Recovery of damages from St Thomas’ Hospital for renal transplant patient left with neurological disability due to delayed diagnosis

The claimant in this case was a renal transplant patient requiring immunosuppression with drugs including tacrolimus. She brought a claim against St Thomas’ Hospital for alleged failings in her medical care in terms of a delayed diagnosis and treatment of posterior reversible encephalopathy syndrome (PRES).

A few days after hospital admission with signs of neurological dysfunction, she suffered a large left fronto-parietal intracranial haemorrhage resulting in severe neurological disability, including a right hemiplegia. As a result, she is significantly dependent on others, lacks capacity and is a protected party.

PRES is a rare condition but one that should be taken into account in renal transplant patients who are immunosuppressed – as the claimant was. After investigations involving a range of experts, we presented a claim that PRES should have been considered in the differential diagnosis and that urgent MRI imaging should have been performed – and that with appropriate care the permanent neurological damage sustained by the claimant would have been avoided

The parties proceeded through the pre-action protocol for clinical disputes and the defendant denied liability in the letter of response. We issued and served proceedings and a defence was served, which made limited admissions of breach of duty but denied liability for and causation of the claimant’s neurological injury. We obtained expert evidence in the fields of nephrology, neurology, haematology and neuroradiology in respect of breach of duty and causation. Additionally we sought evidence on condition, prognosis and quantum in the fields of nephrology, neurology, neuropsychiatry, neuropsychology, speech and language therapy, physiotherapy, care and occupational therapy, professional deputyship costs and accommodation. The claim proceeded all the way through a court timetable, ultimately settling in principle at a round table meeting six weeks before a ten-day trial was scheduled to begin. Given the claimant is a protected party, the matter was heard at an approval hearing at the High Court.

Senior associate Lucie Prothero, who led the team advising on this case, comments: “This was a very sad story where despite the claimant’s history and her sister taking her to hospital and raising concern, no single department took responsibility for her care and no one properly considered the possibility of PRES or investigated the claimant urgently. She has been left significantly disabled and dependent on others and has a poor quality of life. This all should have been avoided with appropriate care. The significant delays by the defendant in dealing with this case at every step have been frustrating – while ultimately we were able to achieve a good result, we had to take the case almost to trial before the other side engaged properly to resolve the claim.”