Abstract
Background
On 4 May 2004, the Claimant, then aged 68 years, underwent a right total hip replacement. She had a history of hip arthritis and underwent a successful left total hip replacement in 2001, from which she had fully recovered by the time of the second operation.
Following on from the operation, the Claimant was seen by a physiotherapist on a number of occasions. On 6 May 2004, the physiotherapist noted that the Claimant was having problems with her right foot, and thought that the signs were indicative of drop-foot. The physiotherapist noted that the matter would be referred on to a SHO. She was discharged on 13 May 2004, having seen only the physiotherapist.
On 18 June 2004, the Claimant attended a six-week review with the operating surgeon, who identified the development of drop-foot. The surgeon arranged for a series of nerve conduction studies, which would identify any improvement in the nerves. The studies identified a problem with the common peroneal nerve, a branch of the sciatic nerve.
No significant improvement was experienced by the Claimant, and as a result, the right foot was rendered severely disabled. The Claimant required a significant amount of past and future care in respect of her injury, as well as substantial adaptation of her home.
The Claimant's case
It was identified that there were three possible causes of the damage to the sciatic nerve: retractor damage; inclusion of the nerve in sutures; or pressure on the nerve from a postoperative haematoma. The latter two causes are potentially reversible if postoperation explorative surgery is completed. In any event, a noticeable improvement would be expected over the course of several years.
It was the Claimant's case that the postoperative care which was received, fell below an acceptable and reasonable standard. Upon identifying drop-foot, failure to notify the SHO, or the SHO's failure to act upon that notification meant that there was no immediate explorative surgery as to the cause of the drop-foot. Two of the three potential causes could have been rectified immediately upon discovery. The Claimant's drop-foot was not investigated by anyone other than a physiotherapist until the six-week review. At that point, nerve conduction studies were scheduled to begin in October 2004, some five months after the operation.
Proceedings were issued in April 2007, as the Defendant initially asserted that the only possible cause of the damage to the nerve would have been retractor damage, which is irreversible.
In February 2009, an experts' meeting was held, after which a joint statement was issued, in which both the Claimant's and Defendant's experts agreed that either senior or consultant orthopaedic review was required upon the noticing of drop-foot on 6 May 2004, and that the nerve damage could have been caused by any of the three possibilities identified by the Claimant, and that two of those three possibilities could have responded well to early intervention.
Settlement
Negotiations were entered into, after which the parties agreed on a settlement figure of £160,000, less any recoverable benefits. The claim was settled on a global basis, although the Claimant's advisors had it valued as follows:
£40,000 £73,512 £18,440 £10,132 £6920 £5244 £1040 £4712