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Diabetic Injury Claim

Diabetic injury claim? What are the associated failures…

These claims tend to fall into 3 categories, those that involve a delay either 1. a failure to diagnose a condition, 2. those that involve a failure to refer onward for more specialist care and 3. those where specialist practitioners have erred and or not taken the severity of the situation into full account.   Contact us to to discuss if you have a compensatable diabetic injury claim or even if you believe that your care has been substandard.

As a consequence of the work of the Diabetic Unit, we have gathered a great deal of expertise in â€‹ophthalmic and optical claims.

In particular actions for delay in treatment of detached retina,  misdiagnosis of intra-ocular pressure and subsequent vision distortion / defect,  premature or avoidable partial vision loss,  blindness or other permanent vision defects.

Delay in treatment for a Diabetic Condition

Breaking down the sections of diabetic injury is no easy task. Ultimately many of the injuries associated with diabetes are those that can cover all of the headings in one way or another. However, the most commonly recurring issue is probably delay. This can be a delay in making a referral, especially to ophthalmic or foot care but could also be a delay to appropriately diagnose and medicate.

Failure to Refer

The issue of onward care usually occurs at the primary care level. In other words, it is usually a failure of the GP to recognise the seriousness of symptoms. In many ways this is a delay action that never occurred. Usually and sadly, something goes wrong before the referral is made. The resultant diabetic injury claim was entirely avoidable.

Diabetic Treatment

Diabetes is a chronic illness that requires significant continuing primary medical care as well as good patient self-management. It is also necessary for primary care givers to ensure that the patient is educated to prevent acute complications. This will also help avoid or reduce the risk of long-term problems.

There is no doubt that diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. Failure to account for changes in condition and or risk, is likely to bring about a poor perhaps even catastrophic outcome resulting even in avoidable amputation.

The Diabetic Conditions and why they require careful clinical managment.

diabetic claim insulin check
Most of the issues in diabetic claims are dirived from the fact that there is a lack of clinical history accounted for in any future treatment. Every sufferer from diabetes has the same medical issues as every one else its just the medical history needs to be checked first.

Pre-diabetes

It is a generally accepted fact that more people than ever have blood sugar levels above the normal range, but not high enough to be diagnosed as having diabetes. This borderline condition has become known as pre-diabetes. If your blood sugar level is above the normal range, your risk of developing full-blown diabetes is increased. If you suffer chronic, that is prolonged blood sugar levels then the deterioration of the bodies systems for secretion of insulin can become compromised.

It’s very important for diabetes to be diagnosed as early as possible because it will just get progressively worse if left untreated.

Diabetic eye screening

Everyone with diabetes and is aged 12 or over should be invited to have their eyes screened once a year. Those with diabetes, are at significant risk from diabetic retinopathy, a condition that can lead to sight loss if it’s not treated. Screening, which involves a 30-minute check to examine the back of the eyes, is a way of detecting the condition early so it can be treated more effectively.

It is of course important to state that it usually takes several years for a progresive condition such as diabetic retinopathy to reach a stage where it could threaten your sight. The retina is the light-sensitive layer of cells at the back of the eye that converts light into electrical signals. The retina requires a constant supply of blood, which it receives through a network of blood vessels. Over time, a persistently high blood sugar level can damage these blood vessels in 3 main stages:

  • background retinopathy â€“ tiny bulges develop in the blood vessels, which may bleed slightly but don’t usually affect your vision
  • pre-proliferative retinopathy â€“ more severe and widespread changes affect the blood vessels, including more significant bleeding into the eye
  • proliferative retinopathy â€“ scar tissue and new blood vessels, which are weak and bleed easily, develop on the retina, this can result in some loss of vision

However, if a problem with your eyes is picked up early, lifestyle changes and/or treatment can stop it getting worse.

Funding

We have a unique arrangement with our Solicitor Members – we seek to introduce – transparency and trust into the marketplace and our agreements could not be clearer.

Further Diabetic Complications and Managment

Apart from the above documented issues of diabetic retinopathy, there are other issues associated with diabetes that both primary care and specialist care teams need to be conscious of. In particular:

Foot Problems

Having diabetes means that you’re more at risk of serious foot problems and which can lead to amputation if untreated. Nerve damage can affect the feeling in your feet and raised blood sugar can damage the circulation, making it slower for sores and cuts to heal. That’s why it’s important to tell your GP if you notice any change in how your feet look or feel.  

Heart Attack and Strokes

When you have diabetes, high blood sugar for a period of time can damage your blood vessels. This can sometimes lead to heart attacks and strokes. 

