Britchford v Staffordshire And Stoke-On-Trent Partnership NHS Trust [2018] EWHC 2109 (QB) (06 August 2018)

C attended at the [walk-in] centre …on 3 October 2011 complaining of a painful right hand and wrist and was seen initially by a receptionist and then by a nurse practitioner with the consultation taking place at around 1524 hours. A student nurse was also in attendance. (paragraph 2)

There is a stark factual dispute between the parties as to the nature and extent of C’s presenting symptoms… D’s conclusion was that the likely cause of the C’s pain was tendonitis. He supplied C with a splint and prescribed analgesia… (paragraph 3)

The next day, 4 October 2011, C complained of a headache and at about 11 o’clock in the morning she collapsed and was taken by ambulance to hospital… She was assessed and noted to have a left hemiplegia. A CT scan and angiogram confirmed that she had suffered an ischaemic stroke involving the right basal ganglia. She was given intravenous thrombolysis and subsequently intra-arterial aspiration… (paragraph 4)

…on behalf of C… on 3 October 2011 she presented at the centre with clear signs of a new onset vascular problem affecting her hand and that she should have been referred to a doctor for a further assessment. Rather, the history taken by D was superficial, perhaps because he was flirting with the trainee nurse and therefore distracted. Had C been referred, the probability is that the ischaemia which was probably then present would have been detected and would have led to C being started on a course of treatment of heparin which, in turn, on the balance of probabilities, would have prevented the resulting vascular event which took place on 4 October. Her collapse at home would have been avoided… (paragraph 8)

D asserts that [practitioner] did indeed consider a vascular cause but having looked for discolouration and found none, D reasonably concluded that there was not a vascular problem and a diagnosis of tendonitis and discharge were reasonable. The allegations relating to D being distracted by the trainee nurse are denied. (paragraph 9)

This is an unusual claim not only because of the very stark factual dispute between the parties but also because of the way in which D responded to a complaint made on the C’s behalf… (paragraph 12)

[The claim concerned complicated issues of fact.]

Whilst it is tempting, because of the temporal link between the presentation at the centre on 3 October and the occurrence of the stroke on the 4 October to conclude that there must be such a link there is no medical reason why the stroke which took place on 4 October could not have been one event with no prodromal symptoms. That is more probable than an embolic process commencing the day before in the absence of any report of any circulatory and/or vascular symptoms in any part of C’s right upper limb. (paragraph 39)

Whatever the cause of the pain that took C to see D on 3 October, D was not given any information that should reasonably have caused him to suspect a vascular or circulatory problem which needed to be referred to a doctor and the standard of the history taking undertaken by D was reasonable. (paragraph 40)

Claim fails (paragraph 41)