Mr R McLaughlin FRCSI FCEM MMedSci CFEU

Consultant in Emergency Medicine

 

 

Appointments:  Tel 07799147477  

Email vivhastings1066@gmail.com

 

 

Our ref:  RMcN/VH

 

John Radcliffe Solicitors

27 West Street

Belfast

BT12 7XY

 

Re: Percy Jones  27 West  Nile Street  Belfast

 

Date of Birth: 7 May 1955

 

Date of Incident:  17 January 2011

 

Date of Medico-Legal Report:  27 April 2012

 

 

I, Russell McLaughlin am a Consultant in Emergency Medicine at the Royal Victoria Hospital.  I possess the qualifications FRCSI FCEM MMedSci CFEU.  I have been asked to provide comment in the matter of Percy Jones v The Central Hospital Trust.

 

I have been asked to provide opinion in terms of standard of care your client received in the Emergency Department of Central Hospital following a fall on 17 January 2011.

 

In order to provide my opinion in this matter I have reviewed the following documents as supplied.

 

  1. Mr Jones’s General Practitioner’s clinical notes and records (257 Pages in total).
  2. Mr Jones’s Hospital clinical notes and records (35 Pages in total).
  3. Mr Jones’s Radiographs dated 17 January 2011 and 20 January 2011.
  4. Radiology reports of x-rays of pelvis and right hip dated 18 January 2011 and 23 January 2011.  

 

 

 

 

 

History:

 

Your client is a 57-year-old Plumber who attended the Emergency Department of the Central Hospital on 17 January 2011 following a fall.  The history recorded in the triage notes by Staff Nurse Polly Smith indicate that your client had slipped on ice and was unable to weight bear. He was complaining of pain in his right hip.  His pain score was recorded as 8 out of 10. This equates to severe pain.  Mr Jones was attended to by Dr B Sharkey at 19:10 hours, a physical assessment was undertaken and Mr Jones was noted to be complaining of pain in his right hip. There was no evidence of shortening or rotation or the right lower limb and he was able to weight bear with the assistance of his daughter and with some discomfort.  Dr Sharkey requested an x-ray of your client’s pelvis and right hip and recorded the findings as ‘NAD’ (nothing abnormal detected).  Mr Jones was discharged with Co-Codamol and advised to attend his General Practitioner for physiotherapy.  

 

Mr Jones re-attended the Central Hospital Emergency Department on 20 January 2011 accompanied by his daughter and son who were concerned that he had taken to his bed and was unable to walk following his discharge from the hospital.  A further x-ray was undertaken and this revealed a sub capital fracture of the right neck or femur.  Mr Jones was admitted to the fracture ward and underwent surgery to his right hip.  

 

Comment:

 

Your client underwent a thorough assessment following his initial attendance at the Central Hospital Emergency Department on 17 January 2011.  The doctor indicated that your client was able to weight bear and there was no evidence of any shortening or rotation of his right lower limb.  The absence of these findings to do not exclude a hip fracture.  I have reviewed the x-rays of your client’s right hip at his initial presentation and I am of the opinion that these reveal an obvious sub capital fracture of the right neck of femur.  The x-ray reported on 19 January 2011 by Dr Smithers Consultant Radiologist indicated that a fracture was present.  

 

Summary:

 I believe that the treatment afforded to your client fell below an acceptable standard of care for the following reasons: 

  • The original x-ray revealed what I believe to be an obvious fracture that should be detectable by a doctor of Dr Sharkey’s training and experience.  
  • Your client was treated with cocodamol for pain despite his pain score being 8 out of 10, this equates to severe pain and should have been treated with strong analgesia such as morhpine or a nerve block. This severe pain should have alerted Dr Sharkey to the presence of a fracture despite not detecting any fracture on xray.
  • Dr Sharkey’s did not advise your client what to do if his symptoms worsened or he was unable to weight bear. It is standard practice to advise patients such as your client  to re-attend for further imaging if pain worsens or they cannot bear weight. 
  • On the following day the Consultant Radiologist noted that the fracture was present and there   does not seem to have been any action resulting in the urgent recall of your client. 

I believe that there has been negligence in this case. I believe that your client had a sub-capital neck of femur fracture, which was apparent on his original x-ray. Your client should have been admitted to hospital for immediate surgery on his first presentation.

 

 

 

 

Practice Statement:

 

  • I understand that my primary duty in furnishing written reports and giving evidence is to assist the court and that this takes priority over any duties which I may owe to the part or parties by whom I have been engaged or by whom I have been paid or am liable to be paid.  I confirm that I have complied and will continue to comply with this duty;
  • I have endeavoured in my reports and in my opinions to be accurate and to have covered all relevant issues concerning the matters stated, which I have been asked to address, and the opinions expressed represent my true and complete professional opinion;
  • I have endeavoured to include in my report those matters of which I have knowledge and of which I have been made aware which might adversely affect the validity of my opinion;
  • I have indicated the sources of all information that I have used;
  • I have were possible formed an independent view on matters suggested to me by others including my instructing lawyers and their client; where I have relied upon information from others, including my instructing lawyers and their client, I have so disclosed in my report;
  • I will notify those instructing me immediately and confirm in writing if, for any reason, my existing report or opinion requires any correction or qualification;
  • I understand that:
  • My report, subject to any corrections before swearing as to its correctness, will form the evidence which I will give under oath or affirmation;
  • I may be cross-examined on my report by a cross-examiner assisted by an expert;
  • I am likely to be the subject of public adverse criticism by the judge if the court concludes that I have not taken reasonable care in trying to meet the standard set out above. 
  • I confirm that I have not entered into any arrangement whereby the amount or payment of my fees, charges or expenses is in any way dependent upon the outcome of this case. 

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Mr R McLaughlin FRCSI  FCEM MMedSci CFEU

Consultant in Emergency Medicine