Cauda Equina Compensation Payouts Guide

Cauda Equina Compensation Payouts Guide

Introduction

Cauda equina is a condition when a group of nerves at the base of the spine (known as the ‘Cauda Equina’ – Latin for ‘horse’s tail’), that supply the lower parts of the body, become compressed. This is usually because of damage to the discs in the spine in the area of the Cauda Equina. The discs act as shock absorbers in the spine, but when they are damaged and spill out into the Cauda Equina, that bundle of nerves can become compressed.

An estimated 400-600 patients are diagnosed with this spinal condition every year in the UK. It is a medical emergency, needing urgent surgery to relieve the pressure. Otherwise, permanent and life-changing injuries can be suffered.

Cauda Equina Syndrome can be caused by various medical accidents and medical conditions such as: –

  • complications of spinal anaesthesia
  • arthritis
  • a blood clot
  • complications from cancer
  • side-effect of medication
  • a car accident or fall
  • a penetrating injury, such as a knife or gunshot wound.

 

Do you have a claim?

If your cauda equina has happened because of something that happened that was preventable with better medical care, then you may have a clinical negligence claim against your healthcare provider, entitling you to compensation. For example, if you have suffered a blood clot that has caused the spinal injury and you were given too much medication, or conversely, not given medication to prevent blood clot, then that may represent negligent medical care. Also, it is not uncommon to hear complaints that patients visited their GP, a chiropractor or osteopath, or the accident and emergency department on many occasions, only to be turned away and not given the crucial MRI needed to diagnose this serious medical condition. In such cases, it can often be shown that earlier MRI would have led to earlier surgery which, in turn, would have prevented a patient from suffering from permanent disabilities for life.

There are symptoms that should alert a GP, or other care providers, to err on the side of caution, and to refer you to a hospital for urgent investigation. Cauda Equina Syndrome can often come on after a patient has been suffering from back pain for some time. A doctor should not assume that new symptoms are part and parcel of a less serious minor health condition. A doctor should be concerned if a patient is complaining of loss of sensation in the genitals, around the anus, numb buttocks, bowel or bladder problems, loss of sensation in the lower limbs (that can also be accompanied by shooting pains) and particularly loss of ankle movement.

If a patient is quickly diagnosed and promptly receives surgery, then a full recovery is possible. However, a delay can lead to permanent disabilities that can have life-changing and financially devastating effects on the patient and their family. A patient may find they can no longer walk normally and have to use a stick or other aids. They may become permanently incontinent and lose sexual function.

Patients may lose function below the waist and can even be paralysed below the waist. Cauda Equina Syndrome can lead to loss of feeling, or tingling, in the genital area (in men perhaps the inability to have an erection). There can be mobility problems (difficulty walking or dragging feet, or weakness/loss of sensation or pain down one leg and particularly an ankle loss of function), as well as continence issues affecting the bowel and bladder (inability to urinate, or to hold in urine or stools). These problems can become permanent if surgery is undertaken quickly enough. There is a period of up to 48 hours to treat the patient. The sooner surgery is done, within that time, the more chance there for better recovery.

 

How are cauda equina syndrome payouts calculated

‘General Damages’ i.e. What is the value of a back injury?

In other countries, punitive damages are awarded and this is why we see such high award of damages in the United States. However, in the UK, punitive damages are not awarded. The Judicial College sets out a brackets for the value of particular types of injuries. There are a wide range of figures, examples below are taken from the 14th edition of the Guidelines.

£79,890-£141,150. Most severe injury, involving damage to the spinal cord and nerve roots, leading to a combination of very serious consequences not normally found in cases of back injury. There will be severe pain and disability with a combination of incomplete paralysis and significantly impaired bladder, bowel and sexual function.

£65,030-£77,540. Cases which have special features of back injury, such as nerve root damage with associated loss of sensation, impaired mobility, impaired bladder and bowel function, sexual difficulties and unsightly scarring.

£34,000-£61,140. Cases of disc lesions or fractures of discs or of the vertebral bodies or soft tissue injuries leading to chronic conditions where, despite treatment (usually involving surgery), there remain disabilities such as continuing severe pain and discomfort, impaired agility, impaired sexual function, depression, personality change, alcoholism, unemployment and the risk of arthritis.

£24,340-£34,000. Cases where any residual disability is of less severity than in the examples above. This covers a wide variety of injuries, including the risk of osteoarthritis and constant pain and discomfort. Spinal fusion may be deemed necessary. Nerve root irritation and reduced mobility.

£10,000-£24,340 for disturbance of ligaments and muscles giving rise to backache, soft tissue injuries, resulting in acceleration and/or exacerbation of pre-existing back condition, usually by five years or more, the necessity for laminectomy or involving repeated relapses. The precise figure will depend upon the severity of the original injury, the degree of pain experienced, the extent of any treatment required in the past and future, the impact of the symptoms on the injured person’s ability to function day-to-day and engaging in social/recreational activities and the prognosis for the future.

£2150-£10,970. Three remaining brackets for more minor injuries, such as where a full recovery takes place without surgery within about 2 to 5 years and, at the lesser end of the brackets, where a full recovery is made within three months.

‘There can be other consequential injuries that fall under the category of “general damages” above but are not included in the brackets mentioned above.and are separate heads of claim. For example:

  • compensation for breakdown of a relationship.
  • compensation for loss of enjoyment of a holiday.

‘Special Losses’ i.e. What can I claim for past, current and future financial losses?

