A 43 year old woman suffered a catastrophic brain injury after an NHS trust failed to administer life-saving treatment while she was admitted under their care.
The deceased had suffered a leg injury and presented to A&E with a suspected ruptured Achilles tendon. She was discharged with an ankle sprain but subsequently returned two days later when the Achilles tendon rupture was correctly diagnosed. She was placed in a cast but was not prescribed any anti-coagulant medication despite her reduced mobility.
A number of days later, the deceased lost consciousness at home, and subsequently returned to the A&E department. Imaging confirmed that she was suffering from saddle pulmonary emboli (blood clots) in almost all of the main branches of the pulmonary arteries. Further imaging noted that her heart was under considerable strain as a result of the emboli.
The deceased was monitored between 23 May 2017 and 25 May 2017, during which period she demonstrated several episodes of haemodynamic instability. On 24 May the deceased suffered another collapse, yet thrombolysis was not administered in accordance with the plan to administer the life-saving medication if she suffered another collapse.
On 25 May, the deceased became unresponsive, followed by a second episode of instability leading to a cardiac arrest. CPR was commenced and thrombolysis was administered. The deceased was resuscitated, intubated and taken to intensive care. However, imaging revealed that as a result of the cardiac arrest, she had suffered a hypoxic ischaemic insult, brain herniation and diffuse encephalopathy.
The deceased was left severely disabled, requiring 24-hour nursing care, and died a year later.
Penningtons Manches Cooper were instructed to act on behalf of the deceased’s family. Despite initial issues obtaining full medical records from the defendant trust, early expert evidence highlighted numerous failings in the deceased’s care. In particular, it was the estate’s case that the deceased should have received thrombolysis upon her admission on 22 May and at multiple times prior to her cardiac arrest on 25 May. Had this life-saving medication been administered on any one of those occasions, her cardiac arrest and subsequent hypoxic brain injury would have been avoided.
The defendant denied liability following service of a pre-action protocol letter of claim, however the parties entered into fruitful early settlement negotiations without the need to commence court proceedings.
An internal investigation into the failings was conducted and ultimately led to the trust updating and amending their guidelines concerning anti-coagulation for patients requiring lower limb casts.