‘Philippa’, 58

Philippa was left with bladder and bowel incontinence, severely impaired mobility, and the loss of her sexual function, after her GP failed to refer her for emergency treatment when she had the red flags of cauda equina syndrome, a frequently devastating spinal injury. 

Sadly, Philippa’s life has been completely devasted by these failings and she can no longer work, has lost much of her independence and has a poor quality of life. Absolutely nothing could make up for this, but after Philippa’s case was taken on by Mark Havenhand, a cauda equina specialist solicitor at JMW, she was awarded £900,000 in compensation to provide her with the financial means to cope with her lifelong disabilities. 

What went wrong?

Philippa had been suffering with lower back for about four months and given the symptoms didn’t go away, thought it best to attend her GP. At this point Philippa’s bowel and bladder were working normally.

The doctor said he would refer her for a non-urgent MRI scan and some physiotherapy and told her to come back if she had any further problems. 

About two weeks later, Philippa noticed a deterioration in her condition in that both her buttocks felt numb, with the numb sensation also extending to her groin and vagina. She had also noticed that she was having to strain to open her bowels when she felt that she needed to go. She was seen by the same GP as previously, who carried out an examination, but omitted a vital part that would have enabled a diagnosis of suspected cauda equina syndrome to be made. The doctor made a non-emergency referral to hospital spinal injury specialists for Philippa and told her to go to A&E if she became worse, or if she suffered any episodes of incontinence. 

Philippa was becoming increasingly concerned about her condition and contacted her GP on a further four occasions. Her back and leg pain continued to worsen. She could not open her bowels and was relying on laxatives, much of the lower part of her body felt numb and she had to strain to urinate. These symptoms should have painted a picture of cauda equina syndrome being a strong possibility, yet the GP (who had seen her previously) failed to recognise this and arrange an emergency hospital admission.

The final time Philippa contacted her GP her appointment was with another doctor. This doctor called the orthopaedic and spinal team at Philippa’s local hospital and arrangements were made for an MRI scan to be carried out. The scan revealed a huge bulging disc in the lower part of her spine that was compressing the cauda equina nerves, those that control sensation in the lower body, as well as bowel, bladder and sexual function. Philippa was told she had cauda equina syndrome. This was the first time she had heard of this condition. 

After Philippa was blue-lighted to a larger spinal injury specialist hospital, in the early hours of the following morning surgery was carried out to remove the disc and relieve the pressure on her nerves. 

Sadly, Philippa made a limited recovery due to the amount of time that had passed since her symptoms had first appeared. The window of opportunity to prevent permanent nerve damage had gone and she was left with lifelong consequences that were preventable if surgery had been carried out at an earlier stage. 

JMW’s investigation

It was when Philippa started to research the condition cauda equina syndrome that she began to realise that surgery should be carried out within 24-48 hours of the red flag signs, such as numbness and bowel and bladder dysfunction, appearing. Philippa recalled how many times she had spoken to the GP about her symptoms in the weeks running up to her emergency surgery. It didn’t feel right to her that she had been left to progress to such a severe stage when she had asked for help on multiple occasions. 

Her research brought to her to JMW, and she read about the many other people that we have helped who have suffered almost identical delays to their treatment for cauda equina syndrome. We took on Philippa’s case and her solicitor Mark Havenhand used his experience of cauda equina cases to do an initial assessment of what went wrong. This involved speaking to Philippa and analysing her medical records. Mark felt that the case needed to be investigated further. He asked leading independent medical experts, to prepare reports on the quality of the GP’s care and separately whether earlier treatment would have improved her condition and halted any deterioration. 

The expert revealed that the GP had failed to carry out a crucial physical examination, namely assessing sensation to “light touch” on the skin and, bearing this mind, together with her other symptoms, he concluded that this was poor care. When the case was put to GP, the doctor admitted a full examination had not been performed, but denied anything abnormal would have been discovered, or that earlier treatment would have made any significant difference. However, Mark was able to push on with Philippa’s case due to the strength of the evidence, and the doctor later agreed, via his insurance company, that he should compensate Philippa so that she could cope financially with her appalling injuries. 

Cauda equina compensation 

Mark negotiated a compensation settlement that totalled £900,000 for Philippa. Whilst the compensation can’t turn back the clock, Philippa now has some financial security for the future. The award was calculated to enable Philippa to obtain appropriate rehabilitation and therapies to manage her condition and to also purchase a new house that was more appropriately suited to her needs.