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Claimant’s Incontinence From Slipped Disc Op Not Due To “Late” Referral

MRI scan
16th September 2015

A court has dismissed a claim of negligence against a GP for not immediately referring a patient with the symptoms of Cauda Equina Syndrome (CES)* to a consultant orthopaedic surgeon. As a result of the permanent nerve damage, the patient was left with a loss of normal bowel and bladder function.

The court heard that the GP had, instead, sent a letter to the orthopaedic specialist who the claimant, a 33 year old woman, first saw three years earlier. The GP made a similar request to the letter written on the first occasion for the consultant to review the patient’s condition. Following the first visit, an MRI scan revealed the slight bulge of a lumbar disc which was not causing any pressure on a nerve.

In the second letter, the GP mentioned the patient’s recent episodes of severe back pain “radiating down both legs “and being “barely able to walk”, although there was “no associated urinary or bowel problem.” On the day following the second letter, the claimant was admitted to hospital as ‘an emergency’ via A&E. The hospital noted that the patient had a eight year history of back pain, which had become worse, and a difficulty in getting out of bed.

An urgent MRI scan was ordered, which revealed the complete collapse of a central disc. Surgery was agreed with the patient and the risks, such as paralysis and bladder/bowel dysfunction, were discussed. However, the outcome of the operation left the patient with a total loss of normal bowel and bladder function and back pain.

The risks would have equally applied

The court heard from the surgeons that, if the operation had been carried out on the same day the patient had seen her GP, the development of incontinence from the CES would “in all probability” not have occurred. The surgeons also said that the back pain would “in all probability” be the same.

The judge commented that the risks, which the claimant had accepted, would have equally applied if the operation had been performed at any other time. It also follows that there was always a risk that the claimant might have been in the same condition, even if the operation had been performed earlier. At the same time, the claimant would not have known whether she would have gone on to develop CES, the effects of which the operation was intended to prevent.

In the judge’s view, the case was to be decided on whether there was an alleged failure to refer to another doctor, and the response by the surgeon responding to the referral. In the court’s judgement, the GP was “not in breach of his duty of care” in his management of the claimant's condition and the claim was dismissed.

*Cauda Equina Syndrome (CES) is the paralysis of nerve endings between the first and second lumbar vertebrae of the lower back. The nerves branch out individually in a formation resembling a "horse’s tail", known by the Latin term, cauda equina. Nerves in the cauda equina help to control and manage many lower parts of the body including the bowel, bladder, legs and sexual function.