Analysis

The MDU undertook an analysis of CES claims that were closed between January 2005 and August 2016. During that period nearly 150 claims were notified to the MDU, with 92% of these brought against GPs. The MDU successfully defended over 70% of the claims notified in this period, including one claim which was won at trial. In order to defend these cases, the MDU spent nearly £350,000 on legal costs.

Of the cases that were settled, over £8 million in compensation was paid out by the MDU. Damages payments ranged from £2,250 to £670,000, and of the cases settled, 12% attracted damages payments of over £500,000. However, the large majority of cases settled by the MDU have had compensation agreements of under £100,000.

The MDU also paid over £4.5 million with respect to claimant solicitors' costs. Only one of the cases settled related to a claim against a private hospital doctor, and this related to a failure to consent a patient for the risk of CES, which she eventually suffered, prior to spinal surgery.

Out-of-hours GPs

When analysing the GP claims made in relation to an alleged delayed diagnosis of CES, 10% related to an out-of-hours consultation or telephone call. Of these out-of-hours claims, a third were settled, which perhaps illustrates the difficulty of assessing this condition in an out-of-hours setting.

Red flags

The following indicators should be considered 'red flag' symptoms that should raise suspicion of CES in a patient with back pain.

Pain that radiates below the knees bilaterally (on rare occasions this can be unilateral).
Bilateral lower limb numbness or weakness.
Numbness either side of the buttocks and saddle area.
Bladder and/or bowel disturbance (including difficulty passing urine, poor stream, loss of sensation).
Erectile dysfunction.
Loss of anal tone or impaired sensation on per rectal (PR) examination.

MDU top tips

Conduct a full examination to establish the likely cause of the back pain and make a record that this has been done.
Consider whether there are any red flags.
If red flags are present, the patient needs to be seen in hospital urgently. Call the orthopaedic or neurosurgical specialist for immediate advice, or if this is not available, arrange for the patient to be admitted to hospital via the emergency department.
If no red flags are present, make a record in the notes to demonstrate you have actively considered the condition.
If, after the assessment, the patient is being managed as having simple mechanical back pain, make sure you give appropriate safety netting advice. This should include advising the patient of the red flag symptoms and the importance of seeking urgent medical attention if these appear. Again, try to make a record in the notes of the specific safety netting advice that has been given.

Analysis of cauda equina syndrome claims

Charlotte Taylor

Analysis of cauda equina syndrome claims