Case Report: Settlement following negligent treatment resulting in long-term impairment

Case Report: Six-figure settlement following negligent treatment of a rotator cuff tear resulting in long-term impairment

Helen Morland, Partner in our Clinical Negligence team at Hay & Kilner, has acted on behalf of a Claimant, who received substandard treatment from a Hospital Trust. It was alleged that there was significant delay in diagnosing a rotator cuff tear and initiating appropriate treatment which resulted in a suboptimal surgical outcome and long-term functional impairment.

The Claimant sustained an injury to his left shoulder whilst working on a barge and experienced immediate pain and restricted movement. He attended his GP surgery the following day, where he was advised to attend the Accident & Emergency department of an NHS hospital. An x-ray confirmed there were no broken bones or fractures. However, despite presenting with significant pain, bruising and inability to lift his arm, he was assessed solely by a registered nurse and discharged with a sling and without safety netting advice. He was reassured that there were no concerns and was advised to resume normal activities and return to work.

Over the following months, the Claimant’s symptoms persisted. He attended his GP surgery regularly. One-month post-injury, his GP raised concerns about a possible rotator cuff tear and referred him for an ultrasound scan. However, the referral lacked urgency and clinical detail, resulting in a delay of nearly 2 months before the scan was performed. The ultrasound scan which was performed 6 months post injury confirmed the Claimant suffered a full thickness rotator cuff tear with retraction and recommended urgent specialist referral.

With no further action taken, the Claimant requested a referral through his private healthcare. An MRI scan confirmed a rupture of the supraspinatus and subscapularis tendons, along with displacement of the bicep tendon. An Orthopaedic Surgeon offered the Claimant a surgical repair, but the Claimant requested to defer the procedure due to concerns about taking further time off work. The surgeon however failed to advise that Claimant of the risks associated with delaying surgery. The surgery was therefore performed over a year after the Claimant’s initial injury which hindered a successful outcome. Although initially successful, the tendons re-ruptured post-operatively. A follow-up MRI revealed multiple torn muscles, tendon damage, and significant muscle wasting.

Due to the poor surgical outcome, the Claimant was advised he would require a reverse shoulder replacement by the age of 64. He was also informed that he would not be able to continue his physically demanding job role beyond that age and would be significantly handicapped on the open labour market.

Helen was instructed to investigate a potential clinical negligence claim. Expert evidence was obtained from an A&E Consultant, a General Practitioner, and a Consultant Orthopaedic Surgeon. Although all experts were supportive of a claim, court proceeding against the GP and Orthopaedic Surgeon were discontinued and the claim proceeded against the NHS Trust only.

The Emergency Medicine expert criticised the initial assessment, which was conducted by a nurse with no evidence of diagnostic reasoning. The use of a collar and cuff sling was inappropriate for the suspected injury, and no safety netting advice was provided. The expert concluded that a competent assessment would have led to referral to a fracture/trauma clinic within a week and ultrasound imaging the same day. Surgery would have been offered shortly thereafter which would have been successful. The Claimant would not have required revision surgery and would have been able to stay in employment until retirement age.

Court proceedings were issued, and Particulars of Claim were served on the Defendant, identifying multiple breaches of duty. The NHS Hospital Trust made an admission of liability. Following negotiations, a six-figure settlement was offered to the Claimant and accepted.
Helen comments: ‘This was a very difficult case involving three potential defendants and extensive investigations had to be carried out. I am absolutely delighted we were able to come to a successful resolution as my client will need to retire significantly earlier than he had planned and his compensation will provide financial security in his later years.’

If you know anybody who has suffered in a similar way, or you believe you have a potential claim, please do not hesitate to get in touch with Helen or a member of the clinical negligence team on 0191 232 8345.