Hospital liable for worsening of patient’s existing spinal condition
A recent legal case examining the consequences of negligent hospital care on a patient’s pre-existing condition.
In the case of Reaney v University Hospital of North Staffordshire NHS Trust and another  EWHC 3016 (QB), the High Court examined the consequences of negligent hospital care on a patient’s pre-existing (non-negligently caused) disability.
Christine Reaney, the claimant, was diagnosed with the rare inflammatory condition transverse myelitis in December 2008 at the age of 61. Sadly, she failed to recover in any significant way and remained paralysed below the mid-thoracic level with no control over her bladder or bowels.
During an extended stay in hospital, the claimant developed a number of deep (Grade 4) pressure sores. These led to an infection of the bone marrow, an abnormal shortening of the muscle tissue in her legs and a hip dislocation. As a result of her lower limb disabilities, the claimant could not attain a satisfactory posture and would fall from an upright sitting position to the left.
The defendant NHS trusts admitted liability for the pressure sores and their consequences. Due to the effect of transverse myelitis, the claimant would have remained in a wheelchair permanently in any event. The key issues were therefore the extent to which the pressure sores made the claimant’s pre-existing condition worse and what damages the defendants should pay in respect of her current condition. At present, the claimant could only sit in her wheelchair for up to four hours and otherwise stayed in bed.
In law, defendants could only be held liable for damage which they had caused or to which they had materially contributed. However, this case should be seen as a reflection of the principle that a tortfeasor (defined as an individual who commits a wrongful act, either intentionally or through neglect, that injures another and for which the law provides a legal right to seek relief) had to take his victim as he found him. If that involved making the victim’s current damaged condition worse, then the tortfeasor had to pay full compensation for that worsened condition.
On the evidence, the defendants’ negligence had made the claimant’s position materially and significantly worse. “But for” the development of the pressure sores, the claimant’s quality of life would have been much better. She could have spent her waking hours out of bed in a standard, self-propelled wheelchair (with the ability to maintain a good spinal posture and balance), undertaken a few basic household tasks and gone out much more than was presently possible. While the claimant would still have been doubly incontinent, her bowel management would have been much better and she would not have required a urethral catheter.
If the claimant had not suffered from pressure sores, she would have needed a maximum of about seven hours of professional care each week until the age of 70. Instead, she would now require two carers on a 24/7 basis for the rest of her life, a more spacious property for herself and her husband to accommodate the carers, and a larger vehicle.
Causation was established because the claimant would not have required such a significant care package “but for” the defendants’ admitted negligence. As the pressure sores had a material impact on the claimant’s physical well-being and care needs, the court awarded her £115,000 for pain, suffering and loss of amenity.