Prison Healthcare Negligence

Nicholas Leahy, a solicitor in the Clinical Negligence Department at Osbornes Law, has  recently successfully settled a long running case against a prison healthcare provider, following their failure to diagnose and treat his client’s myocardial infarction (heart attack) in a timely manner whilst he was an inmate on 27 November 2015.

Background

Our client, who was 43 years old at the time, had reported to prison staff at HMP Risley on the evening of 26 November 2015 that he was suffering from chest pains, following which he had been provided with ibuprofen by prison guards. He had reported that his pain had been 10/10 in severity, and that he was short of breath, clammy and nauseated. His condition deteriorated over the course of the night and the following morning his cellmate alerted prison staff at 08:00. By this time, our client was unable to speak without great difficulty, felt clammy and sick, and reported that he felt completely paralysed on the left side of his body.

Our client was eventually attended to by a nurse employed by the healthcare provider and a 12 lead ECG was performed at 09:45. The report of this ECG said:

“poor R wave progression V1-V4 and ST elevation, acute myocardial ischaemia cannot be excluded … for immediate GP clinical review. Poor R wave progression and ST elevation in anterior leads which appear indicative of acute myocardial ischaemia despite no reciprocal changes. Based on symptoms and ECG abnormalities transfer to A&E for further management is recommended but the decision remains at the GPs clinical discretion”

It would appear that the nurse showed the ECG to the GP who was working on the prison site at around 10:46, and the nurse’s note then records “ECG shown to Dr Clift. V1-V4 high take of, no ST elevation observed…Repeat ECG to be taken this afternoon”.

Our client reported that as the day progressed his condition became worse, with other inmates becoming concerned about his condition. He was eventually seen by the prison GP at 14:38, who reviewed the ECG from that morning, noted the findings, and noted the symptoms which our client had been reporting. The GP examined our client and took a repeat ECG which showed “changes and T wave inversion V4-V6…’. The GP’s impression was that the chest pain was cardiac in origin and so an emergency ambulance was called.

Our client was conveyed to Warrington Hospital by ambulance, arriving at 16:14. Various tests and investigations were performed including 12 lead ECG, chest x-ray and blood tests. He was diagnosed with a late presentation NSTEMI (heart attack) with ongoing chest pain. He was admitted to the CCU at 19:05 and commenced on cardiac treatment and monitoring.

Our client remained an inpatient on the CCU at Warrington Hospital until his transfer to the Liverpool Heart and Chest Hospital on 1 December 2015, where he underwent percutaneous coronary intervention (PCI) on 2 December 2015. He was discharged back to HMP Risley on 3 December 2015. Residual symptoms continued after his release from prison and included shortness of breath on exertion and difficulty  in climbing the stairs.

Legal Proceedings

Our client instructed Nicholas Leahy of Osbornes Law to investigate a claim for clinical negligence in November 2018 for the delay in diagnosing his heart attack. As the three year limitation period was about to expire, an agreement was reached with the Defendant to suspend limitation so that the case could be properly investigated.

Expert evidence was obtained from a nursing expert, a GP expert (both on breach of duty) and a Consultant Interventional Cardiologist (on causation and Condition and Prognosis). All of these reports were supportive of our client’s case. The case raised complex issues in relation to breach of duty however, because the negligence took place in a prison setting. Our GP expert was very clear that typically in a prison such as HMP Risley, there would only be one GP present throughout the working day, and attending on any patient for immediate review is often not possible. Despite this, our GP expert agreed that nursing staff in a prison setting are perfectly entitled to call and ambulance without discussing a patient with the GP, if they feel this is clinically indicated. Our nursing expert was of the firm view that this should have happened once our client had been seen by the nurse on the morning of 27 November 2015.

In respect of causation, the cardiology expert was of the opinion that the ECG on the morning of 27 November 2015 showed ongoing cardiac ischaemia, and that the delay in conveying our client to hospital meant that he was started on the acute coronary syndrome pathway later than he otherwise would have been. However, his view that our client would still have needed the treatment he had, including angiography and a stent. He was therefore asked to address what material difference the delay made, and was of the opinion that prompter medical treatment would have ameliorated and improved the ongoing ischaemia which continued for another six to eight hours because of the alleged breach of duty. He was of the opinion that this would have aborted his acute infarct and reduced the amount of damage which he suffered to the left ventricle of his heart.

A Letter of Claim was sent to the healthcare provider on 12 February 2020. On 4 June 2020, they responded, denying liability in full. The Defendant took the position that as our client was clinically stable on the morning of 27 November 2015, it was reasonable to wait and take a repeat ECG that afternoon, especially as he could then be seen by the prison GP. Further, in terms of causation they argued that the delay of a few hours was unlikely to have made a significant difference to the eventual outcome.

In light of the Defendant’s denial of liability, Counsel, John Schmitt of Deka Chambers, was instructed to advise on liability and quantum. Our experts remained supportive of the case in conference, however there were considerable risks given the unique nature of the prison environment. Following the conference with Counsel, various Part 36 offers were made by the Claimant, all of which were rejected by the Defendant. Our client reasonably agreed to the without prejudice disclosure of his evidence on breach of duty and causation, yet the healthcare provider would still not admit liability.

Eventually, our client was advised that the only option left would be to issue court proceedings. The Defendant was informed of our client’s intention to do so, at which point a five figure offer of settlement was finally made in early 2023. Our client accepted this offer.

Nicholas Leahy, who acted for our client in this case, commented “this was a very interesting and complicated case in respect of both breach of duty and causation. However, our client had strong expert evidence in support of his case, and it is a shame that the Defendant would not take a reasonable approach to negotiations until court proceedings were threatened. Sadly this is often the case, which causes additional stress and upset to patients and their families at what is already a difficult time. I am pleased that we were able to secure a positive outcome for our client in this case, which will allow him to move on with his life”