We have secured settlement for a client who pursued a clinical negligence claim against Southern Health NHS Foundation Trust. The claim related to a delay in diagnosis and treatment of his wet age-related macular degeneration (wet AMD).
Our client was an NHS patient. On 16 December 2016 he attended his opticians. At the time he was 78 years of age. He complained of some disturbance to his vision from his left eye; seeing vertical lines in his left vision.
On examination the corrected visual acuities were normal on the right but moderately reduced at 6/15 on the left. There was some evidence of abnormality in the left eye, with the presence of macular drusen, a protein that is indicative of developing macular degeneration.
Following examination the optician concluded that wet AMD may have been developing in our client’s left eye. The optician telephoned the defendant hospital to which he then faxed an ‘urgent’ referral letter requesting an urgent assessment for suspected wet AMD.
The referral form was received at the hspital the following day. However our client was not seen for an appointment with an ophthalmologist at the hospital for four months, by which point his eyesight from his left eye had deteriorated considerably. He had lost all of his central vision but retained some peripheral vision. He was able to see hand-movements but could not focus his sight from his left eye on any detail.
Following a variety of tests, the consultant diagnosed our client with wet AMD. He was advised that the hospital was not equipped to treat the condition and he was referred on to Southampton General Hospital for further assessment and, if appropriate, treatment.
One month later our client was seen by a consultant ophthalmologist at Southampton General Hospital. His eyesight was unchanged. He was advised that there was little prospect of improvement but a short course of treatment was attempted in any event. Our client attended for three treatment appointments following which his sight from his left eye was unchanged. No further treatment was recommended and our client was advised that his vision would be permanently impaired.
Our client was concerned about the long delay in receiving treatment for his deteriorating eyesight between December 2016 and April 2017 and approached us to investigate a potential claim. He had already complained to the NHS trust, which had investigated his treatment and indicated that mistakes had been made.
After obtaining and reviewing our client’s medical records, we sent instructions to an expert ophthalmic surgeon to provide his opinion on when our client should have been seen for management of his deteriorating eyesight and, if he had been seen at that time, whether his wet AMD would have been diagnosed. The expert confirmed that our client should have been seen within two weeks of the referral and that he would then have been diagnosed with wet AMD. Treatment would have been commenced immediately and our client would have retained his central vision and reasonable sight from his left eye.
A letter of claim was sent to the defendant trust setting out the formal allegations of negligence. We then took steps to investigate our client’s condition and his future prognosis. The expert’s opinion was that our client’s loss of central vision from his left eye was permanent. As a result, he had lost three dimensional and stereoscopic vision which caused him to experience difficulty navigating stairs and uneven ground, and performing tasks of daily living that required three dimensional vision, such as pouring drinks, typing and performing DIY, which was one of our client’s pastimes in his retirement.
The expert also identified a small risk to our client suffering loss of right sided vision in the future. Were that to materialise, the cumulative impact on his vision as a whole would be significant as he would, in effect, have very little functional vision at all.
After quantifying the claim, an early offer to settle was sent to the defendant trust. The offer was stated to include a claim for provisional damages - if accepted by the defendant, this would have enabled our client to return to seek additional damages if, in the future, he suffered deterioration in his right sided vision.
The defendant trust admitted breach of duty and that, but for this breach of duty, our client’s vision would have been better than it is now. The defendant offered to settle the claim but did not accept that an award for provisional damages was appropriate.
The defendant’s logic as to why provisional damages did not apply was flawed. In addition, the offer made by the defendant did not reasonably reflect the injury caused to our client. We took the view that disclosing our own evidence on a without prejudice basis would assist the defendant in understanding our valuation of the claim. In addition, we set out case law in support of our claim for an award for provisional damages.
After some negotiation, the defendant’s solicitor offered to settle our client’s claim for a larger compensation award, the sum of £35,000. The defendant did not agree to a provisional damages award, but ‘bought-off’ the risk of our client returning for further damages in the future by settling the claim for a higher amount. This was acceptable to our client and settlement was agreed.
This case demonstrates the importance of health services having in place appropriate safeguards to ensure that patients are seen and treated within the appropriate timescales when urgently referred. Wet AMD is a treatable condition and, had the negligence in our client’s care not occurred, he would not have suffered the permanent loss of sight from his left eye which will affect him for the rest of his life.
Wet AMD is a progressive, non-curative, condition. It occurs when abnormal blood vessels grow into the macula (the part of the retina at the back of the eye responsible for all of our central vision, most of our colour vision and the fine detail that we are able to see).
Whilst the condition cannot be cured (and any damage caused by the condition is irreversible), treatment is available by way of a medication being injected into the back of the patient’s eye. This slows the growth of abnormal blood vessels, reducing macula scarring. Appropriate management of the condition is often associated with good results, with vision stabilising with repeat treatment.
Best outcomes are associated with early intervention. Patients suspected of having developed wet AMD should be assessed by an ophthalmologist (specialising in macula disease) within two weeks and treatment should commence immediately upon diagnosis.