Henry, a 50 year old male consulted his GP with a history of a
few days of sweating, malaise, mild cough, tiredness and waking up
shivering in December 1997. On examination, Henry had lost weight.
His chest was clear and there was no lymphadenopathy (swelling of
the lymph nodes). A diagnosis of a possible viral infection was
made.
The next day Henry consulted his GP again complaining of
dark urine and feeling generally unwell. Blood tests were carried
out and the GP referred Henry to Dr Sevitt, consultant general
physician who arranged his admission to the London Clinic on 9
December.
On admission laboratory investigations were undertaken and
showed renal dysfunction with raised urea and bilirubin, poor
reticulocyte response, low haemoglobin (indicating anaemia) and
there was a low platelet count.
Henry was given a transfusion of six units of platelets and a
course of intravenous antibiotics. Platelet transfusions were
continued daily until 15 December 1997.
Blood film results reported on 10 December 1997 showed
microangiopathic and haemolytic anaemia (MAHA).
On 11 December, he was seen by Dr Kaczmarski, haematologist, who
concluded “I would recommend supportive care only, avoid further
platelet transfusions unless neurological signs manifest … plasma
exchange not indicated at present as it seems to be settling. May
consider if develops neurological problems”. Despite this advice,
platelet transfusions were continued.
On the nights of 11 and 12 December, Henry had neurological
symptoms and was noted to be confused. Post-infective HUS was
queried.
In fact the correct diagnosis was thrombotic thrombocytopenic
purpura (TTP).
On 13 December notwithstanding Dr Kaczmarski’s advice platelet
support was continued and plasma exchange was not commenced. At
7:00 p.m. on 14 December, Henry suddenly deteriorated and was noted
to have left-sided hemiparesis, sensory abnormalities, confusion,
restlessness and was dysarthic. He was transferred to the ITU.
On 15 December, Henry was again reviewed by Dr Kaczmarski who
specifically noted that Henry’s condition was behaving like TTP. He
recommended that further platelet transfusions be avoided and
plasma exchange be considered.
Even with the correct diagnosis and appropriate advice as to
treatment, Henry was not given plasma exchange, but 10 further
platelet transfusions were given.
On 18 December, Henry was transferred to UCH under the care of
Professor Machin.
Henry was discharged at the end of April 1998 on long-term
cyclosporin therapy and prophylactic dose aspirin and folic acid
with regular follow-ups.
Expert evidence from a consultant haematologist was critical of
the failure on or after 11 December 1997 to make the correct
diagnosis of TTP, which should prompt immediate plasma therapy and
immediate cessation of platelet transfusion. The delay in
diagnosing the illness and instituting appropriate treatment caused
Henry to suffer a life threatening illness requiring long-term ITU
care on a ventilator.
The platelet transfusions contributed to the TTP progression,
the deterioration of Henry’s neurological function and the need for
ITU and ventilatory support. But for the negligence, Henry would
have been hospitalised for three to four weeks and would have been
back to work by 1 February 1998.
On 22 September 2000, the claimant made a Part 36 offer in the
sum of £300,000. This offer was rejected and so proceedings were
issued on 27 November 2000 and were served on 13 March 2001.
The defence made limited admissions in respect of breach of
duty. In November 2001, the defendants made a 'without prejudice'
offer in the sum of £50,000.
On 14 December 2001, the defendants made a payment into court of
£75,000 which was rejected. Factual and expert evidence was
exchanged. Expert meetings took place and 21 days before trial, the
defendants paid into court a total sum of £200,000.
After negotiation, Henry’s claim was settled in the sum of
£240,000.
Paul McNeil conducted this under a
conditional fee agreement.
For further information or if you have an a general medicine claim please call Paul McNeil on 020 7861
4019 or email paul.mcneil@ffw.com
You can discuss your general medicine claim with any member of
our medical negligence team on
freephone 0800 358 3848, email personalinjury@ffw.com or
complete our short enquiry form.