A man whose leg was amputated following misdiagnosis and substandard surgery was awarded £1.71 million in compensation.
The claim included substantial special damages of over £1.5m for his financial losses as well as specialist prosthetics. After losing his leg, he had to give up his job as managing director of a recruitment company. He was in his mid-50s at the time and will likely suffer reduced mobility in the near future and rely on the use of a wheelchair. As his care needs increase with age, he will require home adaptations or to move to a bungalow.
His solicitor, Christine Brown, a director of Medical Solicitors, supported him to make a medical negligence claim against the defendant trust.
Case summary
On Boxing Day 2017, the claimant ‘C’ dislocated his left knee and had immediate swelling. Due to the time of year, an ambulance couldn’t be sent straight away so his daughter drove him to A&E.
Here, a doctor noted discolouration and loss of pulse, sensation and movement in C’s left foot. However, there was no obvious deformity or fracture on the x-ray.
It was suspected that C had a popliteal artery injury. The popliteal artery is the primary vascular supply to the knee and lower leg. Irreversible ischaemia (decreased blood flow) can happen in as little as six to eight hours of the injury.
The on-call vascular surgeon at the regional vascular unit was called who requested a CT angiogram before C was transferred. There were considerable delays to both the scan and transfer – he wasn’t sent to the other hospital until 1.30am, almost six hours after the injury.
There, C was examined by a general surgical registrar who noted a swollen lower leg, diminished sensation, severe calf pain, tenderness behind the knee, and no ankle movement.
A vascular consultant was called who wrongly diagnosed arterial compression and compartment syndrome despite signs of severe acute limb ischaemia. C was referred to orthopaedics for urgent fasciotomy with a view to reducing the pressure in the muscle.
An orthopaedic registrar correctly diagnosed the artery injury following dislocation, but the vascular surgeon maintained that compression and compartment syndrome was the appropriate diagnosis. After toing and froing, an orthopaedic consultant was called who agreed with the orthopaedic registrar and recommended emergency vascular surgery was needed.
C had surgery at 5.45am, ten hours after the injury. It lasted for eight hours, during which time another vascular surgeon was called who spotted that the popliteal artery was completely disrupted. A vascular bypass with vein graft was performed.
While recovering on the ward in January, C’s Doppler signals in his foot became weakened and a duplex ultrasound scan showed no flow in the bypass and severely dampened blood flow below the knee. A blood clot was suspected and it was advised that angioplasty was the best option to stretch the artery.
However, C was not warned of the risks that such procedure may make the ischaemia worse or of amputation. It did, in fact, cause the blood clot to fragment resulting in distal embolization; subsequent thrombolysis to destroy the clots was unsuccessful.
C was told that his leg was now non-viable and life-threatening. The only option was amputation. There was no discussion about the level of amputation. A through-knee amputation has much better outcomes than an above-knee amputation.
C’s left leg was amputated above the knee on 15th January 2018 and he was given an NHS prosthetic. Afterwards, C had stump and phantom limb pain. He also suffered mentally, with an adjustment disorder, depression, poor energy and libido, and sleep problems. He has social paranoia, becoming reclusive and irritable.
Litigation
C argued that there were unacceptable delays and sub-standard vascular surgery which led to critical limb ischaemia.
Had he been promptly transferred to the vascular unit and undergone immediate arterial repair, successful vascular reconstruction would have been achieved. He would then have undergone splinting of the unstable knee and later reconstruction of his anterior cruciate ligament, leaving him with satisfactory left knee function.
He also claimed that the vascular surgeon failed to use a temporary shunt to restore arterial blood flow to the lower leg. Attempts to salvage the failed vascular repair by angioplasty were inappropriate because of the high risk of fragmentation; a graft revision should have been performed instead.
After the defendant admitted liability, C was awarded an interim payment in June 2021 which enabled him to pay for a private prosthetic to replace the unsatisfactory NHS issued one.
The claim eventually settled in November 2022 for £1.71 million. This included £133,000 general damages for his pain and suffering, £225,000 for past financial losses, and £1.35m for future losses.
Do you need support with an amputation negligence claim?
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