Prevention is better than Cure - A cause for Celebration for Patients with Cauda Equina

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28 November, 2018

Cauda Equina Syndrome (CES) is a rare and potentially life changing condition where It is a severe narrowing of the spinal canal usually caused by a prolapsed invertebral disc. It happens when the nerve in the "cauda equina" suddenly become severely compressed. This can lead to numbness and weakness in the legs, numbness in the saddle area, difficulty controlling the bladder and even loss of bladder control. Timing issues are key and it ought to be treated as an emergency, rather than with urgency.

The consequences of failing to spot it can be catastrophic and lead to irreversible nerve damage, permanent disability and psychological problems. Given the nature of the problem that this can cause it quite often leads to six figure settlements where negligence can be proved.

The Warning Signs (red flags)

In May of this year the Medical Protection Society and NICE worked together to revise the guidelines in the hope that this would help GP's and other healthcare professionals make appropriate referrals.

Practice Business reported that the Medical Protection Society and NICE had updated the cauda equina "red flags" that could have significant impact on patient's safety;

  • Bilateral sciatica
  • Severe or progressive bilateral neurological deficit of the legs, such as major motor weakness with knee extension, ankle eversion or foot dorsiflexion.
  • Difficulty in urinating or impaired sensation of urinary flow, if untreated this may lead to
  • urinary retention with overflow urinary incontinence.
  • Loss of sensation of rectal fullness, if untreated this may lead to irreversible faecal incontinence.
  • Perianal, perineal or genital sensory loss (saddle anaesthesia or paraesthesia).
  • Laxity of the anal sphincter.

The majority of negligence cases arise from delay in referral and diagnosis and these changes reflect the importance of urgent investigation.

Generally, the earlier the decompression surgery (normally a laminectomy) is performed, the better the outcome.

In the case of Barry Frederick Hewes v (1 West Hertfordshire Hospital NHS Trust) (2 East of England Ambulance Service NHS Trust) (3 Panjak Fanna 2018) the GP was a Defendant and sought to make an application for a decision on an issue before the trial. The application was to remove the doctor from proceedings. The Court on Appeal decided that the Application would not be considered until the experts had reported and the evidence exchanged. It was unlikely to be allowed until after the experts had met and produced joint reports to see if they could narrow the issues.

To succeed in clinical negligence you have to show that the doctor had failed to act in accordance with a responsible body of medical opinion. Until the Claimant had the chance to report properly as directed by the court, this issue could not be determined.

This demonstrates the importance of medical evidence in these cases and the willingness of the Court to allow proper reporting within the court timetable on these complex issues.

Going forward, Investigation reports prepared by the Scottish Public Services Ombudsman under Section 15 (1)(a) will hopefully add weight to a number of recommendations to improve patient care.

If you are affected by any of the issues mentioned above, you can find support with Leonie Millard is working with CESA (Cauda Equina Syndrome Association) to promote awareness, and can provide advice and guidance in exploring whether a medical case has been dealt with negligently.

For more information contact Leonie Millard in our Clinical Negligence department via email or phone on 01254 770517. Alternatively send any question through to Forbes Solicitors via our online Contact Form.

Learn more about our Clinical Negligence department here

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