Posted: 17/09/2019
Penningtons Manches Cooper’s clinical negligence team has settled a claim against Basildon and Thurrock Hospitals NHS Foundation Trust on behalf of a husband whose wife died two days after routine coronary surgery, following a failure to diagnose and treat cardiac tamponade.
The wife had a history of heart problems and was advised that she would require coronary surgery to treat her symptoms – she was told that without surgery, her prognosis was poor.
She was admitted to hospital on 22 November 2017 for surgery. The surgery itself was uncomplicated and she was transferred to the cardiothoracic critical care unit (CICU) on minimal support at 18.15.
The following morning, she was extubated at 01.30 and she was noted to be hypotensive (abnormally low blood pressure), which persisted over the course of the morning, and she was also noted to have a decreased urine output. The CICU team treated the hypotension and reduced urine output with fluids but as the day progressed she was noted to be ‘mildly confused and agitated’ and she was restarted on Noradrenaline (used to treat her abnormally low blood pressure).
During the early hours of 24 November, she was noted to be medically unstable with hypotension on standing. Despite this, she was not reviewed by a consultant until 11.30, by which point she was noted to have had two episodes of profound hypotension requiring transfer back to bed.
At this stage, the consultant performed a bedside transthoracic echo (TTE) which showed a 1.6cm rim of pericardial collection. An urgent TTE was requested to be performed by a cardiac physiologist to identify whether or not there was evidence of cardiac tamponade, and whilst this did not show any evidence of a pericardial effusion or tamponade, it did show a left sided pleural effusion. An urgent chest X-ray was performed, and the plan was to request a chest ultrasound, but although her observations remained abnormal throughout the course of the day, no further action was taken.
By 22.00, she was noted to be delirious and complaining of delusions, and by 22.20 she had gone into an arrest requiring CPR. Sadly she was pronounced dead at 23.12.
In light of the circumstances of his wife’s death, the husband was contacted by an anonymous member of staff who raised significant concerns about the care his wife received. This led to a coroner becoming involved and an inquest being listed. As a result, the husband instructed Penningtons Manches Cooper to represent him at the inquest as well as to investigate a claim against the trust for failing to recognise and intervene during a suspected cardiac tamponade.
During the course of the instruction, Penningtons Manches Cooper’s clinical negligence team obtained a copy of the hospital’s serious incident investigation which highlighted a number of problems in the care that the wife received prior to her death, and also obtained evidence from two experts (an ICU consultant and a cardiothoracic surgeon) prior to the inquest which identified a number of failings in her care. The experts were of the view that there was a failure by the ICU team to identify that there were worrying features in her condition following surgery, which should have prompted further investigation. Had these investigations taken place, cardiac tamponade would have been diagnosed in a timely manner, leading to the wife being returned to surgery and her death ultimately being avoided.
Following the inquest, where evidence was heard from clinicians involved in her care, a letter of claim was submitted to the trust which set out the allegations of negligence. After investigations, the trust served a letter of response admitting liability in full and shortly afterwards, Penningtons Manches Cooper was able to secure settlement for the client without the need to issue court proceedings.
Amy Milner, an associate in the clinical negligence team who ran the claim, said: “This was an extremely sad case that has had a devastating impact on our client and his family. Whilst, during the course of our investigation, our expert evidence was highly critical of the care received, prior to our instruction our client was met with some resilience from the hospital and the clinicians involved in his wife’s care when pressing them for answers as to what had happened. Credit has to be given to the anonymous staff member who contacted our client directly raising a number of issues they had noticed in terms of his wife’s care, which ultimately led to him seeking legal advice.
“While the case itself brought about a number of emotions for our client, particularly given how critical the expert evidence obtained was, we are pleased that the trust took a sensible approach and admitted liability relatively swiftly and that we were able to reach a good settlement for our client. We hope this has now brought the family some closure and that they are able to move on from what has been an extremely difficult couple of years.”
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