Kidney problems (nephropathy)

Diabetes can cause damage to your kidneys over a long period of time making it harder to clear extra fluid and waste from your body. This is caused by high blood sugar levels and high blood pressure. It is known as diabetic nephropathy or kidney disease.

Nerve damage (neuropathy)

Some people with diabetes may develop nerve damage caused over time by high blood sugar levels. This can make it harder for the nerves to carry messages between the brain and every part of our body so it can affect how we see, hear, feel and move. 

Gum disease and other mouth problems

Too much sugar in your blood can lead to more sugar in your saliva. This brings bacteria which produces acid which attacks your tooth enamel and damages your gums. The blood vessels in your gums can also become damaged, making gums more likely to get infected.

Nursing Negligence Example

Some examples of nursing negligence would be:

  • Failing to refer a patient who is suffering from an open wound or pressure sore that is not healing.
  • Failing to gaurd against pressure sores, ulcers and weeping wounds.
  • Failing to lift a patient safely leading to fractured bones which can go unnoticed or untreated
  • Keeping a patient on antibiotics for a urinary tract infection when the infection is not responding.
  • Not keeping a patient hydrated or not noticing that a patient is dehydrated or undernourished.
  • Administering the wrong medication or the wrong dose.
  • Not reffering a patient who is not responding to medication
  • Not taking a patients consent or ignoring a patients wishes
Nursing Negligence Consequences

The consequence of negligence for the patient is nearly always injury or harm, for the responsible nurse the consequences vary but could be:

  • The Nurse will likley have to be questioned and a statment taken by the Hospitals legal department.
  • The Nurse will likely have to given an account to thier manager or supervisor
  • They may face and investigation by the NHS Trust or the Hospital.
  • They may have to face an investigation by the Royal College of Nursing and Midwifery.
  • They may have no conseqeunces at all.

Ultimately much depends on the degree of negligence or harm that has been caused.

Nurse Negligence Wrongful Death

FATAL ACCIDENT INQUIRY INTO THE CIRCUMSTANCES OF THE DEATH OF MR JAMES MCNEILL [2010] FAI 50

DESCRIPTION

In terms of section 6(1)(a) of the Fatal Accidents and Sudden Deaths Inquiry (Scotland) Act 1976, the Sheriff found that Mr James McNeil (DOB 14th September 1935) died at 08:30 hours on the 22nd of October 2008 at Belhaven Hospital, Dunbar. The cause of death was (i) bronchopneumonia; (ii) pressure sores on back, ischemic heart disease, and dementia.In 1989, Mr McNeill was diagnosed with Alzheimer’s disease, and his condition eventually deteriorated in 2007. On 18th April 2008 Mr McNeill was admitted to Lennel House Nursing Home, Coldstream; Lennel House was a nursing home owned and operated by Guardian Care Homes (UK) Ltd. On admission to Lennel House an Admission Assessment Form was completed by the duty staff nurse. The assessment covered, inter alia, the risk of pressure sores; Mr McNeill was assessed as being at high risk of developing pressure sores.


On 19th May 2008 two blood blisters were noticed on Mr McNeill’s sacral cleft. These were the first manifestations of the early stages of pressure sores. In the course of the following days the blisters were treated with creams and dressings. However, the area of the wound, which was measured and recorded daily, increased. By 30th May 2008 the blisters measured 3 x 1.5cm and 1 x 1cm and were recorded as being necrotic and producing an odour, signs consistent with infection. By 9th June 2008 the measures put in place produced no improvement and the odour from the wound was now described as offensive. On 11th June 2008 the districtnurse visited Lennel House by prior arrangement. The wound now measured 13 x 4.5cm and was discharging thick yellow puss. A hole had appeared in the sacral cleft from which fluid leaked. The districtnurse arranged for Mr McNeill to be examined by a GP which examination was conducted on 12th June 2008. As a result of this examination the GP arranged for Mr McNeill to be admitted to the Borders General Hospital on 12th June 2008 in order to obtain a surgical opinion.

On 13th June 2008 surgical debridement of Mr McNeill’s pressure sore wound was carried out. The operating surgeon considered the wound to be serious and described the operation as a “planned emergency”. In his experience of having carried out 12 or so pressure sore debridements over the years, this was described as the worst which he had encountered.Mr McNeill remained at Borders General Hospital until 24th September 2008 when he was transferred to Roodlands Hospital, Haddington. On 20th October 2008 Mr McNeill was transferred to Belhaven Hospital in Dunbar. At about 06:00 hours on Wednesday 22nd October 2008 nurses attended on Mr McNeill to administer medication, including morphine sulphate, and prepare him for a bed bath. After about 30 minutes, when in course of being bathed, Mr McNeill’s condition deteriorated and he expired in the presence of nursing staff.


