Medical Negligence

Hospital Trust agrees seven-figure compensation settlement for patient with rare metabolic disorder which ‘should have been diagnosed sooner’.

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Elizabeth Maliakal 

Principal Solicitor for Training & Business Development 

7 min read time

A South Yorkshire Hospital Trust has agreed a seven-figure compensation settlement with a patient who brought a legal claim against it after being left paralysed by a rare metabolic disorder.

Despite the rareness of the condition – acute intermittent porphyria – it was alleged doctors at Barnsley Hospital NHS Foundation Trust should have diagnosed it sooner in light of the patient’s symptoms.

The woman was first seen in the hospital on September 17, 2014, having suffered from ‘repeated and chronic’ vomiting – as often as seven times a day – over a period of days.

She was initially told she was likely suffering from a virus before doctors then concluded that her illness was alcohol-related.

Over the following four-week period she was seen on numerous occasions in emergency departments, and as an in-patient, suffering from worsening symptoms, having had numerous seizures, and suffering from muscle weakness, blurred vision and ‘flashing lights’, aches, abdominal pain and tiredness.

She began losing the power in her legs and feeling weak in her shoulders and hips, becoming increasingly unsteady on her feet, and suffering falls when trying to get out of bed, or on and off the toilet.

As part of a legal case against the Trust, it was alleged the working diagnosis of an alcohol-related illness should have been reconsidered after symptoms had persisted for a couple of weeks, and full neurological and nerve examinations carried out.

It was alleged that, as the patient had not drunk any alcohol for a number of weeks by that time and had not typically drunk alcohol in amounts indicative of dependence or withdrawal, an alternative diagnosis should have been considered.

Acute intermittent porphyria causes severe abdominal pain, constipation, increased blood pressure, seizures, and damage of the nerves to muscles, often leading to paralysis.

Prior to her illness, the woman had been fit and well, working full-time as a carer and had enjoyed an active social life with family and friends, as well as looking after and riding her own horses.

Now, she suffers from paralysis in her arms and legs and is no longer able to drive or work.

She needs aids and the support of her husband at home and needs to use a wheelchair when she is out. She can no longer care for herself and her husband had to give up his full-time job to look after her.

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Rare condition – but common failure to ’follow the symptoms’

The woman, now 51, has been awarded compensation following a legal case against the Trust, led by medical negligence claims specialist Elizabeth Maliakal, of Hudgell Solicitors.

She said the case had been challenging due to the difficulty finding a suitable porphyria expert, the case being fully denied by the trust, and delays in being able to conduct independent and vital examinations of the woman as she was considered vulnerable during the Covid-19 pandemic and lockdowns.

However, those hurdles were eventually overcome, and the legal claim ultimately focussed on the failure of health professionals to ‘follow the symptoms’ and ‘keep an open mind’ to the possible causes, and their failure to correctly diagnose the condition sooner.

This was a very unusual case given the rarity of the condition, and although it was something most medical professionals will never come across in their entire medical careers, it was our case that more could and should have been done to reach the correct diagnosis sooner.

Doctors initially diagnosed my client’s health issues as being alcohol-related and continued to work to this diagnosis at a point where she had not had an alcoholic drink for four weeks. Added to this, she had never typically drunk alcohol in amounts indicative of dependence or withdrawal.

It was our case that the Trust failed in several ways to meet its duty of care.

We alleged that doctors failed to take a full alcohol history, then made the wrong diagnosis and failed to have open mind as to an alternative possible diagnosis. We also alleged they failed to heed worsening symptoms of motor functioning deficiency, muscle wasting, multiple fits, and the loss of power in her limbs.

Although the actual condition was very rare, the nature of the shortfall in care was something we see all too commonly, a failure to follow the symptoms and keep an open mind when considering the diagnosis.

This should have been diagnosed sooner, even though it is extremely rare.

Earlier treatment would have led to ‘a full recovery’

As part of the case, it was also alleged that had alternative causes been fully considered, the diagnosis of porphyria should have been made around two weeks earlier than it was, and that had treatment started then, the patient would have made a full recovery, and would not have been left paralysed.

The Trust denied all allegations throughout but agreed to provide an interim payment of £50,000 in March 2023 which allowed the woman to make adaptations to her kitchen. It then settled the case, after court proceedings had been issued against it, offering the seven-figure settlement at a meeting of legal teams in March 2024.

The woman’s claim for compensation included a claim for loss of earnings, to cover the costs of care, services, mobility aids and appliances, medication, and further required adaptations to her property.

We were delighted for our client when the Trust came forward and said it wanted to settle this case, as it had been a challenging journey for my client to reach this point. My client had endured some very difficult times.

She initially sought legal advice from another law firm local to her. They took on her case but were unable to find relevant experts to prepare reports, and so advised her that she’d need to find another firm of solicitors.

We took her case on and, after making in-depth enquiries and conducting extensive research, we found an expert on porphyria who was able to provide his opinion on what impact timely treatment would have had on my client, and on her quality of life.

We also obtained expert evidence on the nature of her injuries and what the future holds for her, with reports from a rehabilitation expert, psychiatrist, neurologist, and care expert.

We were then able to present a case demonstrating that, had the diagnosis been a couple of weeks earlier, and treatment started sooner, she would have made a complete recovery and avoided paralysis and disability.

That was crucial in us being able to arrange the roundtable meeting with solicitors representing the Trust and avoid a final court hearing, as we were able to discuss the case face-to-face and agree on the final settlement, which my client was very pleased with.

It is hugely rewarding, particularly in cases involving catastrophic injuries such as this, to be able to secure a settlement which brings a client security for their future. She now knows all her future needs will be met, and that is both a huge relief and a huge comfort for both her and her family.

‘Impact on life cannot be overstated’

The woman says the impact on her life has been huge, and that she can get ‘upset and tearful ‘

She says her life has ‘changed completely physically, emotionally and mentally’, but says the support of Hudgell Solicitors has been ‘exceptional’.

I am a very strong, stoic and resilient person, but occasionally I do break down and cry, and I can get emotional when I think about how my life has changed due to this.

I am no longer able to work, I have lost my mobility and I can no longer take care of myself, my house, or my family. The impact on me cannot be overstated.

However, thanks to the support of Elizabeth and Hudgells, my case has ended with a very good outcome, and I have security for the future. I want to thank all who have helped achieve this result for me and my family.

Mrs Maliakal was supported in the case by a paralegal at Hudgell Solicitors Emma Wilkinson, with barrister Ranald Davidson, of Serjeants’ Inn Chambers, advising throughout the claim, and at the final roundtable meeting.

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