Amputation Claims - written by Marina Nkondi, Clinical Negligence Paralegal

Amputations

Whilst most cases surrounding amputations revolve around the fact that there was a failure by the medical staff in identifying and treating the symptoms which could lead to a limb being amputated, some cases revolve around how the amputation was carried out. The results of an amputation can be devastating and have mental and physical consequences and here at Clear Law we are here to help.

An example of one case which arises due to a negligently performed amputation is described below.

Claimant's Case

The case involved a Claimant whose past medical history included: type 2 diabetes and complications secondary to diabetes such as reoccurring ulcers on his right foot, deformity of his right foot and ankle with Charcot arthropathy and reoccurring wound breakdown. In September 2016 he was being treated for osteomyelitis and was keen to explore the possibility of undergoing a below knee amputation so that he could get on with his life in a healthy way.

At a pre-amputation consultation at the Defendant Rehabilitation Centre in December 2016 the Claimant was advised that he would be a good candidate for rehabilitation following below knee amputation and was given a good prognosis on his standard mobility and recovery.

The Claimant underwent a below knee amputation of his right leg on 3 February 2017 and was then transferred to a rehabilitation centre. The Claimant made reasonable progress and was then discharged from the Rehabilitation Clinic when he became more independently mobile and able to ascend and descend stairs.

Shortly after, the Claimant began to develop pain on the lateral aspect of his stump which deteriorated to the point where he experienced excruciating pain after taking a few steps. He developed a callus at the end of his stump and had issues with using his prosthesis.

By July 2017 it was noted that he had a chronic blister on the lateral aspect of the end of the stump.

The Claimant was provided a new socket in August 2017 which initially helped with his pain and discomfort when mobilising. That progress was lost and in November 2017 the Defendant noted that whilst he was walking well, the Claimant had excessive soft tissue at the end of his stump and pain at the end of his tibia with a possible neuroma.

In January 2018 it was noted that the Claimant was experiencing neuropathic pain

He had a further socket fitted on 2 February 2018 and attended for further adjustment of his prosthesis. However, by August it was noted that he continued to have a painful stump. He was referred to see a Consultant in Rehabilitation Medicine who reviewed him in August 2018.

The Claimant hoped to undergo revision of his stump to reduce the lax soft tissue on the end of the stump however the Orthopaedic Surgeon advised that he was unwilling to operate on him.

It was the Claimant's case that the Defendant was negligent in:-

1. When operating on the Claimant on 3 February 2017 the Defendant failed to properly manage the division of the nerves at the point of the amputation. The Defendant should have divided the nerves under tension so as to ensure that the nerve endings retracted and avoided the formation of superficial neuromas.
2. The Defendant failed to undertake revision surgery on the Claimant’s stump. Following surgery, the Claimant was noted to have excessive soft tissue at the end of his stump, which inhibited his ability to achieve a proper fit on his prosthesis socket. This would have been amenable to surgery and is a relatively common complication following amputation. The Defendant could also have revised the Claimant’s prominent fibula and removed any superficial neuromas.
3. The Defendant failed to advise the Claimant that he could undergo revision of his stump in order to address the problem with excessive soft tissue and/or prominent fibula and/or superficial neuromas;
4. The Defendant declined to undertake revision of the Claimant’s stump when he enquired about it. The Claimant states he was declined further surgery because of the collection of bad outcomes that he had had and in the context of threatened litigation.

As a result of the negligence, the Claimant's mobility using his prosthesis is now limited to only a few meters with pain, he can walk a few steps outside but is not confident going up and down the stairs and when he goes out of the house he will rely upon a wheelchair.

The Claimant suffers from chronic pain in his residual limb for which he has been prescribed medication. The Claimant’s mental health has been affected and was prescribed an anti-depressant and medication for anxiety.

Claim

Upon receiving instructions, the Claimant's medical records were sought for analysis and to create a detailed Chronology. Evidence was obtained from a Consultant Vascular Surgeon and Consultant in Rehabilitation Medicine which was supportive. A detailed Pre Action-Protocol Letter of Claim was served on the Defendant on 13 January 2020. Following an extension on limitation to allow the parties time to fully investigate the matter, a Letter of Response was served on the Claimant on 3 June 2020. The Defendant admitted that the fibula ought to have been transected at a higher level. All other allegations in respect of breach of duty and causation were denied and a Part 36 offer of £14,212.22 was made. The offer was rejected by the Claimant who requested a further extension of time in order to obtain quantum evidence, which was agreed by the Defendant.

In order to progress the matter, the Claimant issued proceedings on 23 July 2021.

The Defendant put forward a time limited offer of £45,000.00, exclusive of CRU, on 15 February 2022 which was open for acceptance until 8 March 2022.

The matter was allocated to the Multi-track and listed for a CCMC on 10 June 2022, with the Parties ordered to file budgets.

The Claimant put forward a Part 36 offer of £150,000.00 on 8 March 2022 alongside a Part 18 Request for further information in respect of the Defence.

The Part 36 offer was rejected by the Defendant on 17 March 2022.

The Defendant agreed to attend a Joint Settlement Meeting following exchange of liability expert evidence on a without prejudice basis. During the meeting, the Defendant put forward a Part 36 offer of £75,000.00 on 30 August 2022 and this was accepted by the Claimant on 31 August 2022.