Margaret, 50

This case studies outlines how JMW helped to secure a woman £2.6 million compensation after the signs of cauda equina syndrome were not treated correctly.Read on for Margaret's story.

Margaret (50) was left with debilitating and permanent pain, paralysis in her feet, loss of sexual sensation, urinary incontinence and bowel dysfunction after her red flag signs of cauda equina syndrome (CES) were not treated appropriately.

Eddie Jones, head of medical negligence at JMW, took on Margaret’s case and secured her £2.6 million in compensation to help her to cope with her tragic situation.

Initial back pain

Many years before her CES ordeal Margaret was affected by back pain but after receiving treatment at hospital as an inpatient her symptoms improved greatly and caused her little trouble. However some years later she injured her neck in an accident and was referred to an orthopaedic surgeon at a specialist hospital.

Margaret was having problems with her right arm and shoulder so was given a full MRI scan which also revealed one of the discs in her spine had slipped. At this point the disc was not causing her any pain or problems. The orthopaedic surgeon told Margaret her neck injury was inoperable but warned her that if she suddenly became incontinent that she should return as an emergency.

Increased pain

However some time later while Margaret was collecting her granddaughter on a Friday morning she felt a twinge of pain in her lower back. The pain spread down her legs and feet and she had a general numbness and tingling in her saddle area. Her bowel and bladder function remained normal but Margaret was bedridden with the pain for the whole weekend. By Sunday she found did she was not getting any urges to go to the toilet, however at this point she could still pass urine.

Margaret could barely walk and on the Tuesday requested a home visit from her GP. The doctor examined Margaret and asked her if she had had any episodes of incontinence. Margaret said she had not, but had other symptoms such as no urge to empty her bladder and no feeling when she did, as well as loss of sensation across her pelvic area – all warning signs of an incomplete cauda equina syndrome (CESI).

The doctor then did a pinprick test of Margaret’s buttocks and perineum and Margaret felt nothing. The doctor said Margaret required an urgent MRI scan and that she would arrange this on her return to the surgery. Margaret had the number programmed into her home phone and offered the doctor the use of this, however she declined.

MRI scan delays

By the Thursday Margaret had still not heard about the MRI with the spinal unit so tried to call the GP. The receptionist told her she was not in and that she should call back the following day. Instead Margaret called the spinal unit herself. She was told that they had received a fax from the GP but as the GP did not have the authority to refer patients for an MRI an appointment with a consultant would be sent to her in the post.

Margaret eventually received her consultant appointment, which was arranged for more than two weeks after the GP had told her she required an urgent MRI. Margaret was taking a lot of pain killers and was still numb in her pelvic area.

When Margaret saw the consultant she repeated all her symptoms and he said he would arrange an MRI as a matter of urgency. However the scan did not take place until about two weeks later. Moreover Margaret’s follow up appointment with the consultant did not take place until about a month after the scan when it was revealed that the slipped disc was pressing on the nerves at the base of her spine.

The consultant said he would book Margaret in for surgery as a matter of urgency however her surgery was arranged for almost two months later.

A few weeks before her operation Margaret became unwell and was violently sick and also lost complete control of her bladder. Her husband rang NHS Direct immediately and she was taken to hospital by ambulance. A consultant was called from home so that Margaret could have an MRI scan. He said her symptoms were being caused by compression of the nerves in the spinal cord and she would need surgery urgently. About four hours later the operation was carried out.

Development of permanent cauda equina syndrome

However the appalling delays that Margaret had faced earlier in her treatment meant that she had developed permanent cauda equina syndrome. While the surgery alleviated her symptoms slightly, it was now too late to prevent permanent and severe mobility problems, urinary incontinence and chronic pain.

If her GP had ensured she received urgent hospital treatment (as she ought to have done) and the first hospital consultant had treated her symptoms appropriately and urgently this would have been avoided.

Settlement

After contacting JMW for advice, Margaret’s case was taken on by CES specialist Eddie Jones, who obtained her £2.6 million in compensation.