The Sheriff noted that from the evidence there could be little doubt that Mr McNeill’s care at Lennel House would have benefitted from better and more promptly implemented care plans and risk assessments; from being cared for by nursing staff who had the advantage of better managerial support; better induction procedures; better training especially in respect of pressure sores and the care of the elderly; better dissemination of information regarding policies and procedures; better access to specialist equipment; and from allocated time for communication as between staff on different shifts.

Focusing on Mr McNeill’s development of pressure sores, the risk of these developing would almost certainly have been reduced with earlier provision of special mattresses, cushions and organised and recorded positional changing. The Sheriff concluded from the evidence that the latest date when Lennel house nursing staff ought to have contacted the district nurse, or general practitioner, regarding Mr McNeill’s pressure sore would have been 4th June 2008. However, the Sheriff noted that in the interim period, key staff had changed at the nursing home and that following the death of Mr McNeill, procedures had been improved radically. For these reasons, the Sheriff considered it inappropriate to make any findings under the Act in terms of section 6(c) and (d).

FATAL ACCIDENT ENQUIRY INTO THE DEATH OF NASRULLAH KHALID, SHERIFF KENNETH ROSS, DUMFRIES SHERIFF COURT, 9TH MARCH 2011

DESCRIPTION

In terms of section 6(1)(a) of the Fatal Accidents and Sudden Deaths Inquiry (Scotland) Act 1976, the sheriff found that Nasrullah Khalid died within cell B/17 at H M Prison, Terregles Street, Dumfries on 23 November 2009 between the hours of 3.15pm and 4.55pm. In terms of section 6(1)(b), the cause of death was (a) Ischaemic Heart Disease (b) Coronary Artery Thrombosis and (c) Coronary Artery atherosclorosis. A formal determination was made under section 6(1)(c).


Background:
Mr. Khalid had suffered from a heart condition since 1996 when he had had a heart attack. The symptoms of his condition were stable angina, hypertension and atherosclerosis. For the three years prior to his death the deceased exercised regularly in Dumfries Prison gym. There was no medical reason why Mr. Khalid should not have participated in the exercise regime.


At about 1.50pm on 23rd November 2009 Mr. Khalid attended the prison gym as usual. About five minutes before the end of his routine the deceased experienced nausea and pains in the centre of his chest. He was examined by the duty nurse who concluded that he had suffered an angina attack. He was returned to his cell at 3.15pm and advised to rest and take his angina medication. At about 4.55pm Mr. Khalid was discovered lying on his bed with his eyes open and with vomit on his face. Officers commenced CPR and continued to do so until paramedics arrived about ten to fifteen minutes later. They took over the attempts to resuscitate Mr. Khalid which continued for a further twelve minutes. Throughout the procedure there was no response from Mr. Khalid. He was pronounced dead when the prison doctor arrived at 5.45pm.

Determination:

Under s.6(1)(c) the sheriff found that, in the examination of Mr. Khalid at the Prison gym, it should have been established if the chest pain of which he had complained had disappeared completely. In the absence of such a finding, the prison doctor should have been contacted and an ambulance called. However, to have done so would not have guaranteed Mr. Khalid’s survival. Nor would that survival have been a probability.

What is a community nurse?

Delivering care to the elderly, disabled and vulnerable patients who are unable to travel to a hospital or doctor’s surgery, community nurses are registered nurses who have undertaken degree level training as a specialist practitioner. This course focuses on four key aspects of nursing including clinical nursing, care and programme management, clinical practice development and clinical practice leadership.

Community nurse roles and responsibilities

A community nurse is responsible for performing many of the same duties as a district nurse. These include basic care (checking temperature, blood pressure and breathing), wound management, administering injections, setting up intravenous drips and assisting doctors with examinations and medical procedures. Community-based nurses are also able to provide vital information to clients, their families and carer/s, much in the same way as district nurses, while emergency support may also be required in cases when a patient is suffering cardiac arrest or a stroke. This demonstrates the many hats a community nurse must don in their line of care.

So what is the difference between community and district nurses?

In recent times, the terms district and community have become interchangeable as a way of describing areas of villages, towns and cities, meaning that there may be no difference between community and district nurses at all.

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About Us

The Law Med Medical Panel is an unincorporated association its members are clinical negligence accredited specialists.

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