Case Study: A Shot In Time

A 23 year old lady tripped on a dance floor and fell, twisting her knee and dislocating the kneecap.? This was pushed back by the ambulance crew and she was taken to a major Accident and Emergency Department.? It was accepted that the kneecap had dislocated (this was the first time) and so, after discussion with the Orthopaedic Department, she was placed in a plaster cylinder and sent home in a wheelchair with crutches to be reviewed in two weeks time at the Fracture Unit.

Five days after she went home she developed severe pain in her leg which swelled markedly.? She went to another hospital where the plaster cylinder was split, an ultrasound test carried out which showed that she had developed deep venous thrombosis, spreading up to her knee.? She was seen by a Haematologist who started her on subcutaneous injections of Heparin.

There are a number of risk factors developing in DVT in a young woman.? These include, her weight, whether she smoked and in particular whether or not she was on oral contraceptive pill.? In this case she was but was never asked.? The guidelines clearly state that in such a patient who is being immobilised she should immediately be started on subcutaneous injections of Heparin on a daily basis for up to six weeks.

She therefore did develop a deep venous thrombosis in the absence of the injections and the Haematologist strongly advised that she should never be placed back on oral contraception once her anticoagulants ceased after six months.? This had considerable consequences for her personal life.

It is true that in busy Accident and Emergency Departments, junior staff occasionally do not properly manage some cases because of their inexperience, even though the guidelines are clearly written in the charts.? However, there is no place for “an L driver” in relation to the care provided to patients.??

Apart from the primary DVT and the likelihood that she could develop this again, for instance after any surgery or pregnancy, she obviously had other difficulties with her personal life because she was unable to take the oral contraceptive pill.? There was therefore a breach of the duty of care with considerable consequences for her, indicating an action in negligence would be likely to succeed.

Initial screening is therefore essential to manage client expectations at an early stage. This avoids unnecessary effort and costs for all concerned. Too many cases are taken to Court with no chance of success. This is stressful for both the client and their legal advisor and indeed for the medical personnel involved.

For fast and effective screening of all potential medical negligence cases contact?

Peyton Medico Legal Services now on 028 87724177 or email [email protected]