifelong damage.

What is sepsis?

Sepsis is a life-threatening condition that occurs when the body’s immune system goes into overdrive as it tries to fight an infection. This can reduce the blood supply to vital organs such as the brain, kidneys, and heart. It is often called septicaemia or blood poisoning. Without treatment, sepsis can lead to multiple organ failure and death.

According to the UK Sepsis Trust , there are around 150,000 cases of sepsis in the UK each year and 44,000 deaths.

Early symptoms of sepsis include fast breathing or a fast heartbeat, high or low temperature, chills and shivering, and people may have a fever.

In some cases, symptoms of more severe sepsis (septic shock – when your blood pressure drops to a dangerously low level) can develop soon after and include blood pressure falling low, dizziness, disorientation, slurred speech, mottled skin, nausea, and vomiting.

Causes of sepsis

Sepsis can be triggered by an infection in any part of the body. The most common sites of infection leading to sepsis are the lungs, urinary tract, abdomen, and pelvis.

People at risk

Everyone is potentially at risk of developing sepsis from minor infections. However the most vulnerable include:

• Those with a medical condition that weakens their immune system
• People who are receiving medical treatment that weakens their immune system
• The very young or old
• Those who  have just had surgery, or have wounds or injuries as a result of an accident.

Sepsis is particularly a risk for people already in the hospital because of another serious illness.

If sepsis is detected early and it has not affected vital organs yet it may be treated at home with antibiotics. Research shows that simple steps – such as IV antibiotics in the first hour – can reduce the risk of death by sepsis by over a third. However opportunities for early diagnosis are still being missed. If sepsis is caught and treated quickly, in most cases, there will be a full recovery with no lasting problems. Just this week there has been another report of two deaths in the media alongside a newspaper article titled  “Most under-fives with high temperatures not checked properly for signs that could indicate sepsis”.

I am currently working on a couple of cases concerning sepsis that highlight the importance of catching the condition early – one involves a baby that needed an amputation because of a lack of bloody supply and the other concerns sepsis-causing the death of a man in his 30s. It appears the basic checks on people that could flag up the life-threatening condition are still not being carried out.

* Disclaimer: The information on the Anthony Gold website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. It is provided without any representations or warranties, express or implied.*

It is a well-established principle in injury and medical claims law that a defendant must “take their victim as they find them”.  For example, a driver runs a red light and hits a man using a pedestrian crossing.  At the time of the accident, this man was using a walking frame because he had problems with his right hip.  The impact shatters the man’s left arm.  The man is no longer able to use the walking frame and becomes wheelchair-bound.  The driver will be responsible for this.  He cannot argue that if it wasn’t for the hip problems, the man would not be wheelchair bound.  The impact is of the injury is greater than to the average man who has no pre-existing mobility problems, but the driver’s insurers will still be responsible for paying a higher level of compensation for the effects of the injury on someone with a pre-existing vulnerability.

What about when it comes to care and assistance for the now wheelchair-bound victim?  Will the insurers be responsible for paying for all of the care and assistance the victim now requires even though he previously needed some help before because of his hip problems?

The case of Reaney v University Hospital of North Staffordshire NHS Trust & Anr addressed this.  This is not a newly decided case but it has become relevant to one of my cases involving an elderly claimant who had mobility and neurological issues before a negligently performed operation  rendered her wheelchair bound.  Although it has not yet reached that stage, it is likely there will be a tussle between the experts in relation to what type and level of care my client would have needed in any event given her pre-existing problems.

In Reaney, the claimant argued the negligent hospital was responsible for paying for all of her care and assistance. Ms Reaney had been diagnosed with non-negligent damage to her spinal cord causing permanent paralysis.  The claimant had obvious care and assistance needs resulting from this.  However, during her lengthy hospital admission, due to the hospital’s negligence, she developed pressure sores which caused an infection of the bone marrow, hip dislocation and spasticity.  As a result of this, the claimant required extra care and assistance.

At first instance, it was held that the hospital was responsible for paying for all of Ms Reaney’s care on the basis that the negligence had made her condition materially and significantly worse.  The hospital appealed.  They argued they should only be  responsible for paying the difference between what care the claimant needed as a result of being paralysed and what extra care she required after the infection.  For example, she only required one carer as a result of the paralysis, whereas after the infection she required two carers.  It was argued that the defendant should only be responsible for paying for the second carer, not for both of them.  The Court of Appeal agreed.  They held that the hospital must compensate for her condition only to the extent that it has been worsened by the negligence.  Although Ms Reaney’s care package had increased significantly, the type of care was the same.  There was no change in the level of expertise and skills of the carers, it was “quantitative” rather than “qualitative”.

