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Following the amazing feedback on my recent CRPS case study, I thought I would share another. So, I contacted Toni, whose compensation claim settled a few months ago. She is delighted to share her story.
CRPS case study: Toni
In 2019, Toni was a mother of 3 working on the delicatessen counter at her local supermarket. One day, following her mid-morning break, she was walking downstairs to the shop floor when she slipped on some unidentified liquid on the bottom step and fell, twisting her left ankle. As she fell, she heard a crack and was instantly in intense pain.
Fortunately, her supervisor, a first aider, was a few steps behind and witnessed the incident. A colleague drove her to A&E, where an x-ray confirmed two ankle fractures. Toni was in a cast for 6 weeks, mobilising with elbow crutches, followed by an air boot for a further 4 weeks.
Surgery
A further x-ray revealed that one of the fractures had failed to unite, and Toni underwent surgery the same day. Although the surgery was successful, on coming around from the anaesthetic, her foot and ankle were extremely painful. The anaesthetist prescribed Tramadol, an opioid painkiller, and told her pain flares were common following this type of surgery. He said the pain would reduce over the coming hours and days.
However, the pain did not abate. In addition, her foot became more swollen, sometimes turning blue. Her toenails began to crack, and she endured intense, unrelenting burning pain. During a follow-up appointment, her orthopaedic surgeon told her that she thought Toni may have developed Complex Regional Pain Syndrome (CRPS).
Union solicitors
Toni had been signed off from work for over 3 months and was only receiving SSP. Her colleagues persuaded her to pursue a claim against her employer through her union, which appointed solicitors. She completed a lot of paperwork, but then everything went very quiet for several months.
Eventually, some 12 months after the accident, her solicitors advised that her employer had admitted primary liability for the accident. However, they alleged Toni was 50% to blame for not looking where she was walking. They suggested she should have noticed and avoided stepping in the liquid on the stairs. But what Toni found most incredible was that her solicitors advised her to accept the 50/50 offer. This would have halved her compensation. Incensed, Toni searched online using the search term “CRPS unhappy with my solicitor” and found my firm.
Medical evidence
My initial conversation with Toni was hugely constructive. She had all the information I needed at her fingertips. We discussed how we would progress her claim and talked at length about treatment. At the end of the call, Toni kindly commented that she had learned more during our discussion than from her union solicitors in almost a year. She was also relieved she would not have any more contact with her current solicitors, as I would handle that for her.
After reviewing her former solicitor’s file, there was a lot to do. In particular, they had taken no witness statements nor obtained Toni’s medical records. Once the complete medical records were available, they were collated and reviewed. In a future article, I will discuss the importance of what lawyers refer to as ‘causation’ and, in particular, ‘medical causation’. However, suffice to say it’s often crucial to obtain medical evidence in a certain order for the benefit of the next medical expert instructed. In Toni’s case, I first instructed an orthopaedic surgeon specialising in foot and ankle surgery (for the initial injury and subsequent surgery), followed by a pain medicine specialist (for the development and management of CRPS), and then a psychiatrist with a special interest in chronic pain (for the psychological management of CRPS).
CRPS Type 2
Toni was surprised to learn that her diagnosis was of CRPS Type 2 [see my earlier article Types of CRPS: diagnosing CRPS (Part 2)] and that her CRPS had most likely developed following damage to the sural nerve during surgery. Of course, her concern was that this would mean pursuing the NHS Trust for medical negligence in addition to her employer. However, our orthopaedic expert was firmly of the view that Toni’s surgeon had not been grossly negligent, the sural nerve damage being one of the accepted risk factors for this type of surgery. Accordingly, the surgeon’s actions were insufficient to ‘break the chain of causation’, and her employer remained liable for all that followed, including the development of CRPS.
Residential pain management for CRPS
Our pain medicine expert believed Toni would benefit from an intense four-week residential pain management programme to help her develop strategies and techniques to manage her condition. Unfortunately, the waiting list for the NHS INPUT programme at Guy’s and St Thomas’ Hospital in London was prohibitive. However, we successfully obtained an interim payment to fund Toni’s attendance on a similar but private programme at the Bath Centre for Pain Services. Although initially sceptical that anything could improve her life, Toni found the programme invaluable and still uses the strategies she learned and developed. Crucially, she says she now has a life alongside her CRPS rather than it dominating every waking moment.
Ultimately, we arranged a settlement meeting with her former employer’s insurer and their legal team, and Toni’s claim settled for £450,000.