A 72-year old female claimant (“C”), received £500,000 compensation, after an out of court settlement was reached. She had suffered compartment syndrome and later an above elbow amputation of the dominant arm owing to a medical error.
The £500,000 amputation negligence settlement was broken down as follows:
£100,000 for general damages (for pain, suffering and loss of amenity) for loss of dominant arm.
£400,000 for past and future financial losses.
The details of C's amputation claim
On 10th December 2007, C was admitted as an emergency to hospital with a chest infection and dehydration. C had a background medical history of a lung condition called bronchiectasis and she had been suffering from breathing problems for two days as a result of this before her hospital admission. At the accident and emergency department, blood tests were done and C was given fluid via an IV drip. She was prescribed an antibiotic called Augmentin, but the first attempt to place the cannula failed and, during the second attempt, another cannula was placed by a member of the nursing staff negligently into C's right brachial artery and not into her vein.
The insertion into the artery was not noticed and a rapid dose of antibiotic was then negligently given via the cannula over a minimum of one hour. C complained of severe pain in her right hand and fingers for several minutes. The nurse stopped the procedure and checked the arm and cannula, but then continued to administer the drug.
When a bag of intravenous fluids was connected to the same cannula it immediately filled with blood and it tracked back along the tube, indicating that it was connected to an artery. C passed out due to the pain. However, the nurse still negligently failed to recognise that the cannula had been inserted into C's right artery, and consequently failed to report the error to the clinicians and seek medical advice.
A further bag of intravenous fluids was then administered and again the nurse negligently failed to recognise that the cannula was in the artery when the bag filled with blood.
C was then transferred to the Emergency Medical Unit without any written or verbal handover. The arterial cannulation and the IV bags were not mentioned. C complained of further pain in her right hand and forearm. A nursing auxiliary on the unit noticed that C's right hand was limp, pale and cold to touch.
A medical registrar then did diagnose acute ischaemia (lack of blood flow) requiring urgent surgical assessment. Despite the urgent request, the surgical registrar did not see the C until one hour later, by which time C's right dominant arm was paralysed and pulseless. A haematoma (collection/swelling) was found around the brachial artery. C was diagnosed as having acute ischaemia of the right hand secondary to a brachial dissection or embolus. An hour later, a vascular consultant took a look in surgery at the right brachial artery under a local anaesthetic due to C's chest condition. The plan was to review C the following morning, however, negligently no completion angiogram was performed.
C continued to suffer from pain in her right hand and developed further issues with her arm, being a compartment syndrome.
Two days later, C underwent further surgery to attempt to relieve the pressures in her forearm (called ‘fasciotomies’) with some muscle taken away (‘debridement’), but this did not relieve the very severe pain. This again had to be done under local anaesthetic, due to C's condition.
The next day, C underwent a further debridement as the deep extensor muscles were necrotic i.e. had died.
Four days later, C was continuing to complain of pain and numbness similar to frostbite that prevented her from sleeping. At one point, she was in such severe pain that she tried to jump out of a hospital window. Later that day, she underwent a further surgical exploration of her arm to try and improve blood flow, ‘embolectomies’ were carried out to all the vessels and thrombi (blood clots) were removed, but her arm failed to improve.
Two further days after that, C's right arm had to be surgically amputated below the elbow joint using a nerve block. Other procedures were later needed for further debridement of dead tissue leading to an above elbow amputation under nerve block on Christmas Eve.
C brought a claim alleging that, but for the neglect in medical care, the inappropriate injection into her artery would not have occurred and she would not have lost her arm and suffered all of the complications after that. C needed help with all day-to-day tasks as she had lost her right dominant arm. Her remaining left arm, being of limited use due to an arthritic condition, which required surgery 5-10 years sooner than would normally be required due to overuse.
The Hospital admitted liability.
Not surprisingly, C suffered a significant psychological reaction thereafter which required ongoing treatment with anti-depressants. Her previous housing situation was unsuitable and she had moved to a two bedroom flat within a retirement complex which provided an onsite manager and emergency call system. C had previously been independent and self-caring in her own home and enjoyed dancing and had a busy social life.