Hospital fails to diagnose patient’s dislocated shoulder on two separate occasions

Posted: 08/08/2017

Penningtons Manches LLP’s clinical negligence team has settled a claim against Maidstone & Tunbridge Wells NHS Trust following a failure on two occasions to diagnose a patient’s dislocated right shoulder.

In March 2012, the patient, a 69 year old lady, tripped and fell on the driveway outside her home. She sustained an injury to her shoulder and attended the emergency department at Maidstone Hospital straightaway.

At the hospital, she described what had happened and complained of pain at the top of her right arm. X-rays were taken from two different angles but an axial view X-ray was not arranged. After the images had been reviewed, the patient was advised that she had not suffered a bony injury, and she was discharged.

Over the course of the following few weeks, the patient continued to experience significant pain in her upper right arm and shoulder. Her right arm movements had become more limited. At the beginning of May 2012, four weeks after her fall, the patient re-attended Maidstone Hospital and complained of ongoing pain. The doctors looked at the X-ray images that had been taken previously but did not arrange new X-rays. Again, the patient was told that she had not suffered a bony injury and was advised to have physiotherapy.

The patient’s pain and range of movement in her right shoulder worsened over the course of the following months. She arranged privately for further images to be taken, which revealed an abnormality. An MRI scan at Maidstone Hospital was subsequently performed, which confirmed she had suffered a right shoulder dislocation.

Later in 2012, the patient saw a consultant for a further opinion on her shoulder injury. By this time, she was in constant pain and could do very little with her right arm. She was advised that she required surgery to relocate her right shoulder. Although she agreed to surgery, by the time it was arranged, a deterioration in her cardiac condition meant that she could not have an anaesthetic. Surgery was abandoned. The patient’s cardiac condition has not improved since, and she has not been able to undergo the corrective surgery she requires to restore some function to her right shoulder.

Penningtons Manches pursued a negligence claim on the basis that the X-rays taken in March 2012 were sub-standard. They failed to visualise the correct area of the patient’s injury and it was alleged that, had an axial view X-ray been arranged, the dislocation would have been diagnosed. It was also alleged that, had new X-rays been arranged in May 2012, the patient’s injury would have been diagnosed.

After diagnosis, the patient would have been referred to the orthopaedic unit at the hospital, which would have been able to treat her dislocation that day, or shortly afterwards. She would not have required surgery, and a closed or open manipulation of the shoulder joint would have resulted in re-location and return of function. The patient would not have recovered full function of her right shoulder, but she would have recovered sufficiently to enable her to perform tasks of daily living without pain and without requiring additional care and assistance.

A firm of solicitors was instructed to act for the NHS trust, and investigated the allegations of negligence. In its formal letter of response, the trust admitted a failure to arrange appropriate X-rays in March and May 2012 and that, but for the negligence, the patient’s injury would have been diagnosed.

However, the trust denied that any injury was caused by that admitted negligence. It stated that she would always have required surgery but would have been unsuitable for such treatment because of her cardiac condition. She would always, therefore, have ended up with the same injury.

Penningtons Manches had strong evidence in support of the patient’s case, and pursued the claim. Further expert evidence was obtained from a consultant anaesthetist, whose evidence confirmed that the patient would have been suitable for the appropriate treatment up until June 2013, by which point her cardiac condition deteriorated. A formal request for further information was sent to the defendant seeking clarification on why the patient would have been unsuitable for treatment.

Following that request, the solicitors for the trust made further admissions. Some protracted negotiations then took place over the value of the claim and settlement. The defendant eventually made an offer that was considered to reflect the injuries suffered by the patient, and she accepted this.

Arran Macleod, a specialist in orthopaedic claims within the clinical negligence team at Penningtons Manches, comments: “We appreciate that in busy emergency departments across the country, there may be an emphasis on dealing with patients as quickly as possible. But, in this instance, simply performing an additional X-ray in March 2012 would have resulted in a diagnosis of the patient’s injury. She would have received appropriate treatment, and would have avoided years of pain and suffering.

“In some situations, patients may be able to undergo appropriate treatment at a later date. However, as this case demonstrates, not all patients will be as fortunate and other medical conditions can intervene to prevent the necessary treatment from being performed. This patient now has to endure a right arm that is far less functional than it would otherwise have been for the rest of her life. So that these types of cases are prevented, it is vital that the correct amount of time is spent with each patient and all appropriate investigations are performed.” 

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