Failure to diagnose and treat subarachnoid haemorrhage
Mrs Derammelaere was admitted as an emergency to the Royal Bolton Hospital having collapsed at work. She had been complaining of a severe headache and had been vomiting. She had also been suffering from headaches since the summer of 2004 and had regularly seen a neurologist.
MR scanning had revealed a Chiari malformation, but it was not considered that this was the cause of her headaches.
Mrs Derammelaere had been incontinent of urine and she was photophobic, and it was recorded there was no neck stiffness and that neurological signs were normal. Over the weekend she continued to suffer severe headaches. A telephone discussion took place between the general physician on duty at Bolton and Mr AK during which it was agreed that further scanning was not indicated.
A CT scan was carried out on 17 January 2005 although it was not reported until 21 January 2005. It was reported as showing: ‘…a 1.5cm high density focus which is suspicious of an aneurysm’
On Tuesday 18 January 2005 Mrs Derammelaere was transferred to Hope Hospital following a discussion with the neurosurgery Specialist Registrar. A further MRI brain scan was performed, which showed an aneurysm and evidence of subarachnoid haemorrhage on the FLAIR sequence.
Unfortunately the clinical records for this period were lost so details were lacking. On 20 January 2005 Mrs Derammelaere deteriorated when her headache suddenly intensified followed by a reduction in her level of consciousness with no respiratory effort. A CT scan was arranged and this showed findings suggestive of diffuse widespread subarachnoid haemorrhage and raised intracranial pressure. She was seen by Mr AK and he felt that no surgical treatment could be offered. An intracranial pressure bolt was inserted and Mrs Derammelaere was transferred to intensive care. At 13.20 the pupils again became dilated and there was suspicion that the she had coned. The situation was discussed with Mr Derammelaere and it was decided to withdraw treatment later that day.
It was alleged that the medical staff at Bolton Hospital failed to investigate the possibility of subarachnoid haemorrhage quickly enough, and that the diagnosis should have been confirmed on 14 or 15 January 2005. Had this occurred Mrs Derammelaere would have been transferred to Hope Hospital 3 or 4 days earlier, and she could have been successfully treated with endovascular coiling.
In relation to Hope Hospital it was alleged that the MR scan of 18 January 2005 was diagnostic of subarachnoid haemorrhage, and that this should have led to prompt endovascular coiling. Our evidence was that even if the procedure had been performed during the morning of 20 January 2005 Mrs Derammelaere would have had a 90% chance of survival and a good chance of being able to live a normal life.
Liability was denied and following a Part 18 Request the Defendants indicated that Mrs Derammelaere could not have undergone endovascular coiling on 19 January 2005 as the lists were already full.
The Defendants made an offer of £125,000 in January 2009 and this was rejected. We made a counter offer of £190,000 which was initially rejected by the Defendants, who made a counter-offer of £175,000. After further discussions a settlement of £190,000 was agreed. This took into account a claim for psychiatric injury on behalf of Mr Derammelaere, although this aspect of the claim was disputed on the basis there was no single shocking event which qualified Mr Derammelaere as a secondary victim.
The settlement was agreed following exchange of witness statements and before exchange of medical reports, and the case was funded by a CFA.
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