Crohns Disease - NHS Negligence.
CROHNS DISEASE - NHS - NEGLIGENCEIN THE MATTER OF:-M-v- PENNINE ACUTE HOSPITALS NHS TRUST
Background to the Claim : -
The Claimant pursued an action against the Defendant Trust alleging negligence in the failure to promptly diagnose and treat his Crohn's disease.
The Claimant was born on the 2nd June 1977 ( 22yrs ) and is a Plasterer by trade.
On the 29th September 1999 he attended his GP complaining of epigastric pains after food, which had been increasingly worse over the preceding 2 months with weight loss. He was referred to North Manchester General Hospital under the care of the Consultant Gastroenterologist as an urgency and was first seen on the 18th October 1999 when the treating Consultant noted that from the history:-
" One would suspect that he has got small bowel pathology, either due to Crohn's Disease or lymphoma."
On the 20th October 1999 the Claimant underwent a gastroscopy and a differential diagnosis of celieac or Crohn's Disease was made. On the 27th October 1999 he experienced sudden severe epigastric pain with vomiting for 3 hours and was admitted to hospital as a matter or urgency,
On the 15th November 1999 the Claimant underwent a barium meal and follow through examination which was interpreted as showing normal appearances. The Claimant's Consultant subsequently wrote to his General Practitioner noting the finding of the barium follow through and further that duodenal biopsy showed no change specific for Crohn's Disease. He noted that the final diagnosis was uncertain but one could not completely exclude a diagnosis of Crohn's Disease.
In the following months the Claimant continued to attend the GP with gastrointestinal symptoms. On the 20th March 2000 due to ongoing ill health the Consultant Gastroenterologist arranged for the Claimant to have a white cell scan. The isotope scan yielded an abnormal result suggestive of Crohn's Disease. Thereafter the Claimant was started on medication namely Pentasa. During August and September 2000 the Claimant remained symptomatic with stomach cramps.
On the 20th October 2000 the Claimant asked for a second opinion. The Consultant Gastroenterologist had retired on the 11th October 2000 and the Claimant was referred to a Locum Gastroenterologist who saw him on the 5th December 2000. Following the Consultation the Claimant was started on 40 milligrams of Prednisolone. The Locum Consultant indicated:-
"Although there is conflicting evidence from our investigations, I think we need to take the bull by the horns here and treat him for presumed small intestinal Crohn's Disease."
In addition the Locum Consultant reviewed the barium meal study noting an abnormality in the terminal ileum consistent with Crohn's Disease previously unreported.
Thereafter the Claimant continued on Prednisolone and subsequently Azathioprine. The Claimant's condition improved noticeably on Prednisolone to the extent that he was able to return to work in May 2001 having been absent from October 1999.
Claimant's Medical Evidence
A report was commissioned from Dr. A F Evans, Consultant Radiologist who reviewed the radiology in the case and in particular the reporting of the barium meal investigations. He concluded that the barium meal of the 15th November 1999 was "erroneously reported" and indeed was consistent with a diagnosis of Crohn's Disease.
A further report was obtained from Dr. John Mayberry, Consultant Physician and Gastroenterologist who concluded there was a breach in the standard of care afforded to the Claimant in several respects namely :-
.Incorrect interpretation of the barium meal following examination of the 15th November 1999;
.Limited use of abnormal isotope labelled white cell scan on the 13th April 2000;
3.Use of a low dose Pentasa regime from 15th May 2000 changed to 500 milligrams BD on the 17th July 2000.
Dr. Mayberry concluded that had the barium meal investigation been corrected report this would have lead to a more effective treatment such as oral steroids or even surgery. He was critical of the delay in effecting treatment following the isotope white cell scan. Dr. Mayberry was of the opinion that the delay in treating the Claimant prolonged his general ill health and delayed his return to employment.
A pre action protocol letter of claim was sent to the Defendant and subsequently the Claimant gave unilateral disclosure of his expert evidence.
The Defendant admitted breach of duty. Thereafter negotiations were entered into by the parties. The matter concluded with a payment of damages in the sum of £18,000.00 to the Claimant of which approximately £10,000.00 represented the sum for the Claimant's pain, suffering and loss of amenity. There was no long term sequelae as a result of the Defendants admitted breaches.
Case report submitted by Eddie Jones, JMW Solicitors, 5/7 Byrom Street, Manchester, M3 4PF, Solicitor for the Claimant. Counsel Sally Hatfield, Peel Court Chambers, Manchester. Defendant's solicitor, NHSLA Legal Dept.