Asante v Guy’s and St Thomas’ NHS Foundation Trust [2018] EWHC 2570 (QB) (05 October 2018)

C claims damages for negligence in the treatment he received for a serious bone infection in 1999 – 2000. Breach of duty and causation only are to be determined at this stage. (paragraph 1)

C suffers from sickle cell disease (SCD)… In June 1999 C attended the hospital for the first time with a sickle cell crisis. He was 17 and had recently arrived from Ghana… Between June and August of 1999… he was admitted on several occasions for treatment for acute sickle cell crises, with symptoms of severe pain in different parts of his body, raised temperature and abnormal blood tests. (paragraph 2)

On 10 August 1999 C was admitted with a further sickle cell crisis and subsequently a diagnosis of acute osteomyelitis in his right tibia was made. It is his treatment in the period after this admission which forms the basis of the claim… the key periods of his treatment were during August/September 1999 and in March/April 2000, although there are some significant aspects of treatment in the intervening months, particularly November 1999, which need to be considered in the overall chronology. (paragraph 3)

…on breach of duty the issues are:

a) In relation to treatment in August/September 1999, whether it was negligent not to undertake further surgical debridement and/or carry out a local gastrocnemius muscle flap procedure to cover the exposed bone. (Whilst the appropriateness of the antibiotic regime is an issue, it is now relied upon by the Claimant as an evidential factor, rather than a separate basis for breach of duty); and

b) In relation to treatment in March/April 2000, whether it was negligent following the guttering procedure not to provide soft tissue cover by a gastrocnemius flap and /or adequate antibiotics. (paragraph 30)

…on 16 August 1999 D was in breach of duty in failing to take C back to surgery for further debridement..(paragraph 88)

…had he been treated by debridement, flap and antibiotics, the likelihood is that he would have been cured of osteomyelitis, or at least free from it for a long period. Flap surgery would have succeeded and the current type of crater with friable skin would have been avoided. He would have avoided the long subsequent history of infection and pain specifically attributable to it. (paragraph 95)

C therefore succeeds on the issues of breach of duty and causation. (paragraph 96)