Claim settled for negligent delay in diagnosis of Hodgkin’s lymphoma

Posted: 06/06/2016

The Penningtons Manches clinical negligence team settled a claim against Worcestershire Acute Hospitals NHS Trust for a delay in the diagnosis of Hodgkin’s lymphoma in a young mother. 

While pregnant in October 2010, the client developed low back pain and consulted her GP who prescribed analgesia and referred her to a physiotherapist at the defendant trust. The physiotherapist found no evidence of any neurology involvement and she was given advice on the management of her symptoms and exercises to help reduce the pain.

By January 2011 her back pain had become worse and was radiating down both of her legs. She also had pins and needles in her legs, which were giving way. On 2 March 2011 our client saw her GP as she had found a lump in the left side of her neck. Her GP was sufficiently concerned to make an urgent referral to the defendant trust for suspected head and neck cancer. She was seen by an orthopaedic surgeon at the defendant trust on 7 March 2011. By this point she could hardly walk. He concluded that she had a disc protrusion in her lower back and provided her with crutches and advice regarding painkillers. He said that an MRI scan was not necessary and made no other referral for investigation. 

The client was then seen by another member of the orthopaedic team on 22 March 2011. She reported that she had lost weight and was feeling weak. She complained of severe pain in her lower back, radiating into her right groin, as well as continued numbness in both her lower legs. She was given advice on heat packs and the plan was to review in two weeks' time. Again, no further investigation or referral was made. 

In the interim, on referral by her GP, she was seen in the ENT clinic where they did a biopsy of the lump in her neck. The results of these were available on 13 April 2011. They were inconclusive and a second opinion was obtained from another hospital. They confirmed that the biopsy showed features of classical Hodgkin's lymphoma. An MRI scan performed shortly afterwards showed extensive spinal disease and she was diagnosed as Stage 4B. The diagnosis was confirmed in May 2011. 

The client was 31 weeks pregnant at the time of her diagnosis. As chemotherapy was to start as soon as possible, her baby was delivered early by elective caesarean section 12 days later and chemotherapy started 10 days after the birth. There was a noticeable improvement in the client’s symptoms very shortly afterwards. 

She made a complaint and there was an independent case review of her care. This concluded that the pathway of investigations from February 2011, when the client was first found to have neurological signs, to diagnosis in May 2011 was unacceptably slow. She was offered £500 compensation but, as she was uncertain if this was an appropriate sum and of the implications of the delay in diagnosis, she instructed Penningtons Manches to advise accordingly.

The clinical negligence team carried out a review of the medical records and, with initial expert input, advised the client that we agreed with the outcome of the independent review that there was a delay in diagnosis. However, as it was only a delay of a few weeks, the slow diagnostic pathway had not necessarily affected the chance of a successful outcome to treatment. Nevertheless, the team concluded that there was a period of debilitating symptoms which could have been avoided and the client had suffered the anxiety caused by the knowledge of a delay in diagnosis. A pre-action letter of claim was sent to Worcestershire Acute Hospitals NHS Trust together with an offer to settle. 

Despite the conclusions reached by the independent case reviewer in its own investigation, the defendant trust denied the claim. In recognition of this, a further lower offer was made to tempt settlement. As the defendant trust made it clear that it was not going to be making any offers to settle the claim, court proceedings were issued and an independent expert was instructed to prepare a full report.

The independent expert was supportive of the delay and the unnecessary pain and suffering the client went through. This evidence was shared with the defendant trust and the offer was re-stated but the claim continued to be denied. The trust’s argument was that treatment would not have been started any earlier due to the fact the client was pregnant. Penningtons Manches obtained informal evidence from a further three experts rebutting this argument which was shared with the defendant trust. The offer was also re-stated again but the claim continued to be denied and the court timetable proceeded.

Penningtons Manches wrote to the defendant trust’s solicitor expressing concern that the claim was ongoing when the evidence was clearly supportive of a claim and that costs were escalating in a relatively modest claim. The client had been sensible throughout, reasonable attempts to settle had been made and the claim could have settled at the outset. In a turn of events, the defendant trust suddenly agreed to settle the claim and accepted the offer of £4,000 which had first been made almost two years earlier.

Elise Bevan, the Penningtons Manches solicitor who dealt with this claim, said: “This case was capable of compromise two years earlier than it settled. The damages offer which was ultimately accepted had been stated on four occasions. Throughout the duration of this case, we provided the trust with regular updates on our costs and brought to its attention on numerous occasions that these were increasing unnecessarily due to its conduct. We were sensible throughout and openly shared with them the evidence we had obtained from our experts. The right result has been obtained for the client.

“Claimant lawyers are often criticised for their costs involved in pursuing claims but, if early admissions are made, then these cases can be settled a lot sooner and costs can be saved. We always encourage defendants to re-think their conduct and take a sensible approach to cases where possible.”

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