Although this may seem unfair to the lay person, the reasoning is sound.  To the lawyer, careful consideration should be given to the need for expert evidence surrounding what is “quantitative” and what is “qualitative”.  The difference in the value of a claim could be quite substantial.

* Disclaimer: The information on the Anthony Gold website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. It is provided without any representations or warranties, express or implied.*

In the recent case of Swift & others v Fred Olsen Cruise Lines the cruise ship operator appealed the court’s decision which had found in favour of 16 claimants.

The claimants had contracted norovirus while on board four cruises from between March and May 2011 and brought claims for damages as a result.  They claimed that the cruise operator had failed to take reasonable steps to manage the risk of norovirus and that this failure caused or materially contributed to their illnesses. They relied on the allegation that the cruise operator had breached their duty of care to their passengers under the Athens Convention 1974.  The judge had found that the cruise operator was at fault because of material failures to implement its own norovirus outbreak and control plan.

The cruise operator appealed on grounds that: 1) the judge’s conclusion went against the weight of the evidence as a whole; 2) the judge had set the required standard of care too high; 3) the judge had failed to fully consider the biological nature and effects of norovirus; and 4) the judge had made a mistake when applying the “but for test” to establish that the negligence caused the illness. They argued that the judge had paid a disproportionate amount of attention to the claimants’ complaints as well as to meeting minutes which detailed crew members’ failures to comply with cleaning and sanitising measures.  It was argued that this focus meant that he had, in effect, ignored evidence relating to the 25 files of checklist records which the cruise operators had created. They argued that the checklist records demonstrated that a cleaning regime had been put in place, implementing the norovirus outbreak and control plan.

The cruise operator also argued that the judge should have applied the “but for test” by asking whether, but for the cruise operator’s negligence, the claimants have still suffered from norovirus. Instead he asked whether the failure to implement the outbreak and control plan had caused the claimants to suffer illness.

The Court of Appeal decided that the totality of the evidence showed that the cruise operator was guilty of multiple failures in implementing their norovirus outbreak and control plan.  The judge was entitled to come to this conclusion based on the complaints of the claimants as well as to focus on the meeting minutes detailing failure to comply with cleaning or sanitising measures. In conclusion, the judge had dealt with the case and the cruise operator’s witnesses in an unbiased way.

The appeal court held that there was nothing in the original judgment to indicate that the judge had set the standard above the duty accepted by the cruise operator, namely to take reasonable steps to implement a reasonable system for the management of the risk of norovirus on board the vessel. As the judge had fully considered the biological effects of norovirus and demonstrated a clear understanding of the nature of norovirus and its occurrence amongst the general population and the way in which it spreads, his decision could not be criticised.

Finally, the Court of Appeal held that the way in which the “but for test” was applied was justified as attention needed to be paid to the implementation of the plan.  The plan was necessary as it had been designed to provide reasonable measures to manage the risk of norovirus.  The judge had not found isolated instances of failure to comply with the plan, rather material instances were found where there had been a clear breakdown in the implementation of the plan.  This breakdown of implementation had effectively removed the safeguards the plan had intended to put in place. Therefore the judge had been able to find causation and that the burden of proof applied by him was correct in the circumstances and had been successfully discharged by the claimants.

The cruise operator’s appeal was therefore dismissed.

This case demonstrates that, whilst it is difficult to prevent the spread of a viral infection on cruise ships or in any other public place, having a sufficient norovirus outbreak and control plan is not enough.  There must be clear evidence to show that it is sufficiently implemented to avoid any liability for negligence or breach of duty.

* Disclaimer: The information on the Anthony Gold website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. It is provided without any representations or warranties, express or implied.*

I recently acted for Mr J who was injured when working as a porter in a hospital.  As Mr J was emptying the domestic waste hospital bins, he sustained chemical burns to both hands from liquids which had been incorrectly disposed of in the domestic waste bins rather than the clinical waste bins.

Both burns resulted in blistering and Mr J had to take a month off work to recover.  He found however that since the accident, his hands are extremely sensitive and he is unable to use standard soap or shampoo as this often causes a rash to both hands, resulting in further blisters.

