C v P Homes Ltd 2004(1) Dr M (Part 20) 4 June 2004

The Claimant was an independent 74 year old woman at the time of the negligence in 1998. She lived alone in a flat, with support from her family and some, limited, assistance from social services. She was on the waiting list for a hip replacement. In addition, she suffered from diabetes and had a past history of depression, for which she had been prescribed Lithium.

Her hip problems led to her being unsteady so, following some falls, she was admitted to a nursing home to await an operation. She was transferred on to the First Defendant's nursing home, already suffering from a small pressure sore on her right heel, on 21 October 1998 .

The intention was for her to return to independent living after her hip replacement.

Whilst in the First Defendant's nursing home her pressure sores deteriorated considerably as a result of the negligent care. The pressure care was inadequate, as was her diabetic control. It was not in fact recognised that she was diabetic and therefore at particular risk. Although the pressure sores were mentioned (though not described in detail) to the Part 20 Defendant on his rounds at the home, he did not inspect them.

The Claimant was admitted to hospital as an emergency on 5 November 1998 suffering from gangrenous pressure sores on both heels and over her sacrum, sepsis and dehydration.

She required an above knee amputation of her left leg, a surgical debridement of her pressure sore and a colostomy in order to keep the sacral pressure sore clean and free of infection.

The family were told that it was unlikely that her sacral pressure sore would ever close entirely; eventually, with their care, it did. However, the skin over the area remained thin and easily broken.

The Claimant suffered phantom limb pains and abdominal pain at her colostomy site. She continued to suffer pain and stiffness in her hip, as it was no longer appropriate to perform the hip replacement. She was confined to a wheelchair. After the surgery she became housebound, partly because of the pain she was in and partly because she felt self-conscious about her appearance. She even had to receive Communion in her own home.

On discharge from hospital, she spent a short period of time in rehabilitation. She then moved in with her daughter, who had to move house in order to accommodate her mother as a wheelchair user.

The Claimant's family provided her with excellent care, her daughter caring for her outside her working hours; her son gave up work to care for her during the day. At the same time he cared for his baby daughter. Social services provided input in the morning and evening to assist her with washing and dressing, although they were not authorised to change the colostomy.

It was accepted by the Claimant that, as she became older, she would have required some care in any event and would probably have moved in with her daughter.

The claim was initially issued against both the nursing home and the GP who cared for the patients in the home. Shortly after issue of proceedings the Claimant discontinued her claim against the GP. However, the First Defendant issued against the GP as a Part 20 Claimant.

Expert evidence was obtained from a tissue viability nurse, GP (not relied on by the Claimant), vascular surgeon and occupational therapist. It was necessary to obtain evidence on life expectancy from a consultant in elderly medicine. Finally, in view of the Claimant's past psychiatric history and the fact that she had been noted to be suffering from mild cognitive impairment, it was necessary at an early stage to ask a consultant psychiatrist to confirm that she was not a Patient under the Mental Health Act 1983.

The Claimant's case was that proper treatment would have prevented the catastrophic deterioration she suffered. There was a one week causation window, when surgical treatment would have avoided both the amputation and the colostomy.

On 23 July 2003 The Defendant admitted breach of duty but not causation. This was despite the fact that the First Defendant's own causation evidence was that the claim should not be defended, relying instead on the Part 20 Defendant's causation expert for the time being. The Part 20 Defendant denied both breach of duty and causation.

In March 2004 an interim payment of £15,000 was made.

The arguments centred on:

The amount of care required by the Claimant, as it was argued by the First Defendant that she received "Rolls Royce" provision from her family;

Whether it was necessary to make deductions for the childcare also undertaken by the Claimant's son to his infant daughter whilst he was caring for the Claimant. The Claimant's evidence was that another member of the family would have cared for the child had her father been working.

Whether she would have returned to living independently and if so, when. There was very little documentary evidence available as to when the Claimant would have had her hip replacement performed from the waiting list. In the meantime the family were paying for private nursing care; and

The level of care that the Claimant would have required in any event, given her age and medical conditions.

The claim settled for £300,000.00 on 4 June 2004 , a week before trial. General damages, agreed with the Defendant, were £85,000.00. The future multiplier, in regard to the care claim, was 6.3.

Special damages included a care claim, together with various aids and equipment, including pressure relieving mattresses and cushions, hoists, an electric bed and lightweight wheelchair. In addition, despite moving house to accommodate the Claimant, the living facilities remained inadequate; it was necessary to build a conservatory extension with a downstairs bathroom and additional storage, to properly accommodate the Claimant with her daughter's family.

Proceedings between the First Defendant and the Part 20 Defendant were concluded separately.

It was particularly gratifying to achieve a settlement of this order for a Claimant who was, at the time of the settlement, 80 years old, because claims for elderly patients are often assumed to be of low value. The negligence alleged was a straightforward, well rehearsed, issue, but the Claimant's age (and consequent unrelated medical problems) meant that a large number of experts were required, making this a complex and interesting case to run.

Claimant's representatives

First Defendant's representatives

Part 20 Defendant's representatives