The Claimant, a 68-year-old man, was awarded £380,000 for a terminal cancer diagnosis caused by the Defendant’s failure to monitor Barrett’s Oesophagus Disease (“BOD”) which was diagnosed following a gastroscopy in October 2014).
The Defendant failed to provide sufficient information to the Claimant in explanation of his diagnosis of BOD and the rationale for two yearly surveillances. The Defendant further failed to arrange and undertake surveillance in 2016 and 2018.
Claimant - Male; 62 years old at date of the incident; 68 years old at date of settlement (“C”)
Clinical Negligence: C had been under the care of gastroenterology from April 2014, following referral by his GP due to Dyspepsia. C underwent a Gastroscopy in April 2014 and a repeat in October 2014. The biopsies and findings on his Gastroscopy confirmed BOD and Hiatus Hernia (“HH”).
- On 8 December 2014 C saw his GP who explained the diagnosis and plan to re-scope in two years (October 2016) and to continue with Proton Pump Inhibitors (PPI) to reduce the amount of acid in C’s stomach.
- In October 2019, following a conversation with a friend about his initial BOD diagnosis and lack of surveillance since 2014, C contacted his GP to explain that he had not been followed up and wanted to arrange the same.
- On 18 October 2019, C’s GP wrote to the Endoscopy Unit to arrange a follow up, which was now 3 years overdue.
- On 26 November 2019, C underwent a Gastroscopy which showed Barrett’s oesophagus and high grade dysplasia.
- On 7 January 2020 the Consultant Gastroenterologist wrote to C’s GP and confirmed that biopsies have shown some areas of low-grade Dysplasia and focus high-grade Dysplasia which required further investigation and treatment. C was taking Omeprazole 20mg per day for his acid reflux symptoms.
- On 27 January 2020 it was reported that there were multiple lymph nodes between 36cm and 25cm. A CT scan of the chest and abdomen was to be requested to investigate further.
- On 19 February 2020 a Multi-Disciplinary Team meeting in Upper Gastrointestinal Cancer took place.
- On 9 March 2020 he had endoscopic mucosal resection which showed nodularity 24cm to 30cm. EMR resection had shown invasive adenocarcinoma.
An FDG PET scan on 20 March 2020 showed middle third oesophageal tumour as well as lymph nodes in station 5, 4L, 4R and 3R. A CT scan showed no abnormality in the sigmoid which suggested a T3/4 tumour close to the trachea with hilar nodal involvement as well as local nodes.
On 31 March 2020 C was seen in clinic by Consultant Clinical Oncologist and who explained that the cancer was more widespread than first thought, that it was incurable as the lymph nodes were considered a distant spread and that his life expectancy would be measured in months. He was told that with chemotherapy the average life expectancy would be about a year up to the maximum of perhaps two years realistically.
Chemotherapy was explained to him including the increased risks of such treatment during the COVID-19 pandemic. C was to consider the diagnosis, treatment options and discuss with his family. He was provisionally booked to be seen again in two months.
C underwent a course of 5 treatments of radiotherapy in May 2020 (20 Gy in 5 fractions) and commenced chemotherapy on 5 August 2020 and had 8 cycles in total (Capecitabaine and Carboplatin).
C brought a claim against the Trust.
A letter of notification was sent on 11 June 2020.
The Trust responded on 27 November 2020. They denied that they have failed to provide sufficient information to C following the gastroscopy in October 2014 but admitted that they did fail to arrange follow up in 2016 and 2018 as planned and that he had been lost to follow up. In relation to causation, they admitted that but for the failure to arrange and undertake appropriate surveillance, he would not have developed low grade and high grade dysplasia, an oesophageal tumour with lymph node involvement.
Medical expert evidence was obtained from Dr T E Bowling, Consultant in Gastroenterology in relation to causation with regards to the failure to undertake surveillance and the implications on his subsequent diagnosis. Further medical evidence was obtained from Dr Stephen Falk, Consultant in Clinical Oncology in relation to causation condition and prognosis.
Given the slow transition rates to cancer, with endoscopy planned in late 2016, there would have been abnormalities either indefinite for dysplasia or lower grade dysplasia. With appropriate management and care, C would have avoided:-
(a) A terminal diagnosis
(b) Palliative radiotherapy
(c) Palliative chemotherapy
(d) Difficulty swallowing and weight loss
(e) Psychological consequences of a diagnosis of terminal cancer.
Dr Falk’s initial opinion as at 22 August 2020 was C had limited metastatic disease simply within the hilar lymph nodes within the chest and not involving major organs such as the lung and liver and in this situation would opine that his average survival would be 18 months from the start of chemotherapy in August 2020. C has outlived this prognosis and done better than the average case. In an updated Condition and Prognosis report dated 6 June 2022, Dr Falk noted that C’s swallowing is currently slowly deteriorating and on balance he will have progressive local disease and the prognosis of survival is less than one year.
Injuries: C suffered additional pain, suffering and loss of amenity (PSLA) and delayed treatment which led to him developing invasive cancer
Effects: C received a terminal diagnosis and required palliative radiotherapy, palliative chemotherapy, had difficulty swallowing and suffered from weight loss and psychological consequences arising from the terminal diagnosis.
Liability: admitted by the Defendant
Out of Court Settlement: £380,000 total damages (PSLA past and future loss)
Breakdown of damages:
- £80,000 PSLA
- Past loss (care): £11,584.30
- Future loss (Loss of earnings): £7,551.00
- Financial dependency: £110,000
- Dependency on services: £150,000
- Bereavement award: £15,120
- Funeral expenses: £5,000