Settlement for a patient who suffered a back injury as a result of a fall

Case Studies

Settlement for a patient who suffered a back injury as a result of a fall


We have secured a settlement for a client who pursued a clinical negligence claim against Spire Harpenden Hospital. The claim arose following the hospital’s failure to assess her as a falls risk following knee replacement surgery, resulting in our client falling and fracturing her lower spine.

In 2015 our client attended Spire Harpenden Hospital (as an NHS patient) for a total knee replacement. On admission to the hospital, a falls risk score was not recorded. Following the operation, no falls risk assessment was performed and our client was not assessed as being at risk of falls.

The knee surgery was uncomplicated, and she expected to achieve a good recovery. She attended post-operative physiotherapy and was making reasonable progress.

During the night, two days after the operation, our client needed to go to the bathroom. She called the nurse for assistance as she did not feel physically well enough to go to the bathroom on her own.

A nurse arrived and helped our client out of bed. She was not given slippers or anti-slip socks, but instead was wearing anti-embolic stockings which were slippery. She was given a Zimmer frame and helped to the bathroom so that she could go to the toilet. The nurse left our client at that point, advising that she would return to help her back to bed after she had assisted another patient.

After a few minutes, our client called for assistance by ringing the bell for attention. She rang the call bell several times, but the nurse did not respond. It was late at night and, after approximately 15 minutes, our client decided to go back to bed on her own. She held on to the Zimmer frame to stand but as she stood, she slipped and fell backwards, hitting her back against the toilet bowl. She landed on the floor with the Zimmer frame on top of her.

The nurse eventually returned and found our client lying on the bathroom floor. She contacted the hospital’s resident medical officer (RMO) who helped our client stand and assisted her back to her bed. Our client complained that she had hurt her lower back, but no assessment or physical examination was performed at that time.

The following day our client attended her knee physiotherapy. It was noted that she was experiencing significant back pain. She was not able to move from the bed to the chair in her room due to the extent of her pain, and although she was seen by her surgeon, he did not feel that her back injury warranted an x-ray at that time.

The following day, our client again complained of significant back pain. Her daughter, who was visiting, insisted that imaging of our client’s back be performed. That imaging demonstrated a burst fracture of her lower spine.

Our client was discharged from the hospital, but she continued to experience lower back pain. Initially she was instructed not to move from her bed. Then, she had to wear a back brace, but any form of mobilising aggravated her back pain. Consequently, she was delayed in rehabilitating her knee and experienced a poor outcome from her knee replacement surgery, with symptoms of pain and restricted movements.

Since then, she has continued to experience back pain, which inhibits her tolerance for walking and standing, and has profoundly impacted the activities and chores she is able to perform on a day to day basis. Her painful knee also affects her daily activities, particularly with activities requiring bending and stair climbing.

Penningtons Manches Cooper were approached to consider the case as our client was concerned that, because of her age, weight, and the fact that she was undergoing knee replacement surgery, she should have been assessed as a falls risk, and had that been identified, she would not have fallen and injured her back.

Based on our experience of these types of cases, we accepted instructions. We obtained and reviewed our client’s medical records and subsequently sent instructions to a nursing expert to report her opinion on whether there was negligence in our client’s care.

The expert was of the opinion that, had an assessment been correctly performed pre- and post-operatively, our client would have been identified as a falls risk. It was the expert’s opinion that our client should have been provided with non-slip footwear, and the nurse’s decision to leave her in the bathroom without assistance amounted to a breach of duty. It was the expert’s opinion that had our client been assessed as a falls risk, she would probably not have experienced the fall against the toilet.

Following receipt of this expert’s evidence, a spinal surgeon was instructed to report on what our client’s outcome would have been had she not suffered the fall. The expert believed that had our client not fallen against the toilet, she would not have fractured her spine and she would have avoided all of the problems that have been caused by her back pain. The expert also commented that our client’s poor outcome from her knee surgery was not affected by her back injury, and would probably have always occurred.

Allegations of negligence were sent to the defendant on the basis of the expert evidence that had been obtained. The defendant hospital made admissions in the formal response and accepted that our client should have been assessed as a falls risk and, had it not been for the failures in her care, she would not have fallen against the toilet, injuring her spine.

Following receipt of the response, we set about valuing the claim. Further expert evidence was obtained from the spinal surgeon, to acquire his opinion on whether our client’s long-term outcome (regarding her spine) had been affected because of the negligence. Evidence was also obtained from an expert knee surgeon in order to understand the impact of the non-negligently caused knee symptoms on our client’s overall poor outcome. The experts were of the opinion that our client’s back injury was probably permanent, and she would experience limitations with activities such as standing and walking for the rest of her life. It was also the experts’ opinion that our client’s (non-negligently caused) knee symptoms were probably also permanent, and would affect her ability to bend, kneel, and climb stairs. 

After completing our further investigations, we entered into negotiations to explore settlement of this claim on our client’s behalf. After some rather drawn-out negotiations via correspondence, we agreed with the defendant to attend a mediation meeting, during which settlement of the claim was agreed for the amount of £160,000.

Arran Macleod of Penningtons Manches Cooper comments: “Our client’s back injury, which will permanently cause her pain and functional limitations, was entirely avoidable and would not have happened had quite straightforward steps been taken when our client first attended hospital. This is very sad for our client as the negligence has materially worsened the quality of her life. 

“Overall, however, we are pleased to have achieved this result for our client as the compensation funds will enable her to manage her loss of mobility and independence in the future, including by making some necessary adaptations to her home and employing a cleaner to assist with the domestic housework, which she is no longer able to perform herself because of her injuries.”


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