The recent case of Pickering v Cambridge University Hospitals NHS Foundation Trust  EWHC 1171 (QB) highlights the importance of carefully prepared expert evidence and thorough analysis of relevant medical literature in clinical negligence cases which turn largely on the issue of causation. In Pickering, a Haematologist Expert Witness assisted the Court with determining that if treatment with heparin had been given to a patient who presented at A&E with a blood clot, a catastrophic stroke could have been avoided.
Background to the decision
The Claimant had had a history of atrial fibrillation and had been taking regular aspirin. She also suffered from muscular dystrophy. On the evening of 24th September 2015, she attended the Accident and Emergency Department at Addenbrookes Hospital, Cambridge with symptoms of pain, coldness, numbness, and pallor in one leg. She was subsequently sent home after being diagnosed with a possible resolved ischaemic event in the right leg and was told to restart her course of aspirin which she had neglected to take over the past few days. She was also told to follow up with her GP over the next 5-7 days. However, when she called the surgery, she was not offered an emergency appointment.
The Claimant suffered a massive stroke at home on 27th September which caused extensive injuries.
Alleging that she ought to have been advised by the A&E doctors that she had probably suffered an embolus in her leg, the Claimant asserted she should have been treated immediately with heparin. If she had had the heparin, she contended, the stroke would have been avoided.
The issue for the court to decide
By the end of the first day of the trial, the Defendant admitted that it had been negligent in failing to treat the Claimant immediately with heparin. This meant the case turned on the issue of causation.
Mr Justice Ritchie, in giving his decision stated,
“By the end of the trial there was one issue for the Court to determine. That was and is whether, but for the negligence of the Defendant, the Claimant would have avoided suffering a stroke due to the beneficial effects of Heparin treatment, which the Defendant should have given her starting just before 02:00hrs on 25 September 2015 and continuing until she was provided with therapeutic anti-coagulation using Warfarin or alternative modern pills.”
The Court’s decision
The expert Haematologists could not uncover any definitive study which would determine whether if heparin had been given in the early hours of 25 September, the Claimant would not have suffered a stroke some 67 hours later. Therefore, they relied upon other literature dealing with related matters, for example, the NICE guidelines, studies on the use of heparin in DVT, and research into the use of heparin in situations of atrial fibrillation peri-operatively, to attempt to answer the causation question.
The reported case stated:
“In their joint report Dr. Michael and Dr. Giallombardo agreed that the Claimant was at significant risk of further emboli after she had suffered the first blood clot in her leg. They agreed that the benefits of administering Heparin to the Claimant outweighed the risks. They agreed that the stroke the Claimant eventually suffered was caused by an embolism from the clot in the heart.”
However, when it came to the issue of causation and presenting an examination of the medical literature consulted, there was opportunity for the experts to disagree a great deal. It is not within the scope of this article to set out the details of the reports and the learned arguments concerning their application to this particular case. However, it is well worth reading the decision to understand the sources consulted and the weight attached to them.
After examining the Haematologist Expert Witness’s evidence, Mr Justice Ritchie found for the Claimant on the grounds that if heparin had been given, it would have started working within one to three hours. This would have triggered the body’s natural processes of dissolving the unstable clot in the atrium and working towards stabilising it and adhering it to the atrial wall. Also, if heparin had been provided over the 67 hours in question, the clot would have decreased in size substantially. Therefore, with heparin treatment, no embolus would have been triggered on 27th September and the catastrophic stroke would never have occurred.
How can Expert Court Reports Ltd help?
At Expert Court Reports, we have a Haematologist Expert Witness who can provide evidence in claims arising from diseases of or caused by blood or bone marrow. Our team can also provide expert reports on chronic pain as well as psychological matters.
Expert Court Reports provides expert witnesses and medicolegal court reports for solicitors, barristers and other agencies including the police, probation services, prisons, and third-sector organisations as well as private clients.
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