Flanaghan v University Hospitals Plymouth NHS Trust [2019] EWHC 1898 (QB) (26 July 2019)

…C was first seen in May 2008 and then in October 2012 when she underwent spinal surgery… following an admission consequent on her having tripped over a hole in the street, fallen and hit her head. Following that surgery, C is now tetraplegic. [2]

C was born on 26 March 1949. In October 2012, she was aged 63… [4]

In 2007, C developed left-sided spasticity… head and neck MRI scan which revealed degeneration of the lower part of the neck.. [cord compression lower neck]… [5]

On 22 May 2008, C [attended neurosurgeon]… a detailed letter… The essence of the letter was that C was asymptomatic apart from an abnormal gait. Examination revealed hyper-reflexia with slightly increased tone in the lower limbs… recommended conservative treatment and said that he had counselled C with regard to symptoms ‘to look out for’ and would necessitate urgent re-referral. [7]

Following that consultation and up until the time of her accident in October 2012 C remained stable and suffered no functional deterioration. [8]

On 23 October 2012 C… tripped over a pothole in the road, fell forward and hit her head on the side of the rear panel of a stationary vehicle. Immediately after the accident, C was unable to move her hands or legs. She was taken to the Hospital. [9]

MRI scans taken on the day of the accident revealed advanced degenerative disease with osteophytes encroaching into the spinal canal. [10]

On 24 October 2012 (the day after the accident), it was noted that C had normal right upper and lower limbs with some distal weakness in the upper left limb and marked loss of power in the left lower limb. [11]

…D recommended surgery to decompress the spine… [12]

D performed an anterior cervical discectomy and fusion at three levels. In summary, the procedure was long and difficult… [13]

D decided that further surgical intervention was necessary. C [underwent] further decompression operation on 27 October 2012 by way of a posterior laminectomy. Subsequent imaging showed that this had provided adequate posterior decompression. [16]

C has made a poor neurological recovery. It is common ground that a spinal injury of some sort occurred during the first surgical procedure… [17]

The allegations of breaches of duty are set out as follows:

i) The failure in 2008 either to recommend immediate decompression surgery or to review C at least annually

ii) the failure on 26 October 2012, wrongly operating without waiting for resolution of the swelling within the spinal cord;

iii) the failure on 26 October 2012, wrongly failing to order a pre-operative CT scan of C’s neck so as to differentiate between bony osteophytes and soft tissue prolapse;

iv) the failure on 26 October 2012, wrongly attempting the cervical discectomy…

v) the failure on October 26 2012, wrongly failing to appreciate the significance of the CSF leak and wrongly failing thereafter to convert to vertebrectomy; and

vi) the failure failing to re-operate as soon as possible after the report of the MRI …. [19]

D asserts [in] 2008 it was entirely appropriate to offer conservative management in conjunction with the advice as set out in the letter… In respect of the 2012 allegations, C suffered a recognised complication of surgery about which she had been appropriately warned and for which she had been appropriately consented and the fact that her neurological function deteriorated post operatively is not evidence of any fault in the timing or nature of the surgery undertaken on 26 and 27 October 2012. [20]

this claim should be dismissed… [82]