We have settled a claim for a client who suffered a neurological injury as a result of withdrawal of her usual morphine dose.
She had suffered from lupus for many years. To control the pain caused by her condition, she needed to take high doses of oral morphine. In 2012, she was admitted to hospital suffering from excruciating left hip pain. Morphine was prescribed to match her usual oral morphine dose and her extra pain relief was managed using a patient-controlled analgesia (PCA) pump.
Over several days, our client’s pain worsened to the point that she could not eat. When her family asked nursing staff for help, they were made to feel that they were a nuisance and were being too demanding. Staff made it clear that they considered the amount of morphine our client took for her underlying condition was too high.
Four days after admission, a pain management nurse finally saw our client and noticed that the PCA pump had not been programmed correctly and therefore she had not been receiving sufficient oral morphine. The nurse recorded that our client was suffering from withdrawal and an appropriate pain relief regime was written up, although treating staff continued to express their disapproval about her usual morphine dose.
The family became increasingly concerned that she was suffering from withdrawal. Nine days after admission, disaster struck when our client suffered a series of seizures over two days. At one point, her husband was told to prepare for the worst.
Thankfully, our client survived but her family realised that she had suffered a neurological injury. Whilst still in hospital, she was not able to make sense of what she was seeing around her. Although an EEG was recorded as ‘very abnormal’, our client was discharged without seeing a neurologist and neurology follow-up thereafter was patchy.
Our specialist team investigated the prescription charts. On various occasions, the morphine dose had been allowed to fluctuate or fall. A seventh of the usual dose had been given on one occasion.
According to the medical records, the treating doctors acknowledged that it was likely the seizures were related to morphine withdrawal. We instructed a pain management expert who confirmed that this was an entirely reasonable conclusion.
Morphine is a controlled drug. Its use and management in a hospital setting is controlled by Government regulations; each ward must keep a separate record of morphine prescriptions. These records were missing in this case so we were unable to compare them with our client’s in-patient prescription records. A freedom of information request revealed that, in 2012, the trust had suffered 59 incidents where controlled drug regulations had been breached.
Following submission of the letter of claim, the trust served a preliminary letter of response. It was unable to address our allegations of breach of duty as the controlled drug records (and the PAC pump records) were missing. Nevertheless, breach of duty and causation were both denied. The trust told us that a supplementary letter of response would be provided once the records were found. This never materialised.
We obtained a report from a neurology expert dealing with causation and condition and prognosis. Witness statements were taken from our client and her family, which documented the neurological problems she now faced on a daily basis.
Our neurology expert was supportive of the seizures being the result of acute withdrawal of long-standing dosing with morphine. He was also supportive of the fact that our client’s cognitive impairment was likely to be the result of the continuing effect of the seizures.
We entered into negotiations with the trust’s solicitors and, initially, the trust made a couple of very low offers. We disclosed our client’s neuropsychology report, which described her day-to-day problems and concluded that her cognitive issues were likely to be related to the withdrawal of morphine in 2012. We disclosed our expert causation and condition and prognosis evidence as well as the witness evidence.
The trust made a more suitable offer of £100,000, without prejudice to the defence in the letter of response and our client accepted the offer. The claim was concluded without the need to issue proceedings.