C v Princess Alexandra Hospital NHS Trust

C was a type 2 diabetic.  He complained of left foot pain and saw his GP who diagnosed plantar fasciitis.  A steroid injection was given which was four times the appropriate maximum dose (and more appropriate for a hip joint).  C developed an infection near the injection site.  He attended the D hospital on a number of occasions.  There was a failure to expedite referrals to the vascular service when seen in A&E and when he was seen by a vascular surgeon, a failure to undertake vascular imaging investigations to determine the adequacy of arterial supply to the foot before it became unsalvageable.  In the event, C underwent a below the knee amputation when he was 51.  He struggled with his prosthesis and became wheelchair dependent.

Allegations were made both against the GP and against the trust.  The trust made partial and then, after Part 18 Requests for Further Information were made, entire admissions as to breach and causation.  Notwithstanding the strength of the standalone allegations against the GP (with the C firmly of the view that the GP’s actions set in motion the chain of subsequent events), the claim against the GP was discontinued.

Condition and prognosis evidence was obtained from a vascular surgeon, a diabetologist (including as to life expectancy), a pain medicine expert, a psychologist, a care report, a physiotherapist, a prosthetic expert and an accommodation expert.  As in many diabetic amputation cases, life expectancy was a contentious issue.  C’s diabetology expert utilised the statistically-robust Brackenridge methodology which suggested a far longer life expectancy than that advanced by the D bearing in mind the C’s relatively young age of 51 at date of amputation and that, by the time settlement negotiations commenced, he had already survived 5 years.

Following negotiations between the parties the claim settled for £1.3 million.