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Case Study

Instructions received in connection with a claim for damages for clinical negligence, under the Law Reform (Miscellaneous Provisions) Act 1934 and the Fatal Accidents Act 1976. The Claimant is the widow of the deceased (‘the deceased’). On 2 March 2003, the deceased had been admitted to the Defendant’s hospital with beta-haemolytic streptococcus sub-acute bacterial endocarditis. He was treated with intravenous antibiotics and diuretics until 1 April 2003, when he was discharged home. An echocardiogram from Walsgrave Hospital (to which hospitals patients would be referred and/or transferred in the event of their requiring surgery) had shown significant arterial venous vegetation with arterial regurgitation. On 14 April 2003, the deceased was reviewed in the hospital’s out-patients department by Dr Hadier, who wrote to the deceased’s general practitioner; stating that he had.discussed the echocardiographic result at a combined meeting, and that it was noted that aortic valve replacement was indicated, but that this should be deferred unless and until there was evidence of progressive cardiac dilation or symptomatic deterioration. On 27 April 2003, the deceased’s condition had deteriorated significantly and he was re-admitted that morning to hospital. He was seen by one of the Defendant’s house officers and was found to have a gallop rhythm in his heart with a diastolic murmur. Later the same day at approximately 18:00 hours, the deceased was seen by Dr O’Brien, but notwithstanding his previous recent medical history, his deteriorating condition and the results of blood tests taken earlier in the day, which showed not only that he was dangerously ill but also that aortic valve replacement was indicated, Dr O’Brien discharged the deceased home. The deceased’s condition deteriorated at home and he was re-admitted again to the hospital on 29 April 2003. His condition continued to deteriorate rapidly during the day and at approximately 19:50 hours he was admitted to the intensive care unit, where it was noted that he had severe valvular regurgitation. By 20:17 hours cardiac pulmonary resuscitation was being attempted, but at 20:45 hours he was declared dead. He was 30 years old. Following the receipt of instructions, the deceased’s medical records were obtained and considered. A consultant cardiologist, who was instructed to prepare a report, concluded that there had been a considerable breach of duty by the Defendant hospital. He considered that when the deceased re-presented himself at the hospital on 27 April 2003, the symptoms then constituted a deterioration to fulfil the criteria that Dr Haider had stated that he should be referred for surgery. He further considered that Dr O’Brien had clearly mis-managed what was a severe case of aortic regurgitation and a possible gallop rhythm. If the correct diagnosis had been made on this occasion and the deceased had been referred for cardiac surgery, on the balance of probabilities, the consultant cardiologist considered that the deceased would have survived and would have had a good prognosis for the future. Conducting solicitors wrote to the Department of Social Security to obtain the deceased’s employment history and to his previous employers to obtain confirmation of his periods of employment and details of his pay. A pre-action protocol letter was sent to the Defendant. Care consultants were instructed to prepare a report. The Claimant’s medical evidence was served. The deceased’s general practitioner records were sent to the Defendant’s solicitors. The Defendant’s letter of response was received, together with a Part 36 offer in the sum of £175,000. Breach of duty was admitted in relation to the failure to admit the deceased to hospital on 27 April 2003. It was admitted that the symptoms the deceased displayed indicated left ventricular failure which required an urgent referral for aortic valve replacement surgery. It was further admitted that if surgery had been performed on 28 April 2005, on the balance of probabilities, the deceased would have survived. However, it was denied that the deceased would have had a full life expectancy following aortic valve replacement surgery. Correspondence ensued with the Defendant’s solicitors and the consultant cardiologist in relation to life expectancy issues. A conference with counsel and the consultant cardiologist was attended in relation to the Defendant’s Pat 36 offer and life expectancy issues. A life expectancy report was received from the consultant cardiologist, who considered that the deceased would have lived to between 70 and 75 years of age. The Defendant’s solicitors subsequently provided an extract from the Society of Cardiothoracic Surgeons of Great Britain and Ireland national audit of their cardiac surgical database and stated that on the basis of the figures quoted in the said report, the Defendant’s current estimate of 20 years life expectancy for the deceased could be, if anything, optimistic, based on the data. The consultant cardiologist pointed out that the data supplied by the Defendant’s solicitors was not applicable to the deceased, but to older patients. Extracts from the text book of Cardiac Surgery were provided to the Defendant’s solicitors, who were informed that a man aged 30 years, having had successful valve replacement, could expect to live around 46 years. Further correspondence ensued with the Defendant’s solicitors and the consultant cardiologist in respect of life expectancy issues. Proceedings were issued. A Part 36 offer in the sum of £225,000 was made by the Claimant. A defence was served, confirming the admissions of breach of duty and causation made in the letter of response dated 8 August 2005. An interim payment in the sum of £10,000 was received. The claim was stayed to facilitate an experts’ meeting on the life expectancy issue. The parties’ medical evidence in relation to the life expectancy issue was exchanged. Agendas of matters required to be discussed were sent to the parties’ experts. Judgement was entered for the Claimant for an amount to be decided by the court and the case was listed for a case management conference. The experts’ joint statement was received. The Claimant’s care report was served. The claim was stayed for a further two months, in order to allow the parties to negotiate a settlement. A request for clarification of the joint statement was sent to the Claimant’s consultant cardiologist. The Defendant’s solicitors were requested to provide their expert with the relevant material, which was not before him at the joint telephone conference, and the Defendant’s expert was instructed to re-consider his conclusion with regard to life expectancy.A without prejudice offer in the sum of £200,000 was made by the Defendant. An order was obtained for the Defendant to pay the Claimant a further interim payment in the sum of £10,000. An application to set aside the order made relating to the further interim payment was issued by the Defendant. A Part 36 offer in the sum of £215,000 was made by the Claimant. Witness evidence in respect of the interim payment application was served by the Claimant. The Claimant subsequently agreed to accept the Defendant’s offer in the sum of £210,000. The infant settlement and apportionment was duly approved by the court.