Out of Court Settlement for NHS Trust’s Failure to Diagnose Achilles Tendon Injury

A man from Slough who suffered a delay in diagnosis of a partial rupture to his Achilles tendon, which went on to fully rupture, has secured damages in an Out of Court Settlement.

The patient, who wishes to remain anonymous, instructed Specialist Clinical Negligence Solicitor, Adam Wright and his team, at Setfords Solicitors to conduct an investigation into the standard of care he received.

In April 2021 the Claimant injured his ankle whilst he washing his left foot for prayer. The basin he was washing in fractured and caused a deep laceration to his left ankle, leading him to attend A&E that day.
The Claimant was triaged and seen by an A&E nurse before waiting to seen by an Orthopaedic surgeon.
There was no detailed note within the medical records as to the examination of the wound.

A review concluded that the Claimant was able to fully flex his foot without difficulty, the wound was closed and he was discharged as it was felt the laceration did not involve the Achilles tendon.

The extent of the treatment provided in A&E was a washout of the wound and suture to the wound to the skin.

Thereafter, the Claimant commenced physiotherapy but continued to struggle with weight-baring. The Claimant reported worsening pain to both his GP and NHS 111 over the coming few weeks in May 2021. He was suffering pain on walking and an inability to flex his foot upwards.

The Claimant attended A&E again in June after he felt a painful “pop” when performing physiotherapy exercises and the healthcare professionals queried a rupture to the Achilles tendon. A referral to the Orthopaedic doctors was made alongside provision of a Plaster of Paris cast and crutches.

When the Claimant was reviewed in June by an Orthopaedic doctor, he had an ultrasound scan, and it was discovered that he had a complete rupture of the Achilles tendon. In June 2021 the Claimant underwent surgery to repair his Achilles tendon. He was then discharged with instructions to avoid weight bearing whilst wearing a boot to help the rupture heal.

The Claimant contacted Adam Wright, a Senior Clinical Negligence Solicitor at Setfords Solicitors, to investigate the standard of care he had received. He was concerned that there had been a failure to diagnose a partial rupture to tendon when he had presented to A&E in April. Accordingly, his medical records were obtained and expert evidence was sought from an Emergency Medicine Doctor and an Orthopaedic Surgeon.

That experts identified a number of failings in care. For example, the Emergency Medicine Doctor opined that, when the Claimant attended A&E in April there were numerous failures in care including:-

• There was a failure to appreciate and document his inability to weight bear which should have put the clinicians on heightened notice that there was an Achilles tendon injury.
• There was a failure to assess the nature and severity of the wound and a failure to have conduct an adequate and sufficiently diligent examination of the wound to confirm or exclude the presence of an Achilles tendon injury, given the location of the laceration.
  The doctors had failed to establish the position of the limb when the injury was sustained and had failed to examine the Achilles tendon when the Claimant was weight bearing.
• There were also multiple failures in relation to the care provided to the Claimant and a lack of documentation regarding review by the Orthopaedic team.

In short, the main allegation to be made against the NHS Trust was that there had been a breach of duty (i.e negligent care) in failing to diagnose a partial rupture of the Achilles tendon of the left heel during the attendance in April. The Orthopaedic expert opined that, had such a diagnosis had been made in April, treatment would have most likely involved placing the Claimant in a Vacoped boot to secure the foot in position to relax the tendon and promote healing of the partially ruptured tendon.

With such treatment, the Claimant would have avoided the complete rupture of the tendon. Instead, he would have made a full recovery and avoided the pain and suffering associated with the undiagnosed partial tendon rupture injury, the pain of the physiotherapy exercises he performed whilst without diagnosis and the need for a surgical repair along with the associated recovery from that procedure for the fully ruptured tendon. A formal Letter of Claim was submitted to the NHS Trust, detailing the allegations of breach of duty and causation of injury, as supported by the expert evidence obtained.
Upon receipt of the Defendant’s response to the allegations made, in a document known as a Letter of Response, it was admitted that there had been a negligent failure to identify the Achilles tendon injury in the Emergency Department.

The Defendant further admitted that, absent the negligence, the Claimant would have been treated non-operatively with a boot for protection and immobilisation for a period of 8 weeks and thus avoided the need for surgery. Thereafter, and in light of the admissions made, the Defendant made a formal offer to settle the claim. This initial offer was not accepted because it was deemed to be insufficient to adequately compensate the Claimant for his injuries. The Claimant was however able to access part payment of their damages, by way of an “interim payment” on the basis that the Defendant had made some admissions, and so that he could access rehabilitative services to improve his condition. Further expert evidence was obtained from both a Psychiatrist expert and the Orthopaedic Surgeon expert, to report upon the extent of the Claimant’s injuries and these might develop in the future (his prognosis).

Information was also sought on the extent of the Claimant’s financial losses and upon receipt of all of this information, a detailed Schedule of Loss was put together, summarising the value of the Claimant’s claim in one document. This included a claim for lost income, care and assistance, and other miscellaneous financial losses which he had encountered as a result of his injuries. Following this, input was sought from a specialist medical negligence barrister as to the potential value of the Claimant’s claim. Thereafter, settlement negotiations commenced, following a short exchange of settlement proposals, settlement negotiations resulted in an agreed sum of damages equating to tens of thousands of pounds, in compensation to the patient for their injuries and associated financial losses. Upon securing the settlement, the patient said “I hope that by bringing this claim, the NHS Trust can learn from their mistakes and put in place measures to ensure that nobody else has to endure what I have. I am really very grateful to Adam and Matthew for their efforts, they were fantastic and really took the time to understand the effect my injuries had had upon me and my life”.