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30 October 2022 | Case Study | Article by Lesley Herbertson

Failure to diagnose and treat vascular injury resulting in a through knee amputation

In 2017, Adam, then aged 24, was involved in an accident and suffered a traumatic dislocation of his right lower leg and damage to his popliteal artery. Paramedics provided initial treatment at the scene but failed to adequately assess Adam’s distal pulse. Had they done so, they would have discovered Adam’s distal pulse was absent.

Adam should have been treated as a patient with a suspected ischaemic limb and should have been taken to the nearest major trauma centre. He would have undergone urgent re-vascularisation of his right leg. If that had occurred, he would have made a complete recovery from the dislocation and vascular injury.

Instead, Adam was taken to the Accident and Emergency Department of the local hospital. The first A&E consultant who examined him also failed to properly assess his right distal pulse. When the doctors eventually picked up on the lack of distal pulse, they contacted a specialist vascular doctor at another hospital for advice. Unfortunately, the vascular doctor failed to give adequate advice and did not attend the treating hospital as a matter of urgency. As a result, Adam did not receive the revascularisation surgery that he required within the requisite period of time, and he suffered with compartment syndrome and a reperfusion injury.

Unfortunately, Adam’s leg could not be saved and he underwent a right through knee amputation 13 days after the initial injury.

As a result of the amputation, Adam has to rely on right-sided lower limb prosthetics. When not wearing a prosthetic limb, he relies upon crutches around the house and, occasionally, a wheelchair. His home needs to be wheelchair accessible. He requires care and assistance provided by his family and partner. He is also more at an increased risk of developing arthritis and requiring joint replacement surgery. He is disadvantaged in the open labour market due to his mobility difficulties which will progressively deteriorate as he ages.

Lesley Herbertson, Partner in the Clinical Negligence team at Potter Rees Dolan, acted on Adam’s behalf and made a claim for his injuries and associated losses against the three NHS trusts involved. It was admitted on behalf of the Defendants that there was a negligent delay in achieving re-vascularisation of the right leg. It was also admitted that if appropriate treatment had been given, Adam would have avoided his amputation.  However, it was argued that even if his right leg had been saved, his mobility would still have been compromised and he would have suffered significant neuropathic pain. These arguments were defeated by way of expert evidence, obtained on Adam’s behalf, which demonstrated that, absent the negligence, Adam would have undergone intensive rehabilitation for 12 months, would have made a complete recovery from the dislocation and vascular injury, and only be left with minor sensory nerve damage.

Due to the number of potential Defendants involved, Adam was invited to proceed to settlement  without the need to issue proceedings at Court. This proved to be a fruitful and cost-effective way forward.  Expert evidence was obtained in relation to Adam’s condition and prognosis and in respect of all of his future needs. The claim included various prosthetics, provided via the private sector, for everyday use, including swimming, and additional specialist protheses for running and gym work and also for snowboarding/ski-ing.

Round table settlement negotiations earlier in the year eventually led to securing a total award of £4.3million for Adam. During the course of the case interim payments on account of compensation were paid which allowed Adam to source his first high spec prosthesis as soon as possible, as well as funding some adaptations to his home.

Lesley Herbertson comments on the case as follows:

As a young and very active man, Adam has shown remarkable strength of character in the way that he has coped with the loss of his lower right leg. The Defendants and their legal team were pragmatic and co-operative throughout the case and they also acknowledged Adam’s stoicism and positive attitude, despite what happened to him. I am very happy that we have been able to secure for Adam sufficient compensation to ensure that he can, to some extent, resume the active and fulfilling lifestyle that he had before his amputation.

Author bio

Lesley Herbertson is a Partner at Hugh James and a leading medical negligence solicitor with over 30 years’ experience in dealing with catastrophic and serious injury medical negligence cases.

Disclaimer: The information on the Hugh James website is for general information only and reflects the position at the date of publication. It does not constitute legal advice and should not be treated as such. If you would like to ensure the commentary reflects current legislation, case law or best practice, please contact the blog author.

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