Case Study: Leg amputation following failed diagnosis

Case Study: Leg amputation following failed diagnosis

October 29, 2020

Forty-nine-year-old Darren Bishop went to his GP and his local hospital’s A&E department several times over the course of a fortnight, and was told he had tendonitis and sent home.

In fact, the condition he was suffering was a medical emergency, which should have been treated immediately. If it had been, it is expected that Darren would have made a full recovery.

The Case

Darren, who was 44 at the time, first went to the A&E department of his local hospital as he had been suffering from pain in the right foot and lower leg for two days. He was examined but there was no redness in his leg and no signs of deep vein thrombosis, so he was sent home.

A week later he went to his GP as the pain in his leg had become worse. He was diagnosed with Achilles tendonitis. Within a couple of days, he had to call an ambulance because the pain had become unbearable. He was taken to hospital and both the paramedic and triage nurse noted that his foot was cold to touch.

He told them that it was also tender, bruised and losing sensation, but again he was told it was tendonitis and discharged.

Three days later he attended a different hospital and this time he was sent to undergo an immediate vascular review. He was told that he was suffering from acute limb ischaemia – a sudden decrease in arterial blood flow to a limb.

He was then advised that he needed a below-knee amputation, and the operation took place just two weeks after first presenting to his medical team with a sore foot.

Unfortunately, after the operation, the wound became infected and despite a course of antibiotics and maggot therapy – where maggots are introduced to a wound to remove infected tissue – it was unsuccessful in stopping the necrosis of the tissue.

This meant that his knee joint had to be amputated as well. Not only did this mean further surgery for Darren but it brought added complications in the type of prosthetic limb he could have and further restricted movement.

“I went in the to doctors with a bad foot and a month later, I had no leg. With how modern medicine works today – that kind of thing shouldn’t happen.”

The impact on his life

Losing his leg has obviously had a huge impact on Darren’s life. One of the aspects that he has really struggled to come to terms with is that he originally went to hospital with a sore foot which he thought he would recover from. He could never have imagined that he would end up losing his leg.

He said: “It was definitely a shock to the system, that’s for sure. I just went in the to doctors with a bad foot and a month later, I had no leg. Sometimes I just think ‘how the hell did I go from that, to this?’ Especially with how modern medicine works today – that kind of thing just shouldn’t happen.

“For me, it all comes back to that one doctor sending me home that day. If all he’d done was keep me in, or transfer me straight to hospital – that could have been all the difference. That’s a lot to swallow.”

Losing a limb has changed Darren’s life physically, but also mentally. Making the adjustments to his life and coming to terms with no longer being able to do some of the things he enjoyed, is something that he continues to learn to deal with.

Darren used to enjoy going to the gym, cycling, fishing and golfing, but he no longer has those hobbies.

He continued: “I used to go fishing quite a lot and I don’t anymore. I do miss it. I know there are some facilities that enable wheelchairs, but a lot of them you have to climb over a gate or climb over a muddy field. I didn’t drive for five years because I lost my dominant leg, which immediately meant I couldn’t drive. And of course, with fishing – you have to be able to drive places.

“After the settlement, I was able to get a new car with the right adaptations. So I’m hoping that when the Covid restrictions are eased, I might be able to be more independent.”

When doctors first spoke to Darren about the amputation, they hoped it would be a below the knee amputation, which would have meant better mobility and more comfortable use of prosthetics. This was another huge blow for Darren.

“For the first few months, you’re just relying on someone else to do everything for you. And when they go out, you’re stuck where you are. In some ways, it’s like a prison sentence.”

He had an infection in his knee and they treated it with tissue – but this was unsuccessful and he suffered a further amputation to remove the knee. He subsequently used a prosthesis supplied by statutory services but it was an uncomfortable fit. His walking tolerance was very limited and he was reliant on a crutch when walking short distances and on a wheelchair when walking over 100 metres. He also sometimes required a stick when walking indoors.

Darren said: “At the start it was all about keeping the knee. Because my mobility would have been better. But after the infection, I lost the knee as well. Which made things even harder.

“For the first few months, you’re just relying on someone else to do everything for you. And when they go out and you’re on your own, you’re just kind of stuck where you are until they come back. In some ways, it’s like a prison sentence.

“But once you master getting up and down the stairs, it’s a big relief. Just being able to hop down the stairs, pick up my crutches at the bottom, go to the kitchen and do stuff for myself – you suddenly feel like you have some control back.”

After the surgery Darren suffered with severe phantom limb pain. He could feel the whole amputated limb as if it is still there, and experiences a sharp needle pain in the foot, and also a tingly sensation around the scar.

Breach of duty

Darren contacted Fletchers Solicitors to represent him in a case against WSH NHS Foundation Trust for a breach of duty of care.

It was alleged that had the hospital provided an appropriate standard of care, the acute limb ischaemia would have been diagnosed and prompt vascular surgical intervention would have been undertaken to restore circulation to the right leg. If this had happened, he would have made a full and uneventful recovery and been fully independent within four months of treatment.

Darren was awarded a suitable settlement out of court, and hopes the money will enable him to make adaptations to his home and go towards his future loss of earnings.

The aftermath

Iain Dodd, a specialist medical negligence solicitor at Fletchers Solicitors, said:

“This case goes to show the huge importance of getting immediate medical attention. In this instance, our client did what anyone should do and he sought medical assistance. Unfortunately, his needs were not addressed. If he had been treated correctly on the first, or even the second occasion, this could have been avoided and he may not have needed his leg amputated.

“Our client was acutely aware that there was something wrong with his leg, but he was at the mercy of the medical experts who wrongly diagnosed his condition. This case highlights the importance of being vigilant; both as a patient and as a medical professional.”

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