Mr J previously instructed another firm of solicitors but his initial solicitor had retired and he was not happy with her replacement.  He approached me almost three years after the accident and I discovered that little had been done to progress his case.

All injury claims have to be issued within three years from the date of the accident or they are time barred and a claim is no longer able to be brought for the injury.  Given that we were nearly three years on, it was necessary to issue court proceedings immediately to protect Mr J’s claim.  I also immediately applied for Mr J’s up to date medical records with a view to having him seen by specialist medical experts who would provide an opinion and prognosis on Mr J’s injuries.  I could not see from the previous solicitors file that we had had a response from the NHS Trust admitting or denying responsibility for the injury so I chased them for this and they came back fairly swiftly admitted liability.

I organised for Mr J to be seen by a plastic surgery and hand expert, and by an expert dermatologist who diagnosed Mr J with contact dermatitis.  It was expected that his condition could be managed conservatively.  However, given Mr J’s job as a hospital porter, the experts felt that if Mr J lost his current job, he would be at a disadvantage on the labour market when trying to secure a similar role.

I disclosed both medical reports to the NHS Trust which then made an offer to settle Mr J’s claim for £20,000 which he was delighted to accept.

* Disclaimer: The information on the Anthony Gold website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. It is provided without any representations or warranties, express or implied.*

New analysis by Diabetes UK suggests that there are now 20 diabetes-related amputations in England every day. This is the equivalent of 7,370 per year and is based on information from Public Health England.

Many of these amputations, however, are avoidable if good care and support is provided.  The vast majority of amputations for diabetes-related complications may ultimately be avoidable, that could mean perhaps 5,000 or more amputations need not have happened, which is an astonishing statistic. Having diabetes does not lead inevitably to an amputation or serious complications. Good quality care, however, should be provided to all.

Foot care which is recognised as a high priority in diabetics is variable depending on geography. In addition, there has been a significant increase in people diagnosed with type 2 diabetes so that resources are stretched. Diabetics need foot care protection, advice, and reviews to ensure that problems are identified long before they become significant and ultimately catastrophic.

In addition, I have clients who received their diabetic foot care from private providers who  undertake some work for the NHS. They may not have speedy referral systems or may have additional budget constraints due to contract terms. There may not be the continuity of care which is preferable, particularly where there is a wound or ulcer.

An amputation, from whatever cause, is devastating and completely changes the way people live their lives. The impact on family, friends, and finances can be significant and is often under-estimated.

The majority of amputations may not result from accidents and negligence but it’s possible that, as resources are more stretched and less available, minor problems may not be detected appropriately and speedily.

Clinical negligence claims involving amputations can be lengthy. Even where a trust may have admitted fault, quantifying the case can take a considerable time. There are, for example, a large number of prosthetic limbs bow available albeit not always on the NHS. For those who are very active or who love water sports, there are specific limbs which can be built with appropriate cosmetic finishes.

Regardless of how well an amputee adapts to their home environment (and I have clients who without prosthetic can go upstairs quicker than most people) ultimately a home which is adapted to their needs should be provided if not at the time of settlement, then for later in life.

Most people require some care and assistance as they age. In some cases amputees can require this earlier or in a different form. They may need wheelchairs and adapted equipment if not at the time, then into the future.   All of these issues and many more need to be reviewed and subject to expert opinion.

Understandably many amputees have ongoing physical problems with their stump and pain control. They can continue to have symptoms of diabetic complications elsewhere. They can require psychological assistance, vascular and orthopaedic reviews. The consequences of an amputation on physical and mental health can be significant.

I recently settled a case of a man in his late fifties that underwent an amputation as a result of negligence.  There was an admission of fault at an early stage in the case but there were still 10 different experts required to prepare reports and comment on what help he would need now and in the future. The defendants had much the same so it was a lengthy process collating all the information.

It is important to remember that people can suffer an accident or a medical condition which develops complications and devastating as it is there may be no one at fault. But there are others who do not receive the care they need and as a result of that failing develop problems.  Compensation cannot make up for losing a limb but it can improve some aspects of life. For those people who have suffered poor care, there is the possibility of a claim and if successful funds which could improve the quality of life and perhaps provide security.

* Disclaimer: The information on the Anthony Gold website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. It is provided without any representations or warranties, express or implied.*