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Case Study

£150,000 settlement five days before trial in fatal aortic dissection against Royal Free Hospital

Arti successfully negotiated settlement of £150,000 for the family of a doctor, Mark*, who died as a result of a ruptured aortic dissection. Liability was denied by the defendant throughout the long-running case, which eventually settled five days before trial was due to begin in the High Court.

Mark was an A&E registrar working as a locum. He supported his wife and five children, while also researching the development of medical supplements for diabetes.

Mark presented to Barnet Hospital complaining of severe back and chest pain radiating down his left side. He was diagnosed with an aortic dissection.

The following day, he was transferred to the Royal Free Hospital where he was treated with labetalol, an IV beta blocker, to stop the progression of the (Type B) aortic dissection. It is recognised that early management is crucial.

The medication regime continued for three days, when Mark's pain recurred and he began to suffer from breathlessness, which he associated with the beta blocker, and increased blood pressure. He requested change to an oral version of the beta blocker.

Over the next two days, Mark's blood pressure continued to rise. He was not advised that his symptoms were signs of progression of the dissection, and no steps were taken to allay his concerns of the impact of the IV or oral beta blockers on his breathlessness. He believed the two were related and refused the labetalol, and his blood pressure continued to rise.

Mark suffered a fatal cardiac arrest the following day, secondary to a rupture of the aortic dissection. He had not been seen by his doctors since the previous morning, and it was admitted that nurses had failed to carry out appropriate observations in the period before his death; he had not been seen for eight hours prior to being found slumped by the side of his bed in the early hours of the morning.

An Inquest was held into Mark's death, where poor record keeping was acknowledged, and that Mark had in fact taken the medication, despite his initial refusal.

Expert opinions from a cardiologist and vascular surgeon supported there being a breach of duty in failing to appropriately advise Mark of the risks in refusing labetalol, and that had he been given appropriate advice, he would have continued with the medication. It was accepted that there would be an element of contributory negligence.

The case was issued and served, and heavily defended. No settlement offers were put forward by the Defendant. A Round Table Meeting was arranged to take place days before trial was scheduled to begin.

In the interim, settlement offers were exchanged following experts' meetings and eventually, a six figure sum was agreed five days before trial was due to start in the High Court. The first day of trial was used as an Approval Hearing for part of the damages to be held for the youngest of Mark's children, who is still a minor. The Judge in the case commended Mark's family, particularly his children, who have all followed their studies in their father's footsteps, including one who is a doctor, and the youngest, who will also study medicine.

At the end of the case, Mark's widow said: 'Arti and the whole team at Fieldfisher have been extremely patient and supportive throughout this long and difficult time. We would like to thank all those involved for their hard work and efforts and we are very happy with the service and support received. It has been a very difficult time but we are glad to finally have some closure.'

*Name changed

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For further information about hospital negligence claims, please call Arti Shah on 0207 861 4139 or email


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