A court has ruled that negligence at Noble’s Hospital led to a man suffering a severe, debilitating, stroke.
Deemster John Needham heard the case of David Scutchings v Manx Care. However, all of the evidence related to events in 2012, long before Manx Care came into existence. As such the fault is that of the DHSC which was in operational control of the hospital at the time.
The civil court heard that Mr Scutchings suffered a severely debilitating stroke in April 2012, when he was 48 and that in the months before his stroke he had visited Noble’s Hospital on two separate occasions.
The first was on January 12 2012, when he attended with suspected gastrointestinal problems but whilst an inpatient suffered a transient ischaemic attack (“TIA”). In his judgement, Deemster Needham said that this was ‘negligently overlooked by staff’.
On March 25 2012, a second occasion where a TIA allegedly was missed was when Mr Scutchings attended A&E with sensory difficulties in his arm and again anti-stroke medication was not prescribed.
Breach of Duty
In his ruling, Deemster Needham said that it was accepted that ‘a breach of duty resulted in that the Defendant (Manx Care/DHSC) was not referred to a specialist in stroke medicine and commenced on anti-platelet medication as a matter of urgency so as to mitigate the risk of stroke’.
He added: ‘Despite an apparent previous admission by the Defendant’s expert in stroke medicine that a TIA similarly occurred on March 25 2012 the expert had apparently resiled from that position.’
The Deemster said that he had to decide, on the balance of probabilities, whether Mr Scutchings’ lifestyle had placed him at a higher risk of a stroke, whether he had suffered a further TIA on March 25 and whether this had been diagnosed would it have lessened the likelihood of him suffering his stroke in April 2012.
Smoking and Medical Records
Deemster Needham said that throughout the hearing, there were times when Mr Scutchings’ evidence differed from that of his medical records. However, he said that memory loss is often a result of such a stroke so he did accept this was not unusual and he added that his impression of both Mr Scutching and his partner Sandra Saada were ‘that each was an honest witness who told me the truth’.
He added: ‘However there were problems also with the contemporary hospital notes in terms of omissions and inherent contradictions and the fact that the clinical notes were completed by ‘foundation year’ doctors.’
Before his stroke, it was accepted that Mr Scutchings was a heavy smoker, overweight, having high cholesterol, suffering sleep apnoea and raised blood pressure. All of this increased his risk of a stroke and he was aware of the risks associated with them.
In the early hours of January 12 2012, Mr Scutchings went to Noble’s complaining of abdominal pain and was admitted to the surgical ward for investigation. The nursing notes indicate that at around teatime that day Ms Saada alerted staff to Mr Scutching suffering facial droop on the right side and some weakness in the left hand.
A FY1 (Foundation Year 1) doctor on the ward examined him and noted a complaint of weakness on the right side of the face and a tingling sensation in the right cheek however on examination the face and cranial nerves were all found to be intact.
Deemster Needham said: ‘The impression formed by the FY1 was that both infection and Bell’s Palsy were unlikely and the condition was “most likely because of sleeping on [right] side”.’
Mr Scutchings’ bloods were reviewed with a senior doctor and nursing notes indicated a request to continue secondary neurological observations. The next day, Mr Scutchings was described as ‘stable’ by the consultant surgeon and he was ‘discharged home and advised to see the GP if further facial weakness was experienced’.
Deemster Needham added: ‘As stated above the experts agree that the Defendant’s staff negligently failed to detect a possible TIA and refer for specialist advice and secondary stroke prevention medication.’
On the afternoon of March 25, Mr Scutchings arrived at Noble’s A&E experiencing tingling and numbness in his left arm. An ECG trace was found in his notes from this time, which had the wrong patients’ name on it before being crossed out and Mr Scutchings’ added. Deemster Needham said he was ‘satisfied that despite the discrepancies the ECG print out probably did relate to the Claimant’.
Mr Scutchings said that having been checked over in A&E, the advice was that ‘he had slept in a “funny position” and trapped a nerve’.
There are differences between Mr Scutchings’ recollection of what happened on this occasion and the notes recorded at Noble’s. One such difference is that the doctor’s notes record the tingling being in his right arm, however he said it was his left as he remembered having difficulty changing gear when he had earlier attempted to drive. Deemster Needham said: ‘I accept the evidence of the Claimant and Ms Saada that it was a problem with the left arm. Such is also backed up by the nursing note.’
During the hearing, Dr Al-Bazzaz, who was the DHSC’s expert, the court report says that he indicated that the ‘considerations were clearly different for an expert in stroke medicine than the average A&E doctor and one needed to consider the knowledge and grade of the doctor who saw the patient’
Deemster Needham added: ‘Dr Al-Bazzaz was asked to direct his mind to whether as an expert in stroke medicine he was able to say whether the presentation of the patient at that time was because of TIA or otherwise. Dr Al-Bazzaz gave the view that on the balance of probabilities it probably was TIA.’
Turning to the treatment Mr Scutchings received at Noble’s, Deemster Needham said he had suffered a TIA in March and that ‘the diagnosis of a trapped nerve made very little sense and the FY2 doctor had a duty to ask someone more senior in the Department to review the matter but failed to do so’.
He added: ‘There was an obvious mistake in the FY2 doctor’s recording of which arm had the problem. That could be a matter of a simple recording error or it could also potentially invalidate any functional test carried out on the wrong arm. The latter explanation would explain the lack of identification of motor functionality in the left arm that I have found did exist.’
Accepting that Mr Scutchings had proved causation and that failings at Noble’s lead to his stroke, Deemster Needham said: ‘The simple significance of the two incidents was that there were two missed opportunities to intervene. My findings on the facts are that the Claimant suffered a TIA on 25th March 2012 which was negligently overlooked and but for that negligence the Claimant would have been prescribed aspirin which on the balance of probabilities would have prevented him suffering a debilitating stroke three weeks later.’
You can read the full verdict below: