Howard Elgot acts for successful claimant in complex above-knee amputation claim.

Howard Elgot was instructed by clinical negligence specialists, Hudgells Solicitors.

A hospital trust has agreed a £1.2m compensation settlement for a man who had to have his right leg amputated after developing blood clots following surgery. The £1.2 million settlement reflected a 60:40 litigation risk in respect of a claim worth about £2 million on full liability.

Hull University Teaching Hospitals NHS Trust admitted delays in referring the patient to its vascular surgery unit and agreed the damages settlement out of court, but medical causation was heavily contested. The causation issues were of very great complexity, but in simple terms the claimant’s case was that the lower limb ischaemia was caused by thrombus from the surface of a ruptured common iliac plaque and therefore remediable with early intervention; whereas the Trust’s case was that the ischaemia was caused by a shower of embolic material that was principally fatty material from the core of the ruptured plaque, and was therefore not remediable.

The patient, who was 59 at the time and in full-time employment, had been admitted to Castle Hill Hospital in Cottingham on October 17, 2016, where he had scheduled surgery to remove a tumour from his bowel.

The operation was a success, but the following day he began to suffer from numbness and pain in his right leg, and a coldness in his foot.

These were warning signs which lawyers alleged should have resulted in him being reviewed by a specialist immediately.

Instead, a diagnosis of potential deep vein thrombosis (DVT) was made and the matter was handled ‘with a completely inappropriate lack of urgency,” said medical negligence solicitor Michelle Tebbutt.

Patient experienced ‘very best and worst standards of care’

No action was taken for three days, when the patient was transferred to Hull Royal Infirmary as an emergency for a duplex ultrasound scan, which examines the blood flow in the major arteries and veins in the arms and legs.

A diagnosis of ischaemic foot (lack of blood flow to the foot) was made and despite surgery the situation worsened over a matter of days, to the point where a decision was taken to carry out a below knee amputation.

Due to further complications, including developing sepsis, a further operation was required to amputate above the knee.

“Our client benefitted from the very best, and the worst standards of care within a matter of 24 hours,” said Ms Tebbutt.

“The operation to remove the cancerous tumour was completed with success and he has lived free of his cancer returning since. However, by the time he left hospital, more than a month after that initial operation, he’d been through horrendous complications and undergone two amputations on his right leg, firstly below the knee, and then high up almost at the groin.

“It was our case, and an opinion supported by independent medical experts, that with the symptoms being displayed the day after our client’s operation, the possibility of a problem with blood flow and supply to the leg should have been considered immediately, and that had action been taken quickly enough, his leg could have been saved.”

Trust admitted breach of duty of care

Hull University Teaching Hospitals NHS Trust admitted that a senior registrar should have been contacted on October 18 and that an assessment should have been carried out immediately and not delayed.

It also admitted that, had a referral been made at that point, surgery would have been carried out in the early morning of October 19, two days earlier than it eventually was.

Although the Trust admitted the delays had surmounted to a breach of duty, they denied it had made a difference to the eventual outcome, saying it was their opinion that the delay had not ‘materially contributed to the need for amputations’.

The matter was set to be heard in court at trial in front of a judge, with the issue as to whether the delay had led to the need to amputate to be considered. However, a few weeks before trial, settlement of £1.2m was agreed at a meeting between legal teams.

“I’m glad the matter was sorted and I’m delighted with the settlement figure because it will enable us to sell our current home which is not suitable anymore, to buy a bungalow and not worry about bills in the future given I can no longer work and my wife has had to retire herself,” said the man, now 65.

“It has been bittersweet in many ways as I know I owe the doctors for what they did in saving my life with the treatment of my cancer, but nurses said to me that I would be back at work within three months.

“When I left hospital after a month I’d almost halved in weight and the amputation had denied me the opportunity of getting back on with my life, getting back to work and enjoying times with my family.

“We’ve children and grandchildren and it has impacted on what I can do with them, whilst me and my wife used to love walking and caravanning. We can’t do that now, and I really miss my work too. I know they denied being responsible for the amputation, but I think settling out of court says a lot.

“We are really grateful to Michelle Tebbutt at Hudgells. She kept us positive when I was finding things hard and when we were worried about the future. Every time we spoke to her she reassured us that we would make things better for the future.”

The man says he is still learning to live life as an amputee, but says he is positive about the future.

“Your life changes forever when you lose a leg. At the time of the amputation I was in pain and confused and I didn’t really take it in. I didn’t realise just how life would change.

“I still struggle now with my prosthetic, as it has been really difficult as my amputation ended so high because of the infections and difficulties.

“I have to go up and downstairs on my bottom, and I can’t do so much that I used to, but I have been going to the gym and playing wheelchair sports, so I am keeping myself active, and my wife is here to support me through it all.

“The legal case has given us peace of mind and security for the future, and for that we are grateful.”

Further reading is available on the BBC News Website.