Abstract
B's date of birth was 26 May 1958. He was aged 45 years at the date of his negligent treatment and aged 49 at settlement.
Background
B was admitted to University Hospital of North Durham on 11 April 2002 with a pyrexia of unknown origin. He had an immediate past medical history of being unwell since mid-January 2002 with thick discharge from his sinuses, episodes of nausea and dizziness, and episodes of rigours with increased temperature for which he had on various occasions been prescribed antibiotics.
A Group B Streptococcus was isolated from blood cultures and on 13 April 2002 benzyl penicillin was commenced intravenously (i.v.). A transthoracic echocardiogram on 16 April noted aortic vegetation. At a review on the following day, 17 April, the antibiotic regimen was set following a discussion between the cardiologist and microbiologist at benzyl penicillin 1.2 mg i.v. and gentamicin 80 mg twice daily (b.i.d.).
B was suffering with bacterial endocarditis and required a heart valve replacement.
On 22 April the dose of gentamicin was increased to 120 mg b.i.d.
On 23 April B's condition deteriorated and he was transferred to the Cardiac Centre at James Cook University Hospital Middlesborough. Gentamicin at 120 mg b.i.d. was continued.
On 2 May B underwent surgery for a replacement of his aortic valve.
On 5 May benzyl penicillin was replaced with vancomycin. The dose of gentamicin was reduced to 80 mg b.i.d.
On 9 May the dose of gentamicin was increased to 120 mg b.i.d.
On 16 May B was transferred back to University Hospital of North Durham. The dose of gentamicin at 120 mg b.i.d. was continued.
On 19 May it was noted by the nurses that B was dizzy when standing up. Upon further review it was noted that there was a history of dizziness over the previous two days with difficulty in focusing. B reported that everything was blurred with a heavy feeling in his head. Gentamicin was ceased on 20 May.
B continues to suffer from severe and debilitating symptoms. He suffers from severe dizziness, severe nausea, impaired balance, reduced mobility and concentration, symptoms that affect all aspects of his daily living.
B's ability to balance was severely reduced with a constant feeling of instability. This led to him spending most of the time sitting on the floor with his back leaning on a sofa. As his balance was affected, he required supervision and assistance when mobilizing both within the house and outside. He required supervision with transfers. Difficulties in coordination related to his balance made him susceptible to accidents when cooking or making drinks, so those things had to be done for him. He needed assistance undressing and bathing. He was unable to coordinate sufficiently to use a shower. He was unable to return to his pre-accident work as a fitter/welder and was unable to drive.
B was diagnosed with suffering from bilateral peripheral vestibular hypofunction arising from damage caused to the structure of his inner ear by gentamicin owing to its ototoxic nature. The structural damage caused to B's inner ear, the peripheral vestibular lesion, was permanent.
Allegations of negligence
It was alleged that between 17 April and 20 May 2002, B was given an overdose of gentamicin. The dose of gentamicin at 120 mg b.i.d. was too high and gentamicin had been prescribed for too long a period. This had resulted in B receiving a significantly higher overall dose of gentamicin that had caused his vestibular dysfunction. If gentamicin had been given at an appropriate dose of 80 mg b.i.d. for a shorter period of time then vestibular dysfunction would have been avoided.
Progress of the claim
The quantification of the claim was complicated by two factors. Firstly, it was identified that B might have had an improvement of his symptoms if he would have underwent rigorous specialist vestibular rehabilitation. Secondly, B's wife, who was his main carer, was diagnosed with breast cancer and her prognosis was uncertain. As a result of those two factors the case was listed for a preliminary issue trial on breach of duty and causation. It was listed for 28 January 2008.
On 19 December 2007 the Defendants made a Part 36 Offer of £950,000 accompanied by an admission of breach of duty. Causation was denied.
On 15 January 2008 the offer was increased to £1.1 million and was accompanied on the 21 January 2008 by an admission of causation. The offer of £1.1 million was accepted by B.
Breakdown of quantum
The quantum issues were compromised to take into account the possibility of vestibular rehabilitation therapy being effective and of B's wife predeceasing him or otherwise being unable to provide the care for him. B had a decreased life expectancy due to his aortic valve replacement.
The case was settled on a global basis but the following is a general assessment of the sums recovered for each head of loss:
£80,000 £3280 £22,000 £75,000 £1500 £5000 £19,500 £25,000 £380,000 £85,000 £14,000 £25,000 £340,000 £25,000