North Bristol NHS Trust v Holly Rebecca White

Hearing dates: 24, 25 and 26 May 2022

Approved Judgment

The Claim

This is a claim for committal for contempt.

The Parties

Miss White is the alleged contemnor. The Claimant in this action is an NHS Trust. Because this claim arises out of an earlier clinical negligence claim brought by Miss White against the Trust in which the terms Claimant and Defendant were reversed I shall not use the terms Claimant and Defendant so as to avoid confusion.

Bundles

For the committal hearing there were 4 digital bundles. A mitigation witness statement from Miss White and a psychiatric report were handed up during mitigation.

The Issue

Sentencing for the contempts of Court by Miss White which were admitted on the day before the contested hearing was due to start.

Background

Miss White was born on the 6th of December 1992 and is now aged 29 and a half. Before the relevant events she had been brought up in the Barnstable area. Her parents separated when she was about 14 and as a result, according to her witness statement, she obtained poor GCSEs, got into a little trouble with the police and was a bit naughty.

As she matured in her late teens Miss White enjoyed horse riding and when she started working she went to the gym four times per week. After ending school at 16 she completed an NVQ 2 but failed to complete an NVQ 3. She was working towards achieving that in 2011. In the summer of 2011 she was working as a care assistant and/or trainee nurse for BUPA in a nursing home in Bristol and earning approximately 18,000 pounds gross per annum. She worked full time and enjoyed the job. In her witness statements she set out that she planned to have a career in nursing and or midwifery.

She had a partner called James Summerill who was also working and earning equivalent sums. They were building a life together.

Her mother had suffered cauda equina syndrome (CES) and had to self catheterise and also had to use anal irrigation. I shall explain more about that syndrome below.

Healthwise Miss White had a past history of irritable bowel syndrome. In April 2011 she strained her back at work helping an old lady out of a chair and the back pain lasted 2 weeks. On the 17th of May 2011 she reported to her GP that she had suffered some urinary leakage since the February of that year but had no lower back pain. A diagnosis of urinary tract infection (UTI) was made. On the 19th of May 2011 she called her GP complaining of lower back pain which was thought to be related to the UTI. On the 16th of June 2011 in a phone call with her GP she continued to complain of urinary leakage and lower back pain which, by that stage was going into her left leg. On the 20th of June 2011 she attended her GP complaining of lower back pain and informed her GP that her mother had suffered a slipped disc resulting in CES. The lower back pain was going into both her left and right legs. She was counselled on red flags relating to prolapsed discs. On the 25th of July 2011 the GP noted she had suffered faecal incontinence on holiday in Tunisia and she had lower back pain going into her left foot and urinary leakage. On the 12th of August 2011 the GP again noted increased lower back pain going into her left leg but no numbness around her bottom. On the 26th of August 2011 at a MATS clinic Miss White was upset due to her lower back pain and her concern that she herself might be was suffering CES. She was referred to the Frenchay Hospital in Bristol for an MRI. The examination of her perineal area was normal at that time.

Miss White attended the accident and emergency department of the Trust's hospital on the 18th of September 2011 complaining of leg pain and lower back pain. The leg pain being in both legs and running into her feet. There was no examination for CES and she was discharged because she was awaiting an MRI. No neurosurgical review took place. This was the genesis of the clinical negligence claim.

On the 11th of October 2011 Miss White underwent a decompression at L4/L5 for a central disc prolapse. She was in hospital for four days. She had presented on the 8th of October with lower back pain and increasing leg symptoms. A rectal examination had been carried out and an MRI scan which had disclosed the disc prolapse.

Miss White suffered CES due to an alleged delay in diagnosis between the 18th of September and the 8th of October 2011. The cauda equina is the horses tail of nerves running into the legs and pelvis from the bottom of the spinal cord. A disc prolapse at L4/5 can damage the nerves irreparably. Early treatment can stop the progress of the nerve damage. Miss White alleged that the CES led to three main areas of symptomatology: firstly her bladder; secondly her bowel and thirdly her left ankle which she asserted was weak. Ancillary to the bladder and bowel sensation issues Miss White alleged that she could no longer enjoy any feeling during sex.

