Delay in Treating DVT (Deep Vein Thrombosis) Resulted in Serious and Lifelong Consequences

Summary

I was instructed to pursue a Clinical Negligence Claimant against West Suffolk NHS Foundation Trust following the Claimant’s treatment in April 2016, when he attended the Hospital with left leg pain and swelling, following a recent long haul return flight from Kenya.

Whilst the Claimant was diagnosed correctly with a DVT (Deep Vein Thrombosis) treatment was interrupted for 2 days resulting in serious and lifelong consequences for the Claimant.

Settlement

Negotiations were protracted and the claim eventually settled for a 5 figure sum very close (6 weeks) prior to Trial. The Defendant eventually accepted the Claimant’s P36 offer in February 2018.

What Happened

In April 2012, the Claimant attended West Suffolk Hospital with left leg pain and swelling following a recent flight from Kenya.

The headline diagnosis was of possible left pelvic vein Deep Vein Thrombosis “DVT”. The Claimant was started on Tinzaparin, an anticoagulant treatment and then discharged and told to return the following day to the radiology department because it was likely that he had a DVT.

The Claimant returned to the Hospital the following day, as requested, for imaging studies which were deemed to be inconclusive. D –Dimer test was 910 ng/ml (elevated).It was noted that they were “unable to visualise proximal veins due to bowel gas’’. A duplex ultrasound was carried out on this day and is formally reported as showing “No evidence of Thrombus identified within the external Iliac, femoral, popliteal and calf veins. Damped low velocity flow with inconclusive Valsalva manoeuvre identified within proximal veins which can be suggestive of thrombosis in more proximal veins such as IVC and common iliac veins.”

The Claimant was sent home, the discharging clinician determined that anticoagulation treatment need not be continued and arranged a follow-up scan in one week.

Two days later, the Claimant returned to the Hospital by ambulance with worsening symptoms. A repeat ultrasound showed occlusion of the common femoral vein by thrombus. The Claimant’s D-Dimer level had grossly elevated to 2135 ng/ml. The Claimant was re-commenced on Tinzaparin and started on Warfarin. The Claimant was discharged home the same day.

The Claimant was then admitted to Adenbrooke’s Hospital ten days later presenting with complaints of chest and leg pain, shortness of breath and a left groin and leg DVT with cellulitis and a suspected pulmonary embolism. A massive iliofemoral DVT was diagnosed. The Claimant’s left leg was swollen from the ankle to the groin with marked erythema, inflammation and tender tense swelling. Imaging demonstrated extensive venous collaterals in the Claimant’s abdomen and chest and a very small calibre inferior vena cava with venous drainage of the lower extremities through the azygos system. A CT pulmonary angiogram ruled out pulmonary embolism.

The Claimant was discharged on 3rd May 2012 on lifelong Warfarin and compression stockings for severe odema of the leg.

As a result of the Defendant’s negligence, the Claimant developed moderately severe post-thrombotic syndrome,  “PTS”. As a result, the Claimant became limited in his activities by a general tiredness and lack of power in his left leg. This was particularly problematic when going upstairs or a hill. He could not walk at a normal pace, and could not run. His previous sporting hobbies of squash and golf were difficult for him to pursue, albeit that he had made attempts to do so. His employment was significantly affected with him having to take a lower-paid job, due to his inability to continue in a job that he had trained for. Even in his new employment, his new employer had to make significant reasonable adjustment for him.

Several times a week he was woken at night by painful cramps in his left leg. The left leg remained significantly swollen at both the calf and the thigh, compared to his right. He had to wear a compression hose daily and was at an increased risk of developing a venous leg ulcer.

It was established that if an ulcer did develop it would be a painful complication, requiring the Claimant to attend at his GP surgery several times a week for compression bandaging over a number of months. Venous ulcers produce a foul-smelling odour and cause increased swelling and feelings of heaviness in the affected limb. The Claimant’s risk of developing an ulcer in the left leg was increased to 25% over the next 15 years. The Claimant sought a lump sum award which encompassed that increased risk.

The issues between the parties related solely to the impact of the discontinuance of anticoagulants in April 2012.

It was admitted that it was a breach of duty that anticoagulation treatment was not provided to the Claimant between 17 April 2012 and 19 April 2012.

The dispute between the parties was whether the failure to provide the Claimant with anti-coagulation treatment between 17 April 2012 and 19 April 2012 had any causative effect.

It was the Claimant’s case that the failure to anticoagulate resulted in massive ileofemoral vein thrombus causing the Claimant to suffer a post-phlebitic limb. The Claimant averred that had the Defendant continued the anticoagulation treatment on 17th April 2012, the development of his massive iliofemoral vein thrombosis could have been avoided or, in the alternative, the two days without anticoagulation treatment caused the Claimant to suffer a more extensive DVT than he otherwise would have.

A Letter of Claim was served in January 2015. A Letter of Response was received in May 2015, with an absolute denial of liability.

The Defendant’s case was that the Emergency Department at the Hospital did in fact diagnose a deep vein thrombosis in April 2012. The clinicians responsible took into account the Claimant’s Wells score and decided there was a high risk of DVT for which they instituted treatment whilst waiting for the ultrasound. The treatment afforded to the Claimant when he presented in April 2012 was appropriate and correct. They stated that tests such as venogram or magnetic resonance venoraphy had no place in the early management of DVT. They suggested appropriate treatment would be to arrange a repeat ultrasound which the Trust requested.

With regards to causation, they stated that although the Trust failed to anti-coagulate for three days, it made no material difference to the Claimant’s outcome and had no long-term consequences. They were of the view that the risk of DVT and complications was increased in the Claimant’s case by the rare condition of IVC atresia which the Trust could not possibly have suspected and which did not alter the need for life-long stockings and anticoagulation which the Claimant would have needed in any event.

The Defendant denied that the breach of duty caused the Claimant to suffer a post phlebetic limb or any other long term consequence and that it had not affected his prognosis.

Supportive causative expert evidence was obtained from a Vascular Surgeon which disputed the Defendants assertions.

Proceedings were issued in July 2015 and upon receipt of the Defence the Defendant continued to admit that anticoagulants were stopped but they denied causation.

 The claim was a budgeted case, and the claim proceeded to expert meetings. Numerous settlement offers were made by both sides (the Defendant’s being significantly low for the value of the claim) in the run-up to this and it was not until February 2018, 6 weeks before the Trial was listed, that the Defendant accepted the Claimant’s offer.

The Claimant was extremely pleased with the outcome of the claim and also our ability to pursue the claim in face of the Defendants continuous denial of causative effect.

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