P v University Hospital Southampton NHS Foundation Trust (2013)

The following PI Quantum report has been published on Lawtel. The report provides details about a serious clinical negligence case successfully won by the Clinical Negligence team at Express Solicitors. 

The Claimant, a 59-year-old man, received £75,000 after a hospital failed to diagnosis and treat his appendicitis. That failure resulted in a perforated necrotic appendix requiring appendectomy with a local washout. The Claimant went on to develop a symptomatic incisional hernia at the top end of his midline wound and required further repair surgery.

Clinical Negligence: On December 28, 2008 the Claimant (C) attended a hospital of the defendant trust (D) by ambulance with severe abdominal pain. C was given Morphine and an X-ray was taken but the only diagnoses considered were gastroenteritis and bowel obstruction. C was discharged on December 29, with no confirmed diagnosis or follow up.

C contacted his GP on December 30, regarding on-going abdominal pain and attended his GP’s surgery on December 31. The GP suspected that C had a ruptured appendix and arranged for C’s re-admission to hospital on December 31. On examination it was noted that C had signs of peritonitis. A midline laparotomy was performed and a perforated necrotic appendix was walled off by the sigmoid colon and the small bowel. C underwent an appendectomy with a local washout. C was in hospital on intravenous antibiotics and morphine. C was off work for all of January and February 2009, he returned to work in early March 2009 but remained in significant pain.

In July 2009 C noted a lump in his stomach. He attended his GP in November 2009 where it was noted that he had developed an incisional hernia which was causing increased discomfort. C was referred back to the surgeons at the hospital.

On January 18, 2010 C was seen by the surgeons and was noted to have a symptomatic incisional hernia at the top end of his midline wound. He underwent a repair of this hernia on February 9. C was off work until March 2010. C regularly attended his GP in June to October 2010 because of on-going abdominal discomfort and he was reviewed at hospital due to persistent and intermittent abdominal pains. A “wait and see” approach was recommended at that time and again in May 2011 when C was referred back to hospital with continued abdominal pain. There was a discussion of chronic pain control management or possibly a re-exploration and re-repair of the hernia.

C continues to suffer with on-going abdominal pain.

C sustained injury and brought an action against D alleging that it was negligent in (i) failing to refer C to the duty surgical team during his emergency admission on December 28, 2008 which, on the balance of probabilities, would most likely have resulted in a diagnosis of acute appendicitis; (ii) failing to refer C for imaging or a CT scan which would most likely have shown the presence of free fluid and which would have resulted in C undergoing a laparoscopy and laparoscopic appendectomy or conventional appendectomy through a gridiron incision in the right ileac fossa and which, on the balance of probabilities would have resulted in the appendix not having perforated and C not having to require a midline laparotomy. It was also alleged that would have avoided the incisional hernia.

Liability admitted.

Injuries: C suffered a perforated necrotic appendix requiring appendectomy with a local washout. He subsequently developed a symptomatic incisional hernia at the top end of his midline wound and required further repair surgery. C has continued to suffer from abdominal discomfort.

Total injury duration: permanent

Effects: C continues to suffer from abdominal discomfort. A Consultant in Pain Management was of the opinion that C suffers from pain comprising of two separate components. The first is pain predominantly on the abdominal wall related to the site of the hernia and the other component is that as C had to have more than one incision in that area, there was potentially an increased risk of developing chronic pain as it would appear that the pain from the original laparotomy never resolved completely prior to the hernia repair.

A recommendation for pain management was suggested. Due to the nature of C’s employment, management of the pain by way of pain medication would not be appropriate.

Out of Court Settlement: £75,000 total damages

Background to damages:

The case settled on a global basis with no particular breakdown of damages. However, the following breakdown was estimated by the claimant’s solicitors:

General Damages: Pain, suffering and loss of amenity: £32,356; Future loss of chance of earnings and pension: £15,000; Future pain management programme: £5,000; Future services: £5,000

Special Damages: Past loss of earnings: £13,539; Past care and assistance: £1,388; Past miscellaneous items: £2,717.

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