£115,000 awarded for pressure sores together with past and future care
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In the case of Reaney v University Hospital of North Staffordshire  EWHC 3016 (QB), Mr Justice Foskett awarded the sum of £115,000 for pain, suffering and loss of amenity, together with substantial care needs for the remainder of the Claimant’s life.
The Claimant was a 61 year old lady who was admitted to the Defendant’s hospital with a condition known as transverse myelitis, a very rare inflammatory condition which causes damage to the spinal cord. She became paralysed below the mid-thoracic level and was T7 paraplegic.
Unfortunately, during an extended period of hospitalisation the Claimant developed a number of deep (Grade 4) pressure sores with consequent osteomyelitis (infection of the bone marrow), flexion contractures (abnormal shortening of the muscle tissue) of her legs and a hip dislocation.
The issue for the court was to distinguish between the Claimant’s pre-existing and "post-pressure sore" needs. Although she had recovered from most of her pressure sores, she was left with a large area of vulnerable skin, which could break down if she was not moved properly by carers.
Foskett J found that the Claimant would have had a much better quality of life, spending her waking hours out of bed in a standard wheelchair (with the ability to maintain a good spinal posture and balance) which she would have been able to self-propel. She could have undertaken a few basic household tasks including chopping vegetables, making drinks and simple snacks. She would have been able to get out and about much more. Whilst she was inevitably going to be doubly incontinent, her bowel management would have been better and she would not have required what she had now, namely, a urethral catheter.
A typical T7 paraplegic at this age was able to insert rectal suppositories and carry out digital stimulation. Such a person would sometimes require assistance with the transfer on and off the toilet or on and off the shower chair that would go over the toilet.
Nevertheless such a person normally had a disciplined bowel habit, such that they had a good bowel programme, with occasional episodes of incontinence, but without bloating and other unpleasant associated features. In relation to catheterisation, an older paraplegic typically managed by means of a suprapubic catheter. Such a person was normally able to change the catheter themselves.
In relation to care requirements, a typical T7 complete paraplegic woman of this age would be able to manage largely on her own. She would require some stand by support with transfers and some hands on support with lower half activities of dressing, undressing and personal hygiene.
Within the NHS the majority of such women would rely on their family members for the support they require. They might receive some local authority support in the morning with getting up and occasionally in the evening with going to bed, though the latter was not common in paraplegics. Between times they relied on their partners or family or friends for support.
Foskett J concluded that:-
- (i) From about six months after her discharge from hospital in October 2009, it became apparent that the Claimant suffered from pressure sores and their sequelae that had made a significant and material difference to her physical well-being and her care needs from the position had those sores and their sequelae not been permitted to develop. She required henceforth two carers on a 24/7 basis, a requirement that would continue for the rest of her life.
But for the development of the pressure sores in hospital and their sequelae, the Claimant would have required no more than approximately 7 hours of professional care each week (supplemented by a very modest level of family support at the time of transfers) until the age of 70. Those needs would have been met by local authority carers and her family. The care would have been unpaid for save to the extent that any State benefits to which the local authority would have been entitled to claim (or re-coup) from the Claimant. She would have expended no personal money on this care because she had insufficient resources to do so.
- (ii) Although the Claimant needed two carers on a 24/7 basis, she did not receive such care because she could not afford it and the local authority was only able to provide only so much. Such gratuitous care as the Claimant received from her husband and other family members from the time of her discharge from hospital should be assessed by reference to the proposition that she required a very high level of care of daily care, including night-time care.
- (iii) The Claimant's future care requirements for the rest of her life fell to be assessed on the basis that she required 24/7 care from two carers such that she and her husband would need to move to a larger property in order to accommodate the carers - and indeed more comfortably to accommodate other necessary aids and equipment to meet her needs.
- (iv) The same considerations applied to the need for a larger vehicle to accommodate the Claimant.
- (v) But for the admitted negligence, the Claimant would have required approximately 7 hours of professional care each week (supplemented by a very modest level of family support at the time of transfers) until the age of 70, whereafter until the age of 75 she would have required gradually increasing visits from one local authority carer until from the age of 75 onwards when, as now, a total of about 31½ hours per week would be provided by the local authority based upon the attendance of two carers. Again, a modest (though somewhat increased) additional family input would probably have been required, but the significant feature of this period is that the professional care provided (in reality through the local authority) would not have been on a 24/7 basis.
Foskett J said that this case was a reflection of the principle that a tortfeasor had to take his victim as he found him. On the evidence, the Defendants' negligence had made the Claimant's position materially and significantly worse than it would have been but for that negligence.
Foskett J had any doubts in this case about the issue of causation in the "but for" sense, he would have been inclined to find that the Defendants had "materially contributed" to the condition that has led to the need for the 24/7 care of the nature discussed earlier in this judgment and that the lack of any joint or concurrent tortfeasor as a potential direct compensator (and/or from whom a contribution might be sought by the Defendants) was no answer to a full claim against the Defendants.
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