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10 November 2022 | Case Study | Article by Ruth Powell

Six figure settlement achieved in delay in diagnosis of cancer claim


The Medical Negligence team at Hugh James were instructed by Mrs P to investigate a claim concerning a delay in diagnosis of cancer of the jejunum (small intestine).

The first step in any clinical negligence case is to request a copy of the medical records. A full set was obtained which was carefully reviewed to identify any possible red flags.

Briefly, the background to Mrs P’s claim was as follows: –

In 2015, Mrs P started complaining of abdominal pains which persisted, and she attended her GP. Her GP referred her to a gastroenterologist for further investigations. A gastroscopy was carried out which suggested that Mrs P was suffering from coeliac disease. She therefore commenced a strict gluten free diet.

However, Mrs P continued to suffer from abdominal pain and further blood tests carried out at the end of 2016 demonstrated low haemoglobin (‘Hg’) levels. A test was also carried out for endomysial antibodies and the results of this did not support a diagnosis of coeliac disease. Mrs P’s GP referred her to the haematology department at the Hospital Trust for further investigations and intravenous iron infusions in December 2016. Following the iron infusions, the Hospital Trust indicated that Mrs P was to be reviewed again in 3 months’ time. It was noted that she was still complaining of abdominal pain. However, for reasons which were unclear, Mrs P was not reviewed at the Hospital Trust again until June 2017.

Mrs P returned to her GP again in September 2017, complaining of continued abdominal pain. Her GP arranged a private referral to a gastroenterologist. An ultrasound scan was carried out which showed an area of bowel thickening. Further investigations resulted in the identification of an adenocarcinoma of the jejunum. In November 2017, Mrs P underwent an operation to excise the tumour. It was necessary also to carry out a hemicolectomy (a procedure to remove one side of the colon), a distal pancreatectomy (removal of pancreas), a splenectomy (removal of spleen) and a left nephrectomy (removal of kidney). Thereafter, Mrs P underwent chemotherapy involving time away from her two young children which was distressing, alongside the physical side effects. Mrs P was also unable to work during this time.

Expert Evidence

Following the identification of several red flags in Mrs P’s treatment, we instructed two medical experts to review her records and provide their comment on whether the care she received was negligent.

Expert evidence was obtained from a General Surgeon and a Haematologist.

The expert evidence confirmed that the hospital had failed to: –

  1. In December 2016 and January 2017, properly consider and investigate the cause of Mrs P’s unexplained low Hg levels and continuing abdominal pains. Low Hg levels can often indicate internal bleeding;
  2. Note that the diagnosis of coeliac disease was not definitive, and the test results did not support this diagnosis;
  3. Immediately refer Mrs P to a gastroenterologist to investigate further;
  4. Diagnose promptly the existence of a tumour.

Further, it was the experts’ view that had the tumour been diagnosed and treated in early 2017, it would have been significantly smaller than it was. This would have meant that: –

  1. The amount of jejunum which would have been removed would have been reduced;
  2. It would not have been necessary to remove any part of the Claimant’s pancreas or to carry out a splenectomy or to carry out the left nephrectomy;
  3. Mrs P would not have required chemotherapy.
  4. Mrs P would not have been left with an increased vulnerability to infection, including the long-term need for prophylactic daily antibiotics. In addition, she was left at an increased risk of long-term kidney disease and risk of venous thrombosis/pulmonary hypertension.

A conference was held with our experts and a specialist barrister, to test the evidence, prior to taking next steps in the claim.

Letter of Claim

On the basis of the expert evidence obtained, we proceeded to draft a Letter of Claim to the Hospital Trust. This is the document that sets out the case, detailing allegations of negligence, resulting injuries and consequent financial losses incurred.

The Trust had 4 months within which to carry out their own investigations and provide a response.

A response was received which admitted negligence. The Trust invited Mrs P to set out her financial losses in detail so that settlement negotiations could commence.


We were keen to ensure that Mrs P was provided with some financial recompense whilst we concluded our quantum investigations. Therefore, we requested an interim payment which was provided by the Trust. An interim payment is the payment of part of the final compensation award in advance.

A detailed Schedule of Loss was then produced, which set out all of the financial losses Mrs P had sustained as result of the negligence. This included loss of earnings, treatment costs, travel expenses and other miscellaneous expenditure. This was then served on the Trust with an initial offer of settlement.

Settlement negotiations commenced and we were pleased to be able to achieve a six-figure settlement on behalf of Mrs P.

Mrs P comments on the process:

I’ve been so happy with the work you’ve done for me and to have achieved a good settlement. I’ve always felt fully included in all decisions made as you provided clear advice on often complicated matters. I always felt like I was able to contact you at any point to discuss things in more detail if necessary. During difficult parts of the case, I found you and everyone involved to be sympathetic and fully supportive of my emotional well-being.

Author bio

Ruth is a Partner and Head of our Clinical Negligence Department. She has exclusively practised in clinical negligence since qualifying in 1995 and has a wealth of experience in complex and high value clinical negligence claims.

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