Hospital trusts agree compensation after failing to manage patient with sufficient urgency

London and South East law firm Penningtons Solicitors LLP has negotiated damages on behalf of a young man in his 30s, Anthony Venner, who despite being admitted to Eastbourne District General Hospital with classic symptoms of cauda equina syndrome, became a victim of bed shortages and lack of appropriate assessment, management and communication. There was a delay of 24 hours in performing surgery on him which, in the view of independent medical experts, should have been regarded as an emergency. As a result, Mr Venner has been left with a considable degree of disability and has had to give up his career.

Cauda equina syndrome (CES) is an unusual but very serious condition arising from compression of the nerves at the base of the spinal cord, usually by a disc. If urgent surgery is not performed to relieve the compression, these sensitive nerves suffer progressive permanent damage.

Mr Venner went to Eastbourne District General Hospital on 4 February 2005 with initial symptoms of CES but predominantly acute back pain. He was reassured and discharged. At this stage it is likely that he was in the very early stages of developing CES but it was not alleged that the A&E management was inappropriate at this time. Over the next 48 hours his symptoms progressed. He visited an out of hours GP who suspected CES and referred him urgently back to the orthopaedic team at Eastbourne Hospital. He was admitted and the initial assessment confirmed the likelihood of CES. MRI scanning is needed for diagnosis but, as Mr Venner was admitted late at night, MRI facilities were not available until the next day. The orthopaedic team were aware that if the MRI confirmed the diagnosis then Mr Venner would need transferring to a neurosurgical team for surgery. They contacted their local neurosurgical unit, Hurstwood Park, which indicated that they could not take him straight away as they did not have any beds available. It was agreed that an MRI would be performed at Eastbourne and they would then discuss things further.

The MRI was not in fact performed until around 1130 am the next day. This confirmed the suspected diagnosis. Mr Venner was informed that he would need emergency surgery to relieve the compression on his nerves and would be transferred to Hurstwood Park for surgery that day. In the event, the transfer did not take place until 830 pm and he did not arrive at Hurstwood Park until after 10 pm. A decision was made then to wait until the next day to operate and Mr Venner did not undergo surgery until 1230 pm the following day, nearly 48 hours after his admission with the suspected diagnosis. By this stage, his symptoms had progressed to include urinary symptoms.

Post surgery Mr Venner has been left with a considerable degree of disability. He remains with significant, disabling back pain and difficulties with one leg. He suffers from affected urinary and bowel function and ongoing issues with sensation in his lower body and limbs. He was unable to return to his job as a prison officer, a career which he was keen on progressing, and his working capacity is now limited. As a result of having to leave his job, he had to sell his home and he is now unable to find work and limited in his day to day activities. Unsurprisingly, he has suffered from depression.

Philippa Luscombe, a partner in Penningtons' personal injury and clinical negligence team, was instructed by Mr Venner and shared his concern that his condition, which is known to be one requiring urgent treatment, did not appear to have been treated with any degree of urgency. Philippa Luscombe sought expert evidence from two leading clinicians and experts – a neurosurgeon and a spinal surgeon. Both were critical of the care received.

Both experts were firmly of the view that Mr Venner presented a surgical emergency at the time of his admission and that he should have had surgery by early in the afternoon of 7 February. The delay of approximately 24 hours was unacceptable given his condition. Had surgery taken place when it should have done, Mr Venner's outcome would have been materially better, with him avoiding the urinary and bowel symptoms that he now has and some of the sensory abnormalities now present. It was accepted that his back pain was not affected by the delay.

Liability was initially denied by both hospitals when the claim was presented to them. Mr Venner therefore issued proceedings in the High Court. A defence was served, continuing to deny liability. However the parties entered into discussions subsequently and a settlement was agreed of £72,500.

Mr Venner's case was funded by the Legal Services Commission which, despite the known difficulties in these cases, accepted the views of Mr Venner's solicitor and experts and provided funding to settlement, thereby enabling Mr Venner to pursue his claim.

Philippa Luscombe commented: "This case highlights the importance of cauda equina syndrome being diagnosed and treated as a matter of urgency. The key problems that ultimately resulted in the delay appeared to have been the lack of beds at Hurstwood Park, lack of emergency MRI facilities at Eastbourne Hospital and a failure on the part of both hospitals to appreciate that Mr Venner was a surgical emergency. It has been a long journey to get to the stage where the hospitals agreed to compensate Mr Venner for the problems caused by the delay." Philippa specialises in spinal injury cases and has dealt with a number of CES claims where the patient's health was significantly compromised by a delay in diagnosis and treatment.