Miss White took three months off work. The medical notes in November and December 2011 included statements by Doctors that her bladder and bowel were normal although Miss White disputed those notes. In December 2011 an MRI was taken which showed no continuing prolapse and no nerve root compression.

Miss White returned to work in approximately January of 2012 and continued working full time for approximately six months as a care assistant.

In March 2012 an MRI scan disclosed multi level disc disease with prolapse at L2/L3 but no compression. At this time Miss White was complaining of pain in her back, going down her left leg and some numbness.

By August 2012 Miss White underwent urodynamic tests because she was not voiding her bladder properly. The month after she was given advice on how to self catheterise and it was her case that she started self catheterising six times per day. She complained of rare faecal incontinence and that she was unable to feel when she was ready to go for bowel movement.

Miss White had given up work by September 2012 having reduced her hours in July 2012, however it stands as a fact that she had worked as a care assistant full time from January to July 2012.

By December 2012 the medical notes disclosed that she was self catheterising six times a day.

Miss White gave birth to a son on the 27th of June 2013.

On the 15th of February 2014 Miss White underwent a second spinal operation which was an L5 nerve root decompression. It was her case that this made no difference to her bladder and bowel symptoms. The notes disclosed that her bladder and bowel sensation were reduced substantially after that operation.

By September 2014 the medical notes showed that her bladder and bowel were incompetent.

In February 2015 an MRI scan showed L4/L5 disc problems.

By April 2015 Miss White was using a bowel irrigation system to avoid manual evacuation which she had previously had to carry out.

In late 2017 Miss White suffered increasing right leg pain and this led to a third spinal operation on the 1st of February 2018 carried out by a surgeon called Mr. Chan. This was a revision discectomy at L4/L5. This was carried out at the Royal Devon and Exeter hospital and was successful in relieving the right leg pain. There is no suggestion that Mr. Chan advised that he could alter the pre-existing neurological symptoms caused by the original events in 2011 and in particular that this operation could relieve the continuing alleged left leg symptoms, bladder or bowel symptoms.

On the 3rd of April 2018 in a letter sent by Mr. Chan to Miss White's GP, Mr. Chan summarised that the response to the third spinal operation was very satisfactory in the leg [I assume the right leg]. Thereafter Miss White failed to attend physiotherapy three times and so was discharged.

Miss White had been claiming benefits from the Department of Work and Pensions since 2012, including income support, disability living allowance (both components) and housing benefits. She was provided with a Motability vehicle.

The clinical negligence action

The claim form was issued on the 23rd of September 2014 limited to a value of 50,000 pounds. In the particulars of claim Miss White alleged that the Trust had been negligent by failing to refer her for a neurosurgical assessment on the 18th of September 2011 and further asserted that had that referral taken place she would have been offered a spinal operation within 48 hours which would have frozen her symptoms in time and prevented any further deterioration.

In the Trust's defence dated 15th September 2015 liability was denied, as was causation.

The trial of the preliminary issue relating to liability was listed for the 22nd of May 2017, however before that date the parties reached agreement to settle liability on a 50:50 basis and that agreement was approved by His Honour Judge Cotter (as he then was) on the 5th of May 2017. The Trust was ordered to pay costs of 82,000 pounds to Miss White's solicitors relating to the liability issue. The settlement covered causation of CES but did not cover causation in relation to the extent of the symptoms claimed by Miss White arising from CES.

Directions were then given in relation to evidence needed on the quantum of the claim.

The Trust made three interim payments to Miss White totalling 45,000 pounds, the first in June 2017, the second in March 2018 and the third in October 2018.

Miss White's schedule of loss was signed on the 10th of August 2018 and claimed £4.1...