Success in the High Court for Stroke Survivor

After a gruelling four-day trial in the Royal Courts of Justice, Mr Justice Ritchie has found that, on the balance of probabilities, the stroke that Mrs P suffered in September 2015 would have been avoided if she had received the proper treatment in A&E when she attended a few days prior.

Ben Ward (Partner) and Tom West (Solicitor) of Ashtons Legal were instructed to represent Mrs P alongside Catherine Ewins of Hailsham Chambers.

View the High Court judgment here.

The Facts

In September 2015, whilst at home one evening, Mrs P suffered symptoms of intermittent coldness, pins and needles and pain in her right leg. She contacted 111 and was taken by ambulance to A&E at her local hospital. Doctors correctly identified that Mrs P had suffered an ischaemic event in her right leg: there had been a small, partial clot which had restricted blood flow. However, because her symptoms had resolved, Mrs P was offered no treatment and was discharged home with advice to follow-up with her GP in 5 – 7 days.

Unfortunately, just 67 hours after being discharged, Mrs P suffered a catastrophic stroke at home. She spent 6 months in hospital undergoing extensive rehabilitation and has been left with life-long disabilities, such as significant right-sided weakness and speech difficulties. She is reliant on a wheelchair and 24/7 care, which is currently provided by her family.

Breach of Duty

The Defendant Trust admitted, on the first day of trial, that it had been a breach of the A&E clinicians’ duty of care to Mrs P to discharge her without first treating her with Heparin, a fast-acting anti-coagulant. This was a breach because it ought to have been known that the ischaemic event Mrs P had just suffered was almost certainly caused by an embolus (a fragment of a clot) being fired off from a larger clot elsewhere, most probably in the left atrium of her heart. This was made ever more likely by the fact that Mrs P suffered atrial fibrillation for which she was not being treated with anti-coagulants. This meant that she was at high risk of this unstable clot firing off another embolus, which could either travel up the aortic arch and into the brain (causing a stroke) or down the aortic arch and into the limbs.

Causation

The issue for the Court to decide, therefore, was whether, on the balance of probabilities, Heparin administered before discharge would have prevented the stroke that Mrs P suffered just 67 hours later.

It was accepted that there was a paucity of direct clinical trial evidence on this issue because it is widely known that Heparin does have some effect at preventing embolic events. It would therefore be unethical to test the efficacy of Heparin by giving some patients placebos in circumstances where they are at risk of suffering an injury such as a catastrophic stroke.

The medical experts were therefore required to rely on their clinical expertise as well as studies which they considered to be comparable to Mrs P’s situation for different reasons.

Mr Justice Ritchie considered the evidence given by the Claimant’s expert to be “more logical and better reasoned” than that presented by the Defendant’s expert, who was found to be “rigid” and “to produce rather extreme opinions”. Where the evidence conflicted, Mr Justice Ritchie accepted the Claimant’s evidence and found that “Heparin would have prevented new clot formation, prevented mother clot propagation (of the existing clot) and would have enabled [Mrs P’s] body not only to reduce the size of the mother clot … but also to make it less friable, more stable and more organised”, so that on the balance of probabilities no further emboli would have been fired off and Mrs P would not have suffered the stroke.

What’s Next?

Work can now begin on assessing the future needs of Mrs P to ensure she obtains the level of compensation required to live as independent and fulfilling a life as is possible.