Cauda Equina Syndrome & Litigation
I received a very worrying letter through my letterbox....
A few years ago I did a four month stint in general practice. I really enjoyed it and did lots of teaching. It was actually how I landed my job as a university lecturer after some of the course admins noticed my enthusiasm for clinical teaching.
I have fond memories of the rotation until one day, 2.5 years later I received a letter through the letterbox…
It was from a company in Gloucester. I’ve never actually been to Gloucester so I put it to the side and forgot all about it. My wife’s a pretty diligent person and she goes through all the post like a hawk. Whilst at work she sent me a few messages followed by an image. It was quite a busy day and I was working in A&E at the time. I sat down for my 1/2 hour lunch break and started reading…
Let’s just say that my shift was ruined for the day.
The letter was from a law firm. It stated that I was being held responsible for a missed cauda equina syndrome (CES). Contained within it was a copy of the consultation I had with the patient. I couldn’t remember the encounter very well as it was such a long time ago. I was worried, really worried. The aura of uncertainty was overwhelming and it was noticed by all my colleagues around me.
I took a moment and called my medical protection agency. They asked me to send a statement. I spoke to my consultant on the shop floor who actually didn’t look that worried. He reassured me and advised me to contact my supervisor. Then a thought went through my mind I thought that I should contact my clinical supervisor from my time on my GP rotation.
Luckily I had her number saved so I texted her. I gave her a summary of what had happened and she called me straight back. We spoke further as she gathered a few more details and said “Mo, don’t worry at all.” I was slightly bewildered but it became a little clearer as she explained her opening statement.
Apparently this law firm has written correspondence to most of the GPs at the practice. The patient attended with back pain so frequently that he had been seen by most members of the practice. On further reading of the letter, it doesn’t actually state that the claim was for CES. The claim was actually for “deteriorating neurological function” which is very different from a claim for CES. The first is a subjective diagnosis whilst the other is an objective MRI/surgically based diagnosis.
From what I hear, such claims are common. Between 2008-2018 there have been a total of 827 claims for CES of which 340 were eventually settled. In total £186,134,049 has been paid out in damages. That’s a heck of a load of money.
You may find that you get such a letter through your door or an email with similar information to what I’ve described. I think I’m really lucky as nothing actually came off this. I’ve learnt lots of lessons looking back at my consultation and practice and having read a lot about litigation in light of what could have potentially happened, here are some useful points:
Document clearly. Regardless of your index of suspicion, perform all the investigations you can to rule out CES.
You cannot get away from NOT doing a PR. It’s vital!
Have a low suspicion for referral/scan. I’ll cover this another time but cauda equina can sometimes present with very subtle features.
Ask and document answers to all the red flag symptoms. Ask about bilateral sciatica, saddle anaesthesia and urinary or bowel incontinence.
Ensure you have indemnity. If anything does happen and you were not covered, you will be in even deeper trouble.
It would be interesting to know if you’ve had any similar experiences? I feel that sharing experiences and lessons can only make us better practitioners. If you have anything to share then please do send us an email!
Until next time
Mo @ Pareto
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