Settlement of claim for failure to properly assess head injury leading to fatal haemorrhage

Acting upon personal recommendation from a family friend who is a leading clinical negligence barrister, our client instructed us to investigate a claim relating to the death of her husband after he suffered a head injury at home.

Her husband had a medical history that included a previous stroke, ischaemic heart disease and arial fibrillation. To manage these conditions, he was on long-term warfarin so as to avoid blood clots, but this put him at increased risk of internal bleeding. He fell backwards in his garden, striking his head on concrete. His wife was concerned about the head injury and alert to the risks of warfarin (and potentially a bleed on the brain) and so took him to hospital. She provided details of his injury and medication but due to COVID-19 regulations was unable to stay with her husband whilst he was assessed.

Despite the A&E team being aware of his head injury and the fact he was on warfarin, he was discharged without investigation as he was not presenting with any symptoms of concern. Two days later, he collapsed at home and was taken by ambulance back to the hospital where head CT imaging confirmed a significant brain haemorrhage. Despite seeking neurosurgical advice and medical staff being told to reverse his warfarin, this was not done. Some 36 hours after his collapse, our client’s husband suffered further significant deterioration and he passed away the next day.

We investigated the claim with expert A&E, neurosurgery and haematology input and also represented our client during the coroner’s inquest. After completing the investigations, we alleged that:

• hospital staff failed to note the information provided by our client when she took her husband into the emergency department and specifically the report of a blow to the head in a patient on warfarin;
• the triage nurse failed to document the mechanism of the fall, the nature of the injuries sustained in the fall; and any symptoms;
• the A&E doctor made a diagnosis of a mild traumatic brain injury but failed to document the mechanism of the injury to the head or ask appropriate questions about this;
• the doctor failed to follow NICE guidelines on head injury assessment and early management for patients on anti-coagulants by performing a CT scan within eight hours.

During his second visit to hospital, we alleged that:

• the emergency department, knowing that our client’s husband was on warfarin and had a suspected intracranial bleed, should have taken an INR test as a matter of urgency;
• the emergency department team failed to follow the NICE guidelines and should have started warfarin reversal as soon as the head injury was suspected by using PCC and at the very least immediately after the neurosurgical advice to do so;
• the delays in starting warfarin reversal and then effecting this by using vitamin K instead of PCC were inappropriate given the time lapse in treatment and his condition.

We maintained that with appropriate care on either occasion the bleed would have been controlled and our client’s husband would have survived.

The defendant trust investigated the claim and although there were delays in their response, they did ultimately admit that the care provided on both occasions was substandard and that with appropriate treatment he would have survived. We commenced negotiations and recovered a six figure sum for our client.

Partner Philippa Luscombe, who handled the claim, commented: “This was an extremely sad case. The patient’s age, his warfarin prescription and the fact that he had suffered a head injury put him at high risk of an intracranial bleed. Under NICE guidance, he should have had a CT scan when he attended A&E, and had he been properly managed, he would not have died. The combination of the inquest and the claim secured answers and an acknowledgement of failings which was our client’s main aim. We hope that lessons have been learned as a result.”