We have recently settled a claim for a GP client who suffered loss of vision and visual disturbance because of negligent anaesthetic management during spinal surgery.
Our client had long-standing problems with compression of nerves in his lumbar spine because of degenerative disease. This was causing him pain in his legs. His medical history also included raised blood pressure and high cholesterol. His spinal surgeon advised that he needed surgery to decompress the affected nerve roots and alleviate his pain.
The surgery took place in June 2014. It lasted six hours. The decompression was successful, but when our client came round following the operation his eyelids were grossly swollen and he could not open his eyes. He was immediately aware that he had lost sight in both eyes. No obvious abnormality could be seen within either eye, but it was not until the following day that a consultant ophthalmologist was called. She found our client was by then able to discern hand movements using his right eye and on the left could just about count fingers. She diagnosed probable ischaemic optic neuropathy. This occurs when the blood supply to the optic nerve has been impaired, damaging the nerve fibres carrying information from the eyes to the brain that normally enable sight.
Over the following few weeks, our client experienced limited return of sight in his left eye. His field of vision was constricted, so he could see only in part of his left eye which was distorted. No useful vision has ever returned in his right eye.
He now suffers disturbing visual hallucinations, diagnosed as Charles-Bonnet Syndrome. This is a relatively common condition among people who have lost sight as the brain tries to make up for the missing information that the optic nerve is no longer able to provide. Our client describes, for example, that if he is travelling in a car, hedges can suddenly appear to move into the road and block the path of the car, so that he senses impending collision. He also sees black dots across his field of vision and has problems with depth perception, particularly when trying to walk across uneven ground or up and down steps. The damage affects his ability to distinguish contrast, particularly in brightly lit situations.
Prior to the surgery, our client was a qualified GP who worked as an advisor to an investor in primary care services. He tried to resume working, but his visual loss and disturbance made it very difficult for him to use computer screens. He works far more slowly than before and felt he could not adequately fulfil the demands of his role. As a result, he reduced his work and ultimately, retired earlier than he intended. He now needs considerable help from his wife to cope with day-to-day life. He cannot see properly to manage many aspects of daily living, including jobs around the house and gardening.
He complained to the Wellington Hospital where the procedure took place, but was dissatisfied with the lack of information they were prepared to give him following their investigation and felt they were dismissive of his concerns.
He therefore approached and instructed us. We first obtained his medical notes and records and reviewed them. We then asked an expert consultant ophthalmologist to report on the cause of our client’s visual problems. That expert confirmed our client suffered bilateral ischaemic optic neuropathy, which had its onset at the time of the spinal surgery and was likely to have been caused during the operation. The expert explained that the reason for the damage appeared to be inadequate perfusion during the surgery; in lay terms that our client’s blood pressure had fallen too low for the tissues around the optic nerve to be adequately supplied with the vital fluid and nutrients needed. The left side did recover somewhat post-operatively, sufficient to restore limited vision, but the right was irreparably damaged. There was no prospect of our client’s condition improving.
The expert suggested the cause of the reduced blood pressure was likely to be related to the administration of anaesthetic during the operation. We instructed an expert anaesthetist to review the notes and records and advise on the standard of care the consultant anaesthetist provided. The anaesthetic expert confirmed that this care fell short of the standard required. He explained that the anaesthetic charts made during the operation clearly showed that our client’s blood pressure – measured by ‘mean arterial pressure’, or MAP – had been allowed to fall below 75% of its usual level for almost five hours of the operation and fell below 60% for well over two hours. He considered this to be negligent.
We wrote to the anaesthetist who had treated our client to set out the background to the case and the reasons why it was alleged that his care had been negligent. The allegations included the anaesthetist’s failure to assess our client properly before the operation and to advise him of the risks he faced. During the surgery he allowed our client’s MAP to fall too low over a prolonged period. In particular, we alleged that if our client’s MAP had been properly managed, he would have avoided the bilateral ischaemic optic neuropathy and visual damage he suffered.
The anaesthetist was represented by his defence organisation, which instructed solicitors to respond to the allegations we made. They denied that there had been any failure to advise our client properly before the operation. While it was admitted that our client’s blood pressure had been reduced, it was denied this fell to the level we alleged. Instead, it was argued our client’s blood pressure fell to a third below its normal level for around two and a half hours. It was accepted this still amounted to a breach of duty, but denied this caused the visual loss our client suffered. Rather, it was said that our client was always susceptible to this type of injury which was unavoidable, even if his blood pressure had been maintained as we alleged.
Notwithstanding the denial of liability, the solicitors instructed for the anaesthetist and his defence organisation made an offer to settle our client’s claim, for £50,000 plus his legal costs. We considered this to be a considerable under-valuation of the claim, given the damage our client had suffered and our experts’ robust support for the claim in the face of the denial we had received.
We therefore investigated and quantified our client’s claim and, after a short period of negotiation, achieved a settlement of £180,000 plus our client’s reasonable legal costs.