The 43-year old male sustained an injury to his left arm while lifting a heavy box at work on the 1st October 2017. He was seen by his General Practitioner the following day. His GP did not diagnose any serious injury to the left arm and didn’t detect signs of any tendon rupture. The Plaintiff remained in pain with his left arm for several days and attended at the A&E Department of a Regional Hospital in the south of the country some five days later where he was seen by an Advanced Nurse Practitioner. The A&E notes record that he was complaining of pain in the distal biceps area of the left arm and noted that there was a tender hematoma present in the region. On examination by the Nurse Practitioner, there was bruising in the proximal ulnar but no bulge in the upper arm. There was pain on flexion of the elbow. The nurse queried a possible fracture of the distal humerus bone or proximal ulnar or alternatively diagnosed a partial biceps tear.

An x-ray performed showed no bony fracture. A diagnosis of soft tissue injury was made, but crucially no ultrasound or MRI scan was arranged to rule out tendon rupture. He was discharged from the hospital and told to see his GP for follow-up. He reattended at his General Practitioner some thirty days after the original injury and was only then referred for an ultrasound scan, which revealed a hematoma and a likely tear of his biceps tendon. A further MRI was recommended. He was referred back to the Regional Hospital where he was seen by an Orthopaedic Surgeon. He was referred for physiotherapy and a subsequent MRI scan was arranged for mid-January 2018 which showed a complete rupture of the distal tendinous portion of the biceps tendon. Unfortunately, by that stage repair surgery was not a viable option insofar as it was unlikely to achieve a good functional improvement given the passage of some three and a half months from the time of the original injury until correct diagnosis of the tendon rupture.

The injury had most unfortunate consequences for the Plaintiff insofar as he was a long-distance lorry driver and the permanent injury to his left arm effectively prevented him from pursuing his vocation as a lorry driver. He did have residual earning capacity and did return to work as a handyman and was fit to carry out some light building repair work. However, he did sustain a significant diminution in his earning capacity.

 

The Plaintiff consulted this firm and we instructed a Consultant in A&E medicine and an expert in general practice. The expert opinion from the General Practice Expert was that the standard of care provided by the treating GP was of a reasonable standard. However, the A&E Consultant was critical of the treatment received by the Plaintiff at the Accident & Emergency Department of the Regional Hospital. The history of the injury was suggestive of an injury to the biceps tendon. The fact that the Nurse Practitioner considered a biceps tendon rupture as part of the differential diagnosis upon first presentation to the A&E Department some seven days after the original injury ought to have prompted an ultrasound investigation to exclude a partial tendon rupture. The records at the A&E Department did not refer to the presence or absence of power in the wrist elbow or arm The expert advice received from the Consultant in Accident & Emergency Medicine opined that given the fact that a possible biceps tendon rupture was part of the differential diagnosis there ought to have been a referral to a more senior doctor in the emergency department and/or referred to the orthopaedic team for further assessment. If this had occurred, it was the considered view of the expert, that it was likely that an ultrasound scan would have been ordered and a partial rupture or complete tendon rupture would have been diagnosed the same day. This would have meant the correct diagnosis would have been obtained within seven days of the original injury. If there had been a diagnosis that early the injury would have been amenable to tendon repair with a likely good outcome and minimal long-term consequences.

Proceedings were issued against the HSE. A full Defence was delivered initially. Subsequently negligence was admitted but there remained a denial that even if there had been a more timely diagnosis, the long term outcome would have still been poor. In effect the Defendants continued to dispute the Plaintiff’s causation case. Ultimately however and shortly before trial the Defendants requested settlement negotiations. The case was ultimately settled at mediation for its full value of €550,000 and costs. The award of €550,000 includes a substantial claim for future loss of earning ability.

If you require further information or advice on any issues arising from this report please contact Gillian O'Connor, Managing Partner, Michael Boylan, Partner or Ciara McPhillips Partner at 01-9017418