Abstract
Background to the claim
The Claimant, who had a history of heart problems since 1986, underwent an aortic valve replacement in February 1995. By July 2002, the Claimant required mitral valve replacement due to worsening left ventricular disease.
Following his cardiac surgery, the Claimant made a good recovery and regained normal cardiac function. He was able to continue in his very active employment as a cold storage facility manager.
On 16 April 2005, the Claimant presented to A&E at Queen Elizabeth Hospital with a history of chest pain. He notified the A&E doctors that he had previously undergone aortic and mitral valve replacement surgery. The Claimant was referred to the on-call registrar and a nurse placed an intravenous line in the Claimant's right arm. The Claimant was admitted to the respiratory ward for further monitoring.
The following day, a chest X-ray revealed cardiomegaly and the Claimant was advised he had suffered a small heart attack. On 18 April 2005, the SHO referred the Claimant for cardiac rehabilitation to include a repeat ECG in a week's time. By this stage, the Claimant had developed phlebitis at the site of his intravenous line. Nevertheless, he was discharged from hospital on 19 April 2005 with low-dose antibiotics.
At no time during the Claimant's admission was he reviewed by a cardiologist. At the time of his discharge from hospital, the Claimant was suffering from a raised temperature. When he arrived home, his wife telephoned a nurse at the hospital. The Claimant was reassured that the flucloxacillin tablets he had been prescribed would take approximately 48 hours to take effect.
The Claimant attended his GP the following day, who advised him to continue with the antibiotics. Over the ensuing few days, the Claimant was lethargic and felt unwell.
On 25 April 2005, the Claimant attended a review appointment with his consultant cardiac surgeon. At this time, his arm was still bandaged and he was continuing to take the antibiotics.
The course of flucloxacillin tablets ceased on 27 April 2005. The Claimant attended his GP on this date and confirmed that his antibiotics had just finished. He had been suffering rigors during the preceding 24 hours, and his temperature was approximately 40°C. The GP prescribed antipyrectics, and arranged to see the Claimant the following day if his temperature had not settled.
The Claimant duly returned to see his GP the next day, having been febrile overnight with rigors. The GP arranged for the Claimant to be readmitted to the QEH Hospital straightaway. Upon admission, the Claimant was diagnosed with infectious endocarditis, secondary to an infected cannular site in his arm.
Tests revealed the Claimant was suffering from a staph aureus infection. It was initially treated with flucloxacillin and gentamycin. The antibiotics were then changed to teicoplanin and gentamycin. On 10 May 2005, the Claimant underwent a transoesophageal echocardiogram, and was subsequently referred to the specialist heart unit at Papworth Hospital. By 8 June 2005, the Claimant's endocarditis had worsened to the extent that his heart function was compromised. Papworth performed a repeat double valve replacement operation, removing the original valves which were fitted in 1995 and 2002.
Postoperatively, the Claimant's recuperation was slow. At review on 16 August 2005, the Claimant was diagnosed with biventricular failure due to leakage from the valves. By 20 September 2005, the Claimant was still suffering orthopnea and was referred to a transplant cardiologist for advice. Due to the Claimant's age and degree of heart failure, the decision was made to defer transplantation.
Negligence
In terms of breach of duty, Clarke Willmott, on behalf of the Claimant, instructed a consultant cardiologist (Dr Charles Pumphrey) to comment on the standard of care provided by the Defendant Trust, and specifically whether there was a failure to identify and treat the phlebitis originating from the intravenous site.
A claim was advanced on the basis that between 16 and 19 April 2005, the Defendant Trust failed to arrange for the Claimant to be reviewed by a cardiologist. The treating doctors also failed to heed the significance of phlebitis in a patient with two prosthetic heart valves. In addition, the prescription of flucloxacillin (a low-dosage antibiotic) was inadequate to control the phlebitis. The Claimant's solicitors alleged that the failure to administer intravenous antibiotics and to properly monitor the Claimant's vital signs amounted to breach of duty. Finally, it was also alleged that the Claimant should not have been discharged before his phlebitis had been properly treated.
Causation
Turning to causation, the Claimant alleged that had his phlebitis been treated appropriately with intravenous antibiotics, the infection would not have spread to his heart valves and he would have avoided the endocarditis and ensuing surgery of 8 June 2005. As a result of the Defendant's negligence, the Claimant developed debilitating endocarditis (which necessitated a redo of the double valve replacement procedure he had previously undergone).
Prior to the endocarditis, the Claimant was leading an entirely normal life and was able to work in a demanding role completing 12-hour shifts. As a result of the endocarditis, the Claimant was very disabled by breathlessness and physical limitations. He was only able to walk 50 yards at a slow place. His sleep was disturbed and he was forced to retire from work. His quality of life was severely compromised by his cardiac failure.
Although the Claimant was considered for cardiac transplantation in the future, he was not thought to be a suitable candidate. The expert evidence confirmed the endocarditis and consequent cardiac failure reduced the Claimant's life expectancy from 20 years to just 2 years.
In their Letter of Response dated 2 April 2007, the NHSLA on behalf of the Defendant NHS Trust denied liability entirely and maintained that the Claimant's care was managed appropriately and did not cause him to develop endocarditis.
Court proceedings were served on 23 April 2008, following which the Defendants instructed solicitors who made a full admission of breach of duty and causation. Judgment was entered for the Claimant with damages to be assessed.
Losses
The Claimant's solicitors commissioned a report from Maggie Sargent & Associates relating to the Claimant's likely care and equipment needs over the remainder of his life. Thereafter, a Schedule of Special Damages was prepared and served upon the Defendants.
Claims were advanced for past loss of earnings (£95,000), travel expenses (£4400), medications (£1500), DIY and home maintenance (£3600), gardening (£1400), car maintenance £865), loss of enjoyment of his daughter's wedding (£1050), gratuitous care and assistance (£35,000), and sundry items (£4700). The past losses amounted to slightly over £147,000, exclusive of interest.
In addition, the schedule included claims for future loss of earnings (£79,000), pension loss (£9800), travel expenses (£3000), medication expenses (£2500), DIY and property maintenance (£3900), gardening (£1700), car maintenance (£375), professional care and assistance (£44,000), case manager (£7320), and aids and equipment (£15,000). The future loss element of the claim amounted to just over £165,000.
The Claimant's solicitors valued general damages at around £65,000 on the basis of mesothelioma cases (because the Claimant's worsening symptoms of breathlessness and fatigue were akin to those suffered by asbestos victims).
Settlement
Following a period of negotiation, an amicable settlement was reached between the parties in June 2009 in the global sum of £325,000. Although the case was settled on a global basis with no particular breakdown of damages, the Claimant's solicitors provide the following breakdown: £65,000 £2000 £82,000 £17,000 £5000 £3000 £4500 £6700 £80,000 £42,000 £5000 £11,000
The Claimant also received an unreserved apology from the Chief Executive of the Defendant NHS Trust.