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Case Study

General Medicine claim conducted on a Conditional Fee agreement

Henry, a 50 year old male consulted his GP with a history of a few days of sweating, malaise, mild cough, tiredness and waking up shivering in December 1997. On examination, Henry had lost weight. His chest was clear and there was no lymphadenopathy (swelling of the lymph nodes). A diagnosis of a possible viral infection was made.

The next day Henry consulted his GP again complaining of dark urine and feeling generally unwell. Blood tests were carried out and the GP referred Henry to Dr Sevitt, consultant general physician who arranged his admission to the London Clinic on 9 December.

On admission laboratory investigations were undertaken and showed renal dysfunction with raised urea and bilirubin, poor reticulocyte response, low haemoglobin (indicating anaemia) and there was a low platelet count.

Henry was given a transfusion of six units of platelets and a course of intravenous antibiotics. Platelet transfusions were continued daily until 15 December 1997.

Blood film results reported on 10 December 1997 showed microangiopathic and haemolytic anaemia (MAHA).

On 11 December, he was seen by Dr Kaczmarski, haematologist, who concluded “I would recommend supportive care only, avoid further platelet transfusions unless neurological signs manifest … plasma exchange not indicated at present as it seems to be settling. May consider if develops neurological problems”. Despite this advice, platelet transfusions were continued.

On the nights of 11 and 12 December, Henry had neurological symptoms and was noted to be confused. Post-infective HUS was queried.

In fact the correct diagnosis was thrombotic thrombocytopenic purpura (TTP).

On 13 December notwithstanding Dr Kaczmarski’s advice platelet support was continued and plasma exchange was not commenced. At 7:00 p.m. on 14 December, Henry suddenly deteriorated and was noted to have left-sided hemiparesis, sensory abnormalities, confusion, restlessness and was dysarthic. He was transferred to the ITU.

On 15 December, Henry was again reviewed by Dr Kaczmarski who specifically noted that Henry’s condition was behaving like TTP. He recommended that further platelet transfusions be avoided and plasma exchange be considered.

Even with the correct diagnosis and appropriate advice as to treatment, Henry was not given plasma exchange, but 10 further platelet transfusions were given.

On 18 December, Henry was transferred to UCH under the care of Professor Machin.

Henry was discharged at the end of April 1998 on long-term cyclosporin therapy and prophylactic dose aspirin and folic acid with regular follow-ups.

Expert evidence from a consultant haematologist was critical of the failure on or after 11 December 1997 to make the correct diagnosis of TTP, which should prompt immediate plasma therapy and immediate cessation of platelet transfusion. The delay in diagnosing the illness and instituting appropriate treatment caused Henry to suffer a life threatening illness requiring long-term ITU care on a ventilator.

The platelet transfusions contributed to the TTP progression, the deterioration of Henry’s neurological function and the need for ITU and ventilatory support. But for the negligence, Henry would have been hospitalised for three to four weeks and would have been back to work by 1 February 1998.

On 22 September 2000, the claimant made a Part 36 offer in the sum of £300,000. This offer was rejected and so proceedings were issued on 27 November 2000 and were served on 13 March 2001.

The defence made limited admissions in respect of breach of duty. In November 2001, the defendants made a 'without prejudice' offer in the sum of £50,000.

On 14 December 2001, the defendants made a payment into court of £75,000 which was rejected. Factual and expert evidence was exchanged. Expert meetings took place and 21 days before trial, the defendants paid into court a total sum of £200,000.

After negotiation, Henry’s claim was settled in the sum of £240,000.

Paul McNeil conducted this under a conditional fee agreement.

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