10th June 2007:
Letter from Abigail's mother:
" My daughter's medical accident happened nine years ago, when she was eight years old. She had been playing in the garden and fell causing a glass puncture wound to her knee. It became badly infected, swollen and painful, it was necessary to take her to A & E - on a Saturday night at 11.30pm. 30th January It was an incredibly busy time. She was seen by a very young doctor who wrongly discharged her without recognising the condition.(error no.1)
She had to be readmitted as an emergency on the Sunday but, unfortunately,the "usual team" were not there. ( Thank goodness it was not the 31st. December , I dread to think what would have happened...) She was then seen by a Senior House officer who correctly diagnosed her condition as 'septic arthritis' and also signed her up for the correct antibiotics - intravenous Flucloxacillin & Penicillin.
She was then referred to the "orthopaedics" who carried out the operation.We were told this was not the 'usual' team- perhaps weekend cover?However, they unfortunately changed her antibiotic prescription and quantity (to a less appropriate one, on a lower dosage) ( Error no.2)and also failed to correctly record the diagnosis ( Error no.3). Therefore, when she was discharged a few days later, she was just given a prophylactic antibiotic dose, which was not nearly high enough. I believe that the discharge note was signed by a different SHO, but he was obviously going on inaccurate information. The inevitable happened, the infection returned with a vengeance.
She then required a second emergency admission. She was correctly diagnosed and was seen by an orthopeadic consultant. However, he unfortunately failed to consult a microbiologist( Error no. 4) the pus from her knee should have been sent to a microbiology laboratory . Consequently she was under-treated with antibiotics! (Error no 5) What a pity he did not refer to his orthopeadic textbook - he failed to consult a microbiologist I think doctors are quite often very bad at referring patients to other specialties, preferring to think they can cope. What she had was quite rare, but it had been diagnosed by a relatively young doctor correctly on the Sunday. There was no adequate follow-up ( Error no. 6).
She had a second operation on 2nd February - discharged 4th February again with the wrong and inadequate antibiotics ( Error no. 7). Another operation was required on 9th February - again no one consulted a microbiologist ( Error no. 8) ....We have discovered that the correct treatment for a septic arthritic joint is 3- 6 weeks of continuous high dosage of correct antibiotics. - intravenous if necessary.
We now realise that the whole injury could have been dealt with by one operation to wash out the knee and remove the shard of glass, a drain to the knee and a high dose of antibiotic therapy for several weeks until all infection had disappeared. She would then have been left with a normal knee!. This did not happen - they messed up the treatment at the local A & E and wrongly discharged her without any antibiotics and without proper laboratory tests to determine the infecting organism -if this had been done, she would have made a complete recovery.
My daughter ended up with four painful operations and septic arthritis of the joint. She required four steroid injections and masses of physiotherapy. She was badly crippled and in pain for several years and had to use crutches for a whole year, in and out of hospital - a really awful time!!
Eights years later the knee is more stable but she still cannot run, do gymnastics, ballet, dance etc - all the normal activities that a young girl should be able to do. Her knee is still very painful when walking upstairs. She has the knee of an old woman. We are grateful that she isn't more permanently disabled, at one time we thought she would be. She is hoping that she will not end up with a total knee transplant in her twenties.
What did we do?
We complained to the hospital [This was the correct procedure for every public spirited person to do. This had all the appearance of a serious Patient Safety Issue - a number of mistakes seem to have been made. Every one of them should, of course, have been recorded and investigated. Did the Trust register them with the NPSA?].The hospital admitted some liability and offered to pay some compensation.[This is exactly what should have happened] We, perhaps foolishly, thought we should contact a medico-legal solicitor whom we thought would be able to establish reasonable damages better than we could.[SIN has been advocating a compensation fund set against a National Tariff - just as they have for car accidents - with Mediation.) The hospital then offered £4,000 . This we thought was too low considering that Abigail has been left with a 70year old knee and would not be able to enjoy normal physical activities, and may need a knee transplant in the not too distant future.
In retrospect, we realise that the solicitors should have suggested Mediation, but this was never raised as an option.[ According the the NHS Complaints & Litigation Department Quarry House, Mediation has always been available and the concern was that very few people used this process. This is hardly surprising when the legal advisors ignore the possibility, even AvMA rarely seems to promote Mediation.Presumably, Mediation is unpopular with the litigation lobby because it shortens the time needed to settle the case and this means, of course, less money in their pockets.] Instead, the solicitors went down the legal route of instructing 'medical experts' to write reports.
In our opinion the experts lied in their reports and found an irrelevant laboratory test which they claimed proved that my daughter's problems were not due to negligence. We kept challenging the 'experts' and ended up with a meeting with our barrister and the experts at the Royal Courts of Justice . We were gob smacked that the experts stuck to their flimsy version of events, proceeded to do a complete whitewash and lied through their teeth. Our barrister did not challenge them once and allowed them to give opinions that were right outside their field of competence/expertise. [This is very common - it is also amazing how 'experts' can change their opinion at the last moment - yet rarely give back their fee - see Julia's case] We can only assume that the legal aid lawyers and the medical experts collude to deny justice to the injured patient in order to minimise compensation.
After this travesty of justice ( the meeting cost more in 'professional' fees than the original £4,000 offer) the barrister announced that the legal aid money had run out, so if we wanted to pursue the case we would have to fund it ourselves. The whole thing was a complete farce - we are worse off than we would have been if we had accepted the offer in the first place.
In our opinion, the medical experts and the legal aid lawyers have been so corrupt it is truly astonishing!"
This case was crying out for Mediation - clearly damage had been sustained and Abigail is part of the 1% that sustained a permanent and serious injury. The Trust was willing to be 'truthful' - what a pity the legal bods messed it up. SIN has been calling for an investigation into the processes of Medical Litigation - with evidence coming from iatrogenic patients.SIN is also calling for a National Tariff - it should not be too difficult to establish compensation for this particular case.
It is interesting to note that in the Houses of Parliament during the Debate on the Redress Bill in July 2006, Mrs Hewitt mentioned a case of one Trust giving out £12,000 to a patient who had had a ankle fracture missed. It was rectified and the assumption is that the patient fully recovered. This suggests that £4000 for a long standing, serious, possibly permanent injury to a young girl was rather inadequate.