We have recently settled for £350,000 a long-running claim on behalf of a client whose developmental dysplasia of the hip (DDH) was missed by a health visitor during routine baby checks, with profound consequences that will affect our client for the rest of her life.
Health visitors perform checks on all new babies to check their development at key early stages. One of those checks is to assess the function of the hips. When our client was checked at eight months old, her mother expressed concern that she was not crawling normally, was slow to start mobilising and tucking up her left leg. The health visitor reassured our client's mother, but did not examine our client or remove any of her clothes and simply noted that our client was reluctant to bear weight.
A further check was arranged for six weeks later, when our client's mother again expressed her concerns and was told there was nothing to worry about. At the next check, our client was using furniture to walk around, but only on tiptoe and dragging her left foot. The health visitor suggested this was simply our client's way of walking and recommended a further check six months later.
It was then that our client was seen by a different health visitor, who identified her as having clear mobility problems. The left leg was shorter than the right, with some muscle wasting. Our client was referred to a GP and sent for an X-ray that revealed dislocation of her left hip leading to the diagnosis of developmental dysplasia of the hip (DDH). This is a known developmental complication that is one of the key tests health visitors should be competent to carry out as part of routine baby checks.
Over the years that followed our client underwent numerous operations and surgical procedures to try to improve her hip, but suffered recurrent dislocations and long-term disability.
We were instructed to investigate and pursue a claim on her behalf. With expert evidence in support, we alleged that the health visitor had been negligent in failing to examine our client and to suspect or refer her with developmental problems affecting her hip. As a result, the diagnosis of DDH was delayed, so that the opportunity to undertake the single, relatively straightforward operation that would have given her a normal hip and full function was lost. Instead, she had already had numerous operations and faced a highly uncertain future.
In reply to these allegations, the trust for which the health visitor worked admitted that there had been some delay in referral, but denied that this made any difference to the surgery our client had needed or the outcome for her. Attempts were made to negotiate, but unsuccessfully and as a result, it was necessary to issue court proceedings.
Our client was still relatively young at that time and her clinical treatment was ongoing. Her long-term outcome and her prognosis for later life could not be assessed until her treatment was concluded and she attained skeletal maturity. The court proceedings therefore provided for a 'split trial', where issues over the standard of care our client had received and a decision on whether or not this was negligent were investigated and addressed while our client's ongoing treatment continued.
Shortly before the court was due to hear evidence on the standard of care, the defendant agreed that it would pay 90% of our client’s claim. This was based on agreement that with acceptable care she would have had a closed reduction at an earlier point in time and had suffered damage as a result of the health visitor's delay.
The value of the claim at that stage remained to be assessed because our client's treatment was ongoing. She needed further surgery at around ten years of age to try to improve significant symptoms of pain she was suffering in her left hip and leg. She later needed another operation to remove the metalwork from her leg. It was not possible to assess her long-term prognosis in the meantime.
After these procedures, she was reassessed by the medical experts and was advised that she might benefit from more surgery. The experts agreed that it was inevitable she would need an early total hip replacement in her 30s. The expert we instructed considered that this hip replacement could be put back by up to 20 years if our client were to undergo a pelvic osteotomy within the next few years. It was necessary to involve an adult orthopaedic expert at this stage, as our client continued to develop and to assess her prognosis in later life. The defendant's expert denied there was any benefit to further pelvic surgery. Nevertheless, steps were taken to investigate the option of pelvic osteotomy, which were delayed, initially to avoid affecting her education. With determined physiotherapy, she was able to improve her condition and manage her pain and so decided to put back surgery until after completing her education, if her symptoms allowed this.
The numerous operations left her with extensive scarring and at risk of early osteoarthritis. She expects to undergo pelvic osteotomy after completing a degree course and before she starts working. She will be limited in the work she can do by the symptoms she experiences and even with pelvic osteotomy, is likely to need a total hip replacement in her 40s and a number of later revisions. She will require considerable additional care and assistance as she ages, for example, when she has young children of her own, as well as needing to adapt her home to cope with some of the physical limitations she will now encounter.