SM - V- North Wales NHS Trust - Failure to diagnose and treat sub-arachnoid haemorrhage

Claim brought by deceased’s partner following her death.

The deceased was 30 years old and had two young children. Around Christmas 2006, she started to get severe headaches. She attended her GP complaining of double vision and vomiting, but she had no photophobia (sensitivity to light) or neck stiffness. The GP thought that the headaches were probably migraines. However, on 21st January 2007, she collapsed at home because of the pain in her head. Her left pupil was dilated and she had ptosis (drooping) of the left eyelid. She was admitted to hospital where a provisional diagnosis of either posterior communicating aneurysm or space occupying lesion was made. She underwent a CT scan which was reported as normal. An MRI scan and MR angiogram was undertaken on 25th January 2007 which were reportedly normal as was an MR venogram on 26th January and a lumbar puncture on the 27th January. The only pathology demonstrated was a left third and fourth nerve palsy. The Consultant Neurologist therefore thought she probably had a rare inflammatory disorder characterised by severe headaches, paralysis and weakness of eye muscles (Tolosa-Hunt syndrome). She was given oral steroids and gradually improved, although the headaches never completed resolved. She was discharged home a week later with a plan to review on 2nd February. At the review, she showed very little further improvement and the steroids were continued. A further review was arranged but in the meantime, she was found dead by her partner on 17th February. A post mortem showed a large sub-arachnoid haemorrhage from a ruptured cerebral aneurysm and also some evidence of a previous bleed. The aneurysm had not been picked up by the radiologist on the MR angiogram, but when the results were later reviewed, it could clearly be seen in a position that would explain the left third nerve palsy.

The case for the deceased was that if the aneurysm had been correctly diagnosed from the MR angiogram on 25th January 2007, it would have been successfully treated by 27th January 2007 at the latest and on the balance of probabilities, a full recovery would have been made and she would have a normal or near normal life expectancy. Breach of duty was admitted ie that there was a failure to diagnose a posterior communicating artery aneurysm on the MRI scan of 25th January 2007. It was also admitted that but for the breach, she would have been successfully treated and would not have died.

The deceased’s partner tried to bring a claim on his own behalf for secondary psychiatric injury as he was deeply shocked by finding her dead and developed an abnormal grief reaction which was made worse on learning that the death might have been avoided. He went on to develop a post traumatic stress disorder and did not return to work for a year because he had to look after their children.

Under the Fatal Accidents Act 1976 (FAA), the partner was not entitled to claim as a dependant as they had not co-habited in the 2 years prior to her death even though they planned to live together in the future. The children were entitled to claim as dependants but neither the partner nor the children qualified under the Act for a bereavement award. However, the children had a common law claim for the loss of the particular love and affection of a mother.

Settlement was reached in the sum of £215,000.00 which was approved by the Court on 12th January 2011. In this case, it was decided that given the substantial offer on the facts of the case that the argument that the failure of the FAA to recognise the partner as a dependant and for both him and the children to be entitled to bereavement damages is contrary to the Human Rights Act 1998 (on the basis that they formed a family unit). The District Judge did express an interest in the argument that Article 8 (Right Family Life) and Article 14 (Right Not To Be Discriminated Against) of the Human Rights Act 1998 might be pursued in appropriate cases in the future.

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