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Posted 5 November 2019
by Endurance Arthur

Cauda Equina Syndrome Case Study: When red flags are missed by GPs

Cauda Equina Syndrome

Cauda Equina Syndrome case: Shaw and Stead

On 1 March 2019, Mrs Justice Yip, High Court Judge found that Dr Stead, a GP had breached his duty of care to a 35 year old patient whom he saw in his “out of hours” clinic. It seems that Dr Stead failed to note ‘red flag’ warning signs for cauda equina syndrome and to refer Mrs Shaw on urgently to hospital.

Dr Stead could not remember his consultation with Kerry Shaw in 2013 but had written “no red flags” in his notes. But Mrs Justice Yip accepted the evidence of Mrs Shaw and her husband that she did have red flag symptoms of cauda equina syndrome or signs that the GP should have elicited.

What were the missed red flag symptoms in this cauda equina case?

Mrs Shaw was a teaching assistant. She had been squatting on the floor when a pupil kicked her in lower back. She fell backwards and as she stood up she twisted her back. She saw a GP the next day, a Friday. The GP recorded that Mrs Shaw had severe pain in her lower back, pain in her legs and thighs and he prescribed pain killers. Mrs Shaw was still in severe pain the next day, Saturday and called the GP practice. She spoke to a nurse who noted that Mrs Shaw’s legs felt numb and tingly, she felt nauseous, she could not get out of bed to use the toilet and had seen a GP the previous day. Mrs Shaw called back again later that day reporting that she felt dizzy and clammy; she was told to go to the out of hours clinic.

At this clinic, Mrs Shaw was seen by Dr Stead. At the trial of her case, the Judge considered the different accounts of what had happened. Mrs Shaw was adamant that she had been in a wheelchair when she saw the Defendant, she also said that she had told the nurse earlier that day that she had not been able to pass urine and had wet herself on her way back from the toilet. She described her legs as feeling like “Bambi”. Mrs Shaw said that Dr Stead had only undertaken a brief examination of her and he had only tested the reflexes in her knees.

Dr Stead, on the other hand, said he could not remember the examination but he asserted that his standard practice would have been to ask a series of questions to eliminate any red flags. He insisted that he would have told the patient what symptoms constituted red flags. His medical note stated that she had a tender back as a pupil had kicked her, her sensation was normal and there were no red flags. In the note, he had written that Mrs Shaw could not do the straight leg raise. Dr Stead diagnosed sciatica, gave her pain killers and advised her to mobilise gently. He told her to call back if the pain got worse. His note did not refer to the wheelchair nor to Mrs Shaw having wet herself.

Detection of the red flag symptoms of cauda equina syndrome

Mrs Shaw contacted the surgery on the Monday and spoke with a nurse who recorded that she had pain in both her legs and her legs were cold and felt like jelly. The note continued that Mrs Shaw was straining to pass urine and was a little constipated. Mrs Shaw was seen by another doctor who noted her symptoms and the previous history. He examined her and referred her to Accident & Emergency. Mrs Shaw had an MRI scan which diagnosed cauda equina syndrome. Following this she underwent an emergency operation.

Outcome of the cauda equina syndrome case

Mrs Shaw’s claim proceeded to a full High Court trial and she was successful in getting compensation because she gave a clear, account of what had happened to her, which the judge believed.

If symptoms of cauda equina syndrome are diagnosed quickly and treated by urgent surgery to decompress the spine, it is possible to make a very good recovery. Unfortunately, where diagnosis and treatment are delayed, significant harm may be suffered. The damage includes permanent pain and weakness in the legs, impaired urinary, bowel and sexual function and depression. For some Claimants it may not be possible to return to their usual work and way of life. The consequences are life-changing and devastating. Should this happen, it may be possible to bring a claim for compensation.

If you believe that your early symptoms of cauda equina syndrome were missed by a health professional, then please contact our specialist medical negligence team on 01392 207020 or email enquiries@tozers.co.uk to discuss this further. For further information on cauda equina syndrome, read our other article here.

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About the author

Endurance Arthur

Partner and Solicitor

Partner and solicitor in the medical negligence department and a member of the Law Society's Clinical Negligence Panel