The High Court dismissed a medical negligence claim against spinal surgeon Marcus Timlin, finding that a patient developed cauda equina syndrome after surgery but that the surgeon’s treatment decisions were not negligent.
In a judgment delivered on 18 January 2019, Mr Justice Cross found that the plaintiff had developing nerve compression after an operation in March 2010. He also found that operating earlier than 19 March would have prevented at least a considerable amount of the resulting symptoms. But he concluded that the plaintiff had not established negligence under the legal test for medical practitioners, and dismissed the proceedings.
The claim concerned the plaintiff’s care after surgery on 11 March 2010. The plaintiff alleged that signs of cauda equina syndrome were missed and that an MRI scan should have been obtained earlier. He also argued that the scan taken on 16 March showed compression requiring immediate surgery. The judge rejected the allegation that the MRI should have been carried out earlier, noting that the plaintiff’s experts had not given evidence to support that timing argument and that it was not pressed.
The judge found that the surgeon ordered the MRI on 16 March after neurological signs developed, and discussed the images with a radiologist and another surgeon. Although the judge found that the developing syndrome and its signs were present on the scan, he accepted that the scan’s interpretation was open to significant expert debate. He held that the surgeon’s interpretation and decision to continue conservative treatment could not be faulted.
The timing of the subsequent operation was also considered. The judge accepted evidence that physiotherapy notes recorded numbness in both buttocks from 11 March, but found that those findings had not been passed to the surgeon. He also accepted that the nursing records did not convey the extent of the plaintiff’s distress and that his complaints were not fully recorded or communicated. The judge said his conclusion would have been different if the surgeon had received the physiotherapist’s findings and nevertheless delayed surgery until 19 March.
The surgeon operated on 19 March, finding an organised and fluid haematoma under pressure. The judge relied in part on the surgeon’s contemporaneous view that it was the most likely cause of urinary dysfunction and right leg weakness. He found that earlier intervention would have avoided some of the plaintiff’s later symptoms, including neuropathic pain, right foot drop, some bladder problems, sexual dysfunction and a considerable amount of his depression.
Despite those factual findings, the judge concluded that the surgeon acted in accordance with reasonable and approved practice based on his examinations and the information communicated to him. The claim against the surgeon was dismissed. The claims against Mater Private Hospital and Mater Private Healthcare had been settled before this case began, and those proceedings had already been struck out with an order for the plaintiff’s costs.