In addition to the value of your actual injury, you are entitled to claim any financial loss, past, current and future that is not merely speculative and can be shown to have arisen as a direct result of substandard care and consequential injuries. For example, such losses can include the following: –

  • Loss of income if you have been unable to work for a period of time, or have had to give up work altogether. Alternatively, a partner may have had to give up work to care for you.
  • Care provided gratuitously by your family or friends. This may be an ongoing requirement and a nursing expert can be instructed if so, to look at the ongoing cost of that and also to cost out future provision for such care to be provided on a private basis by professional carers, to allow a loved one or friend to get back to their normal day-to-day life.
  • If a claimant finds themselves isolated as a result of their injury, and would find it difficult to manage the provision of future carers, then a Nursing Case Manager can be appointed to plan for a claimant’s needs, interview, train and to employ and oversee carers required. A companion, known as a “buddy” can be employed to ease social isolation. The Buddy can regularly visit and support the claimant in the future, help them plan activities they will enjoy and take them out on those activities.
  • Travel expenses to and from medical appointments.
  • Accommodation costs, if you had to adapt your home in any way or even if you had to move to single-storey accommodation or have a requirement to move to single-storey accommodation. In such cases, an architect might be instructed to advise on costs. Also, if a claimant needs help to find an appropriate property, there are also experts we can instruct who specialise in finding suitable property to suit those with disabilities.
  • Aids and equipment around the home such as ramps, grip rails, toilet rail, wheelchairs, scooters et cetera
  • Orthotics- if mobility has been adversely affected and special footwear or spinal corsets can be shown to be of benefit. The purchase of such items and the future replacement costs can be significant.
  • Any other reasonable financial losses. Such losses may at first seem somewhat speculative, but if a court is satisfied there is a reasonable need, then compensation can be given for such things as surrogacy costs (if the medical negligence has left a claimant with infertility issues).

 

Cauda equina settlements

We are currently acting in a case where we have obtained highly supportive medico-legal reports to support our client. In May 2014, she was only 31 years old when she suffered a large disc prolapse with clear cauda equina compression. Her GP referred her to hospital where she was kept in overnight, but no MRI scan was carried out which would have led to proper diagnosis. Diagnosis was only made, after MRI scan, 16 days later at a different hospital. Despite surgery, she has been left with severe symptoms of bowel, bladder and sexual dysfunction, with the left lower limb symptoms and a foot drop. Such complications would have been avoided with timely/earlier diagnosis and surgery. We are in the process of investigating value, having obtained a neuro rehabilitation report but also need a reports and other specialist fields to ensure our client receives all compensation to which she is entitled to provide the her for the rest of her life. Her claim is of very high value.

Some other examples of past awards in cauda equina cases are as follows: –

£3.4 million, to a 35-year-old gentleman who injured his back and was sent away from a hospital emergency department the day after. The next day he went back to the hospital, as his condition had worsened and was then diagnosed with progressive cauda equina syndrome. In the early hours of the next day, he underwent emergency decompression surgery. The defendant partly admitted liability, admitting there had been a failure to recognise and treat the condition on the first hospital attendance and that there would have been some resulting injury. However, it was not admitted that the delay caused immobility, inability to work in dependency on crutches and mobility scooter. Nevertheless, the very large settlement award was agreed pre-trial in January 2019.

£1.6 million for a 42-year-old gentleman for neurological injuries sustained after hospital failed to remove a bulging lumbar disc in September 2005 and instead caused a dual tear. He suffered cauda equina syndrome, not to use a wheelchair and was incontinent of faeces. This was in 2009 and in today’s terms, the claimant in this position would be likely to receive a much higher award.

£1.5 million for a 46-year-old lady for injuries suffered following a delay in diagnosing and treating cauda equina syndrome in 2003. She suffered impaired sphincter control, right foot drop and her bowel and bladder functions were affected and, when later undergoing medical procedures, she contracted MRSA. This was a settlement in 2009 and in today’s terms, the claimant in this position would be likely to receive a much higher award.

£750,000 for a 50-year-old gentleman after failure to appropriately investigate and identify a large central disc prolapse in November 2008. He suffered cauda equina syndrome, resulting in neurological impairment of mobility, incontinence, sexual dysfunction and neuropathic pain. Liability was admitted and pre-trial settlement was agreed in 2013.

£250,000 to a lady who had suffered long-standing back problems and had undergone two past operations on her spine. She developed difficulty passing urine and numbness in her right buttock going down her thigh. Her GP and the local Accident and Emergency Department did not recognise the severity of her problems, so her eventual surgery was delayed. She was left with permanent and severe pain in one leg and foot and a loss of bowel and bladder control.

£225,000 to a 54-year-old man, a former lorry driver, who injured his back after moving road signs around in a lorry. He visited 2 GPs who both failed to spot Cauda Equina Syndrome. He lost his job and was left in permanent pain with mobility problems. He needed shin splints and walks with the aid of elbow crutches.

 

Q&A

  • Where do I go for support after spinal injury?

You may need practical, emotional, or financial advice and support. We have listed many sources of help in our separate web-page. Click on this link to access invaluable information and resources: Support after Cauda Equina

  • How can I pay for a claim for compensation?

All reputable and specialist clinical negligence solicitors offer no win, no fee for cases that look reasonable to investigate. If a solicitor asks you for money upfront they may not be specialists.  Go elsewhere to find a specialist who offers no win, no fee. Click on the following links for our detailed explanation about funding medical negligence claims and the no win no fee agreements that we offer to our clients.

Funding a medical negligence claim

Conditional fee agreements (no win no fee)

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