The previous article in this series on the implications of catastrophic accidents covered the psychosocial issues arising from spinal cord injuries. In this article, partner Stephanie Code investigates the basis for claiming for at home hydrotherapy as part of a personal injury claim.
We regularly include the costs of a home-based hydrotherapy pool within personal injury or clinical negligence claims.
Experts suggests that water-based exercise can provide physical, physiological and psychological benefits covering a range of areas such as:
The costs of a pool at home can be significant as they will include not only the pool installation costs, but also extension and adaptation to the property together with running, maintenance and replacement costs.
The nature of litigation means that the majority of cases settle without a judicial decision on individual claims made. This means there are relatively few judgments dealing with the provision of a hydrotherapy pool.
Examples of such cases are:
A (a child) v University Hospitals of Morecambe Bay NHS Foundation Trust 
The claimant was a child suffering from significant limb spasms and pain which was hard to treat. The judgment confirms that proportionality and whether a similar result could be achieved by less expensive means are relevant factors. In this case, alternatives were not equal to full immersion in a pool. Key to the success of the case was the factual evidence of (a) the degree of pain, (b) the impact on the pain of water-based activities and (c) the lack of suitable alternatives. It was noted that the difference which immersion in water gave was significant, and the case was referred to as ‘unusual and probably exceptional’.
Robshaw v United Lincolnshire Hospitals NHS Trust 
This was a claim on behalf of a child. It was noted that just providing pleasure would not ordinarily be sufficient and some real and tangible benefit would need to be demonstrated. It was confirmed that every case is dependent on its own facts, and the physical and psychological benefits were important. In this case, the cost of a 5m x 3m pool was awarded. The judge acknowledged that it is ‘unknown precisely how frequently the issue of a home-based pool is raised and either conceded or recognised to some extent [in litigation claims]’.
HS v Lancashire Teaching Hospitals NHS Trust 
The judge was satisfied that some use would be obtained but it was thought this would decrease over time. There was said to be a suitable pool 40 minutes away from the claimant’s home which would enable twice weekly visits for life, and therefore the costs of a pool were not awarded. However, the claimant received a ‘not insignificant annual sum of £125,000 for hydrotherapy’ generally.
AB (by his litigation friend CD) v Royal Devon and Exeter NHS Foundation Trust 
This was a claim on behalf of a 50 year old who had a spinal lesion that led to paraplegia. One of the most important consequences of the injury was the frequent extremely painful spasms rated as severe and unlikely to improve. Although the costs of a pool were not awarded, the judge confirmed “after considerable thought I do not award a home hydrotherapy pool. It seems to me that it is expenditure, [with] a risk that it might not be used in the long-term.”
However, the judge did award a considerable sum to support the maximum use of hydrotherapy facilities away from the home.
JR (a protected party) v Sheffield Teaching Hospital NHS Foundation Trust 
A 24 year old was awarded the costs of visiting a local hydrotherapy pool on a regular basis for life. It was noted that the capitalised sum was considerably higher than the costs of a swim spa pool suggested as an alternative by the defendant.
After establishing that a pool is an appropriate provision, the judge will consider the issue of proportionality. It will be necessary to consider the cost to the defendant of a hydrotherapy pool against the extent of the benefit which would be derived by the claimant. The fact that ‘making good’ is expensive is not a reason to refuse. The judge must consider whether a ‘substantially similar result could be achieved by less expensive means’. Other alternatives may be proposed, such as prescribing medication to alleviate pain, installing a Jacuzzi or using the local pool. Evidence will need to be produced to explain why this will not provide a similar result. Factual witness statements, videos and expert reports in support will be needed.
It is sometimes argued that evidence of enjoyment, particularly when activities are limited due to an injury, should be relied upon, however this is unlikely to be enough. The evidence needs to focus on the individual in setting out all the benefits. The water in the local swimming pools may not be at an adequate temperature, and there may not be appropriate changing facilities or access to the pool by way of hoists or specialist wheelchair. Private sessions may be difficult to book or the distance to travel may be too great. Arranging and commenting on a specific trial of hydrotherapy over a longer period, and showing the benefits gained, should help to convince the defendant that a judge is likely to make an award.
The cases reported do suggest that even if the cost of a hydrotherapy pool is not awarded, a ‘reasonably generous annual contingency’ to enable the individual to use hydrotherapy frequently will be. This will lead to a significant capitalised sum on settlement of the claim.
There is no rigid test for the award of damages to fund a hydrotherapy pool at home and each case is dependent on its own facts. However, if a real and tangible benefit can be demonstrated, based on factual evidence which is corroborated, there will be good prospects of achieving an award.