In April 2016 C was an in-patient at D hospital. It is her case that a vascular surgeon failed to diagnose an embolism. By the time this was diagnosed it was too late to save C’s right leg, and in May a below-knee amputation was carried out at a different hospital. [1]
This claim for clinical negligence focuses on just one event, namely D’s consultation and assessment on the ward on 13 April 2016. It is not now contended that D was negligent either before or after that date. [2]
On 5 April 2016 C was admitted to the hospital following a fall. She was 46 years old and had no history of heart or vascular problems… In A & E it was noted that she had an extensive erythrodermic skin eruption which was painful and itchy. C was admitted under the care of the medical team. Their notes record that her rash followed a course of doxycycline and had worsened over the previous two days. Following initial blood tests C was started on intra-venous flucloxacillin and emollients. She was referred for a dermatology review and admitted to the ward under the care of a general consultant physician [5]
[The narrative described symptoms relating to dusky toe right foot. She was investigated by ultrasound – nil found.. On 9 April 2016 new atrial fibrillation was found and treated. She underwent vascular review on 13 April 2015 “Impression – vasculitic picture rather than embolic. Plan – no further vascular input”]
C remained in hospital until 23 April 2016 when she discharged herself. [22]
C returned to the hospital on 26 April 2016 in a confused and very unwell condition… it was too late to save C’s leg… C suffered a further embolus or thrombosis whose source was the lower or distal aorta… C was not suffering from vasculitis on 13 April 2016(or, indeed, at any relevant stage) but from an embolic disease process originating in the distal aorta… [25]
J asked D whether a CT angiogram should have been carried out because the consequences of this being an embolism were potentially catastrophic… it is not realistic to carry out tests to exclude everything. [42]
a common-sense and non-legalistic approach to the evidence of [D vascular surgeon] is required. He lives in the world of clinical judgments rather than fine linguistic and legal distinctions. My overall interpretation of his evidence is that he concluded that this was unlikely to be embolic and/or that the chances of this being embolic were very low. He has explained why: the relative youth of C; the unremarkable scans; the absence of AF (at the material time); and a presentation of ischaemic signs which were more consistent with vasculitis, against the backdrop of serious infection. Statistical and/or epidemiological factors also support him, as does the absence of a relevant medical history. C’s smoking will not have helped, but that factor was expressly noted. D’s diagnostic conclusions may be interpreted as excluding a realistic possibility of digital embolisation, and that a reasonable body of medical opinion would agree. [89]
this claim must be dismissed [90]
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