Our history, some case characteristics – and your opportunity

(Estimated reading time: 3 minutes, 42 seconds)

We work in partnership with a small number of leading specialist litigators, experts and barristers who are highly experienced with Cauda Equina Syndrome (CES) cases. Our underwriting results reflect this and our expertise is second-to-none. The reason for bringing this to your attention is that we have a collaboration opportunity available for a small number of law firms looking to develop their expertise in CES litigation.

These cases have received a high level of press coverage recently and, for the right clinical negligence team, could boost your fee-earning – as well as providing access to justice for claimants who have suffered as a result of a misdiagnosis.

BBC News recently highlighted Cauda Equina Syndrome (CES) cases as an area of clinical negligence which is costing the NHS millions in compensation payments because of its failure to identify and treat a crippling back condition.

Case characteristics
CES results where time is lost in operating to release pressure on the lower spinal cord, when pressure is exerted on it by a slipped disc. Such pressure must be released otherwise the nerves leading to the legs, bladder and elsewhere could be permanently damaged.

• It is unpredictable – CES can emerge over a few days of increasingly worsening symptoms, or can spontaneously and rapidly take place to its full degree. Doctors must be alert.
• Red flag warning signs exist and should be well-known to GPs and A&E doctors. Time is of the essence – decompression surgery is needed within 24 hours ideally.
• An MRI scan is essential and must be reviewed by a neuro-surgeon. The urgency is similar to that with meningitis in children. Clearly, the NHS needs to be at full efficiency if negligence is to be avoided.

When the opportunity to treat is missed by a negligent failure; the consequences can be crippling, in every sense. It need not incur a correspondingly heavy financial burden when the patient instructs a solicitor under a CFA with attendant ATE insurance cover and disbursement funding.

To run a CES claim successfully is no easy task.
Reliance needs to be placed in several areas of clinical expertise including radiography, neurology and orthopaedics. There is a need to address breach and causation, then a further spread of experts to address care, accommodation etc. Damages frequently exceed £1M, depending on individual circumstances.

With experts costing as much as £5,000 each for a report and conference, the need for funding these disbursements can become an acute problem – but one that can be neatly addressed with Temple’s disbursement funding scheme, which works in conjunction with our ATE insurance policy.

Problems particular to CES claims

• The window of opportunity for successful operative intervention is very narrow. 24 hours is now considered the maximum delay from diagnosis to surgery. This has reduced from 36-48 hours in recent times.
• Defendants can argue that the prolapsed disc is only impinging on the nerve root and not compressing it. Thus not preventing the nerve roots from functioning.
• Breach can be admitted, but causation is always harder to prove.
• The patient may have a pre-existing spinal/neurological issues.
• CES claims rely heavily on a spread of experts from different disciplines.

CES claims and delegated authority from Temple Legal Protection

• Several of our clinical negligence coverholders are very experienced in this specialised field and know the best experts and barristers to instruct.
• We have been insuring CES claims from before the LASPO changes in 2013. Since then, our solicitors have a very good track record – they have never lost a trial.
• The majority of our paid claims relate to cases dropped on advice from experts who have warned against proceeding.

The difference we make
A delegated authority scheme from Temple Legal Protection gives our partner clinical negligence solicitors the power to run their case; they can meet the NHS lawyers on a level playing field and not be intimidated into accepting the first offer received.

If the legal team thinks there is more to come in the way of damages, we will support all reasonable efforts to secure appropriate financial compensation. If, due to some adverse development, a Part 36 offer needs to be accepted out of time, our ATE insurance policy will indemnify the costs and disbursements thereby incurred.

Lorraine Taylor, partner at Bridge McFarland said, “Because of the complex nature of these cases, there is a need for a range of very experienced experts. Disbursement funding means I can instruct them directly, not going via an agency, and I can pay them promptly without any uplift.”

If you would like to know more about CES cases contact us via email or call 01483 577877. We look forward to hearing from you.