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Failure to Identify Abdominal Aortic Aneurysm Led to Fathers Death

15 July 2014

Instructions were received to act on behalf of the client in a claim for damages for personal injury sustained and losses and expenses incurred in connection with the death of Mr M, who died on the 3rd November 2011. The claim was being brought by Mrs W, the deceased’s daughter. 

The client's father had a past medical history of chronic obstructive pulmonary disease (COPD), congestive cardiac failure, atrial fibrillation and hyperthyroidism, rheumatoid arthritis and deformed toes on the left foot. On the 22nd September 2011, he was admitted to University of North Staffordshire Hospital for a first metatarsophalangeal joint fusion (MJF). This was performed on the 23 September 2011 by Mr B. 
 
He was unwell following the operation and within 10 days of the operation his foot had developed an infection and had become necrotic.
 
On the 3rd November 2011, he suffered a fall in the bathroom. He complained of no pain or injury other than pain in his left foot. Thereafter, his condition continued to get worse and his toes appeared ischemic and he was urgently referred to a vascular team.
 
On the 6th November 2011, he was reviewed by Mr P, Consultant Vascular Surgeon. At this review, Mr P advised him that his toes were not viable. However, an amputation was not performed until 14th October 2011, at which point, he was advised that an above the knee amputation would need to be performed. On the 25th October 2011, he became septic and was transferred for inotropic support and monitoring.  Sadly, he passed away on the 3rd November 2011. The Coroner’s Interim Certificate of Death notes the precise cause of death as multiple organ failure following above the knee amputation; infected wound following MJF and hypertensive left ventricular hypertrophy, ischemic heart disease and COPD.
 
The matter was investigated by HM Coroner at an Inquest heard on the 4th September 2013 and 23rd October 2013, whereby the Coroner’s decision was given on the 19th November 2013.
 
The Coroner made a recommendation under paragraph 7, Schedule 5 of the Coroners and Justice Act 2009 and regulations 28 and 29 of the Coroners (Investigations) Regulations 2013 to prevent future deaths.
 
Following on from this, a Pre-Action Protocol Letter of Claim was served on the Defendant by way of letter dated 17th January 2014.
 
The Allegations of Negligence were as follows; -
 
An angiogram was performed on the 11 May 2011 which clearly showed an abdominal aortic aneurysm. At the time that this angiogram was reviewed by Dr A on the 12 May 2011 there was a failure to diagnose the abdominal aortic aneurysm. An addendum report was added onto the 11 May report on the 6 October 2011. It was only then that a present of a 5.6cm AAA was mentioned. It was accepted at the inquest that the AAA was “obvious”.
 
It was below an acceptable standard not to note the abdominal aortic aneurysm and the abnormality of the left distal superficial femoral and popliteal arteries which were consistent with popliteal artery aneurysm.
 
Following the angiogram of 11 May 2011 there is no evidence that the abdominal aortic aneurysm  (AAA) or the common iliac artery aneurysm (CAA) and/or the popliteal artery aneurysm (PAA) were investigated and these appear to have been overlooked entirely by the vascular team in May 2011 and thereafter. It is not clear whether Mr W, the Vascular Registrar or Mr P reviewed the angiogram personally. If they did not then our client would consider that to be below an acceptable standard of care.
 
Had Mr M been treated appropriately then he would have been eligible for medical treatment of his AAA, CAA and PAA aneurysms.
 
Had these conditions been recognised it is the case that no reasonable surgeon would have offered Mr M foot surgery or if such surgery had been offered it would have been put forward as an extremely high risk operation and it is asserted that Mr M would not have consented to the same.
 
In the event that the Defendant’s NHS Trust asserts that Mr M would have undergone the operation of 23 September 2011 then the client makes the following allegation:-
 
1. There was a negligent delay in obtaining a vascular opinion (23 September to 6 October 2011) and the patient’s condition worsened very significantly in this period. In particular there is evidence that he had developed a chest infection in this period.
 
2. Had Mr M been seen by a vascular surgeon soon after his surgery of 22.9.11 then he could have undergone a successful femoropopliteal bypass graft and that would have prevented the requirement for the above knee amputation and also his subsequent death.
 
3. With regards to the anaesthetic assessment a decision not to proceed with the life saving surgery to Mr M was made by a very junior anaesthetist in circumstances which were inappropriate.
 
4. Mr P went on holiday on the 13 October 2011 and there is no formal handover recorded in the notes, we do not consider this type of conduct can be supported by a responsible body of medical opinion.
 
In summary the clients case is that had the appropriate diagnosis have been offered to Mr M, The AAA would have been treated with an endovascular aneurysm repair (EVAR).
 
If this is not accepted then the clients case is that there was an inadequate post operative treatment following the operation on 23 September 2011.
 
Causation
 
But for the negligence of the Defendant’s NHS Trust, its staff, servants and/or agents the deceased would not have undergone surgery on 22.9.11 and would not have died in very distressing and painful circumstances on 3rd November 2011.
 
Conclusion
 
By way of letter dated 12th May 2014, the Defendant provided a Letter of Response whereby breach of duty and causation was admitted. A full apology was made. The Defendant put forward a Part 36 Offer and this offer was accepted.

James Bell is a Clinical Negligence Solicitor at Slater and Gordon Lawyers in London.

If you feel that you or a member of your family may have a Abdominal Aortic Aneurysm Compensation Claim or compensation claim for  Hospital Neglligence, contact Slater and Gordon Lawyers for a free consultation and we'll be happy to help you.

Call our Clinical & Medical Negligence Solicitors on freephone 0800 916 9049 or contact us online.