Claim settled for elderly patient with advanced dementia following negligent omission of anti-Parkinsonian medication

Posted: 22/06/2018

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Dartford County Court has approved the settlement of a clinical negligence claim against Oxleas NHS Foundation Trust and Lewisham and Greenwich NHS Trust. Penningtons Manches’ clinical negligence team brought the claim on behalf of an elderly gentleman who suffered from Parkinson’s disease and advanced dementia. The instructions were received from the client’s wife and litigation friend.

The client was admitted to the elderly care unit (the Woodlands Unit) of Queen Mary’s Hospital, Sidcup, suffering from significant cognitive decline. His mobility was good – he was sprightly, able to go up and down stairs on his own and only used his walking stick as a ‘prop’ when it was needed.

On admission, the client’s wife had carefully prepared his medications for nursing staff, including his anti-Parkinsonian drugs, which had to be administered four times a day. Subsequent investigations of his medical records showed that, on the evening of admission, a dose of anti-Parkinsonian medication was missed, followed by another the next day. A further dose was missed eight days later and that same night he was found on his back on the floor with a 5cm laceration to the back of his skull, bleeding profusely from a head wound. As there were no X-ray facilities at Queen Mary’s Hospital, he had to be transported to A&E at the Queen Elizabeth Hospital, Woolwich. By the time he returned to the Woodlands Unit, a further dose of his anti-Parkinsonian medication had been missed.

Four days later, the client fell again during the night. In the morning, he had to make another journey to Queen Elizabeth Hospital for an X-ray, but it appears that he arrived without a note of his medication (which now included antibiotics for a urinary tract infection). G4S, the hospital’s new transport provider, was experiencing delays in providing transport that day, so, once the X-ray was completed, he was left unaccompanied in the departure lounge while he waited for transport. During the early afternoon, nurses at the Woodlands Unit attempted to contact the Queen Elizabeth Hospital but their efforts were rebuffed. According to the medical records, the phone was put down on them at one point.

Transport was not available until the late afternoon, by which time the client had deteriorated so much without his medication that a stretcher was required. There was then a further delay whilst an ambulance was located. In the early evening, his wife met the ambulance on arrival at the Woodlands Unit, but by now he had missed three doses of anti-Parkinsonian medication as well as his antibiotics. The client’s wife was shocked by his condition - he was sweating and shaking with stiffness in his limbs – symptoms associated with anti-Parkinsonian medication withdrawal. She noted an immediate and sharp decline in her husband’s condition which she described as a “dramatic change” from which, she firmly believes, he has never recovered.

The client’s wife had originally asked Penningtons Manches’ clinical negligence team to investigate the incident at the Queen Elizabeth Hospital. However, once the records from Queen Mary’s Hospital were considered, it was clear that the care provided to her husband at the Woodlands Unit also fell below an appropriate standard.

An elderly care expert and a neurology expert were instructed. Breach of duty regarding the withdrawal of anti-Parkinsonian medication was admitted as well as the fact that our client had not been suitable for the discharge lounge at the Queen Elizabeth Hospital and that his progressive deterioration had resulted in the need for a stretcher on the return journey. It was also admitted that the final withdrawal of anti-Parkinsonian medication led to distress (stiffness, tremulousness and sweating) which may have caused a short-term deterioration. Beyond this, causation was disputed. The neurology expert agreed and, accordingly, the case was settled on this basis.

Camilla Wonnacott, an associate in Penningtons Manches’ clinical negligence team, who advised on this claim, said: “The volume of missed doses of anti-Parkinsonian medication which our client suffered over a relatively short period is quite shocking. Furthermore, it was wholly unacceptable for the Queen Elizabeth Hospital to have left an elderly patient with advanced dementia unaccompanied in a departure lounge without his medication, for the majority of the day. This case raises particular concerns about the standard of care given to elderly and vulnerable patients whose reduced cognitive abilities leave them unable to understand or communicate that their care is not of the appropriate standard.”

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