Diabetes is one of the biggest global health challenges, linked to rising levels of obesity, poor lifestyle and an aging population. It is a systemic disease that can cause complications including retinopathy, nephropathy, neuropathy, cardiovascular disease and PAD (peripheral arterial disease), and can cause loss of vision, kidney failure, heart attack, stroke, limb amputations and death.
Major amputation is one of the most destructive complications of diabetes and the depressing news is that numbers continue to rise, with mortality rates post amputation worse than those for most cancers.
7,957 major diabetic lower limb amputations were reported in England between 2017 and 2020, with up to 85 per cent of them avoidable. Major amputation is obviously life-changing for a person with diabetes, with the tragedy even greater when it could have been prevented.
What generally goes wrong for diabetic patients seeking medical help for foot problems is that the seriousness of their condition goes unnoticed, followed by delays in providing urgent and appropriate care.
The NHS report highlighted that high-risk patients were not identified and so received minimal preventative care, such as pressure relief or offloading, and that even when foot problems were recognised, patients experienced delays in being seen by a specialist footcare team.
Notably, the extent and severity of the pathology was realised late or not at all and patients hospitalised with foot ulcers were discharged home too early. In addition, imaging was performed late in the progression of pathology and was poorly correlated to the clinical picture.
This lack of awareness of first recognising and then treating serious foot conditions is generally a result of a lack of thorough, evidence-based assessments, poor documentation, inconsistent terminology and a lack of clarity between different treating teams.
The International Diabetes Federation describes a critical ‘window of presentation’ - the time between when neuropathy is discovered and an ulcer develops. An absence of thorough assessments, and a failure to identify risk factors, meant this window of opportunity was missed, along with it the chance to provide appropriate preventative care, which can then lead to amputation.
The aim of the report is to promote preventative strategies including education, management of risk factors and early intervention, ultimately to reduce the number of lower limb amputations, increasing survival rates, and reducing the personal cost to patients and their families and to the NHS.
The medical negligence team specialises in pursuing delayed diagnosis claims, including the impact of delayed diagnosis of diabetes related disease. We are also expert at settling amputation and limb loss claims, helping clients work towards a brighter future.
As an example, Christina Gardiner is currently investigating a claim against Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, concerning a potential failure to appropriately assess and treat a foot infection of a 46-year-old man with a history of Type 1 diabetes at the Doncaster Royal Infirmary. Unfortunately, our client's case almost exactly mirrors the failings in care identified in the NHS report above.
Our client was seen by multiple clinicians in the diabetes unit and A&E, but was sent home with antibiotics and a diagnosis of Cellulitis and told to see his GP if his symptoms did not improve. X-ray and MRI imaging missed the presence of osteomyelitis. Despite repeatedly attending hospital and being seen by various doctors, his infection progressed and he eventually underwent amputation of his lower left leg.
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