Rai v University Hospitals Coventry And Warwickshire NHS Trust [2019] EWHC 2488 (QB) (12 September 2019)

…It was alleged that as a result of the Defendant’s failure to diagnose and manage a post-operative staple line leak, the Claimant endured avoidable suffering until a diagnosis was made on 11 March 2013, by which time she was suffering from severe abdominal sepsis. Thereafter she suffered the avoidable effects of a persistent fistula and the complications of complex and lengthy treatment and is left with residual physical and psychological injury…[1]

C’s pleaded case on breach of duty is that the respondent failed to heed or adequately act upon C’s persistently high analgesic requirement, dropping oxygen saturation levels, de novo nausea and inability to tolerate food and drink which taken together amounted to a failure to progress as one would have expected following the procedure. It was also claimed to be negligent in that D failed to investigate for leak prior to discharge and discharged the Claimant rather than keeping her in for further monitoring and investigation. As was suggested the case essentially resolves on the court’s assessment of whether C was “well” at the point of the decision to discharge. [57]

The pleaded case on causation is that had C been kept in hospital her fluid intolerance and other symptoms were likely to have persisted or worsened. Imaging of the upper gastric staple line would have been performed on post-operative day two or three. It was accepted in the Particulars of Claim that on the balance of probabilities such imaging would not have revealed signs of emerging staple line leak; however, regardless of the findings of such imaging, it is argued, Cl’s clinical picture warranted continued admission and further investigation of the staple line. It is said that early laparoscopy (post-operative days three or four) with or without methylene blue dye testing would have been undertaken and early over-sewing repair along with drainage (post-operative days three or four) would have successfully prevented the full failure of the staple line. It is claimed that C would have avoided the injuries she suffered. [73]

…on causation as also on breach of duty this claim must fail… [88]