Claim settled against Surrey hospital for woman’s death following delayed diagnosis of a subdural haematoma

Posted: 05/05/2017

Penningtons Manches has settled a claim against Surrey and Sussex Healthcare NHS Trust for delayed diagnosis of a subdural haematoma which led to a woman’s death.

The patient, who was in her forties, was admitted to A&E at East Surrey Hospital in 2013 with a headache, blurred vision, two episodes of vomiting, difficulty opening her eyes and a swollen and droopy left eye.

A CT scan took place and was reported to be normal. She was admitted to a medical ward for observation and to await an MRI scan. The severe headache persisted and her left eye remained droopy (ptosis).

Six days passed by while an MRI scan was awaited. There was no review by the hospital’s on-call neurologist. The next day, the woman collapsed and was found on the floor unconscious. On waking, she complained of a severe headache. Her left pupil was fixed and dilated, with the ptosis still apparent. She vomited. Still, an MRI scan was awaited and no neurological review took place.

On the eighth day, she complained of seeing partly in black. She was nauseous and had a headache that was not helped by painkillers. She vomited twice that morning and suffered a further seizure. A CT scan of her head took place but was reported as being normal. Later that day, she suffered another seizure, with a dramatic reduction in her GCS (Glasgow Coma Scale) score, indicating neurological deficit. A repeat CT scan revealed an acute subdural haematoma and the neurosurgical team at St George’s Hospital was contacted for advice. It was agreed that she should be transferred there urgently for further management once she had been intubated and ventilated.

On arrival at St George’s Hospital, her pupils were found to be bilaterally fixed and dilated, and her heart rate and blood pressure were unstable. It was deemed to be too late for neurosurgery to make any difference to her outcome; she had suffered irreversible brain injury. Brain stem tests were performed and her death was confirmed.

Penningtons Manches’ clinical negligence team investigated a claim on behalf of her partner under the Fatal Accidents Act 1976 and the Law Reform (Miscellaneous Provisions) Act 1934 for his loss of practical dependency on her, bereavement damages, and the expenses of her funeral.

Expert evidence was obtained from a consultant radiologist and a consultant physician that her radiological and clinical management fell below an appropriate standard. It was negligent to fail to consider a vascular, aneurysmal cause for her symptoms or to refer her for neurological opinion. It was crucially important to pursue an active diagnostic pathway rather than just awaiting a scan. The reason for this is that expanding aneurysms causing symptoms and neurological loss are at profound danger of rupture and bleeding, with possible catastrophic effects. There were also failures in the radiological reporting, which should have identified an intracranial haemorrhage and prompted neurosurgical review.

Expert neurosurgical evidence confirmed that these errors led to a failure to carry out urgent surgery to prevent further bleeding in the brain, resulting in the patient’s significant neurological deterioration and death. In the absence of these failures, she would have survived.

A letter of claim was submitted to the trust. Liability was admitted and the claim was subsequently settled after negotiations with the solicitors acting for the NHS Litigation Authority (now known as NHS Resolution) prior to the commencement of formal court proceedings.

Lucie Prothero, a solicitor in Penningtons Manches’ clinical negligence team who conducted this claim and specialises in neurological and brain injury cases, commented: “This is a very sad case where a young woman lost her life from a catastrophic brain bleed which could have been prevented if she had received an appropriate standard of care. While the settlement of the claim will not bring the patient back, it does give her family some comfort to know that the case was investigated properly by the trust and that a sensible approach was taken. Her family hope that as a result of this claim, lessons will be learned and that it will prevent a similar tragedy happening to another family at this hospital.”

For more information on pursuing a legal claim relating to brain injury, neurology or neurosurgery, click here.

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