Delay in Diagnosis of Tumour

C received £80,000 for the delay in diagnosis and treatment of a Schwannoma Tumour of the spine as a result of two sets of x-rays being reported negligently as normal in August and December 2000.

Clinical Negligence: In 2000, the claimant presented to his GP and thereafter to a Consultant Orthopaedic Surgeon with low back pain. He was referred for investigations, including x-rays in August and December 2000. Although the x-rays were reported by a Consultant Radiologist at the Shrewsbury & Telford Hospital NHS Trust; the August x-ray had been reported as part of the Radiologist’s NHS Practice whereas the December x-ray was reported privately. For this reason, it was necessary to issue proceedings against the first and second defendants.

On 3 April 2000, the claimant underwent an abdominal x-ray, which was reported has showing no abnormalities.

A lumbo-sacral spine x-ray was performed on 30 August 2000 and reported on behalf of the first defendant on 31 August 2000 as showing no significant abnormalities of the lumbar spine. It was the claimant’s case that abnormalities were shown and, in fact, the x-ray demonstrated a smaller and partly sclerotic right-sided pedicle at L1 and some posterior scalloping of the L1 vertebral body on the lateral view with an increased size of the foramen.

A further lumbar spine x-ray was performed on 19 December 2000 and reported by the second defendant as showing no abnormalities. It was the claimant’s case that, in fact, the x-ray demonstrated the same appearances as the x-ray reported on 31 August 2000.

It was alleged that if the x-rays had been correctly reported in 2000, the claimant would have referred for a scan, which would have led to the diagnosis of Schwannoma, by September or December 2000. Thereafter, the claimant would have undergone surgery to excise the tumour with the likely outcome of a full recover with no continuing sensory or urinary symptoms and headaches.

However, due to the negligent failure on the part of the first and second defendants, to diagnose the claimant’s condition in 2000, he continued to suffer low back pain until he eventually presented with Cauda Equina Syndrome in April 2004, resulting in the tumour finally being correctly diagnosed. During the period of 2000 to 2004, the claimant continued to experience back pain, which caused difficulties in both his personal and working life.

The tumour was surgically removed in 2004. Following the surgery, the claimant continued to suffer sexual impairment, urinary symptoms, severe headaches and back pain. It was the claimant’s case that the debilitating headaches he experienced following surgery were due to the presence of a pseudo meningocoele, which developed at the site of the large dumbbell Schwannoma tumour. The claimant alleged that this complication would not have occurred if the diagnosis had been made at the time the tumour was small and did not have such a major extra spinal component.

A split trial was ordered. Breach of duty and particularly the central issue of whether the Radiologist had acted negligently in August and/or December 2000 was to be dealt with alone. Breach of duty was strongly denied by the defendants. Causation was initially denied other than a partial admission that the claimant may have avoided the effects of conus compression with earlier diagnosis and treatment.

Following exchange of liability reports, an application was made to Court on behalf of the claimant for permission to instruct a second expert Radiologist to report on breach of duty, or in the alternative to limit the expert evidence of the defendants. The basis of the application was that both parties should be on an equal footing. The Judge gave permission for the claimant to rely on a second Radiologist expert on the basis that justice would not be done without the claimant being permitted a second expert. It was for the Court to determine what a reasonable body of expert opinion would say about the x-rays, and without a second expert, the claimant would be severely prejudiced.

The second Radiologist opinion was supportive of the claimant’s case and disclosed to the defendants. At the joint experts’ meeting, all four experts’ radiologist experts were in agreement as to the abnormalities, which could have been noted on the x-rays, although the defendants argued that this was for the benefit of hindsight.

The defendants were not willing to enter settlement negotiations. The claimant put forward a Part 36 Offer of £80,000, which was rejected. A counter offer was made that the defendants would bear their costs if the claimants were to discontinue the claim. This was rejected. On the final day before the Trial, the second defendant offered to accept the claimant’s initial Part 36 Offer of £80,000, together with the costs of proceedings against both defendants.

Injuries: The claimant suffered a delay in diagnosis of the Schwannoma tumour of his spine at the level of L1/2 such that the tumour continued to grow and he developed cauda equina syndrome.

Effects: The claimant suffered low back pain from 2000 to 2004 when the tumour was eventually diagnosed. The pain caused difficulties with both his personal and working life. Following surgery to remove the tumour in 2004, the claimant has continued to suffer from sexual impairment, urinary symptoms, severe headaches and back pain.

Breakdown of Damages: Estimated by the claimant’s solicitor. General damages £14,000. Past travel and medication £800. Past loss of earnings £1,600.00. Past DIY/gardening £1,600. Future care/DIY £16,000. Future loss of earnings £20,000. Interest £1,600.

Total Damages : £80,000
Type of award : Out of Court settlement (approved)
Settlement date : 5 June 2009
Court : Shrewsbury County Court
Age at injury : 30
Sex : Male