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Diabetes and medical negligence
If a person’s diabetes is not diagnosed or managed appropriately then there can be serious and catastrophic consequences. It is not just diagnosis and treatment that has to be timely; adequate monitoring following a patient’s discharge is important to prevent life-changing complications. Within busy, underfunded and understaffed hospitals, GP surgeries and social care units, this is not always the case and omissions and errors can occur.
What is diabetes?
Put simply, diabetes is a condition caused by too much sugar (glucose) in the blood. The high blood sugar (glucose) levels are caused because the person’s body is not producing enough insulin or the body’s cells are not responding to the insulin properly.
Insulin is naturally produced by the body in the pancreas and is a hormone that converts carbohydrates, like sugars and starches, into energy. It is released into the bloodstream when we eat.
Diabetes can be caused by many factors such as lifestyle (e.g. obesity) and genetics. Certain drugs have also been associated with the causes of diabetes.
There are two main types of diabetes. Type 1 diabetes is where the body’s immune system attacks and destroys the cells that produce insulin. Type 2 diabetes is where the body does not produce enough insulin, or the body’s cells do not react to insulin. In the UK, around 90% of all adults with diabetes have type 2 and the number of people with the condition is growing rapidly.
Currently, 4 million people in the UK have type 2 diabetes. That number is expected to reach 5 million within the next 10 years.
Common claims
Diabetes is a growing medical problem in England and Wales, and it is a difficult condition to diagnose, treat and monitor. The issue of diabetes is further complicated by an underfunded, understaffed and undertrained NHS struggling to cope with growing demand and an aging population. Under these circumstances omissions and errors can occur.
Delayed diagnosis
If doctors and nurses do not heed signs and symptoms of diabetes, this can lead to a delay in diagnosis and the condition going unchecked and therefore untreated. Any delay in diagnosing diabetes, or any misdiagnosis, can lead to a patient developing complications, which can be life-changing.
Inadequate care and management
Quick diagnosis of diabetes is crucial, but adequate care and management of the condition can make the difference between remaining healthy and developing serious side-effects. Medical professionals must provide advice and treatment that allows diabetic sufferers to stay safe in order to prevent injury.
And if complications develop, such as problems with their feet caused by the blood being restricted, then medical professionals must provide a good standard of care to avoid an amputation.
Inadequate care in the community
Some diabetic patients require care in the community to manage their diabetes and any related conditions.
Vulnerable adults may need regular visits from district nurses in their own home in order to keep them safe. Elderly people within a care home environment will need a good standard of care to manage their diabetes. It is a complicated condition that requires the measuring of blood sugar levels, administering the correct amount of insulin, providing the right diet, and monitoring for infections. Diabetes management is further complicated if the elderly person also has dementia and other medical conditions.
Care homes and community health services are widely regarded as underfunded and understaffed. These pressures will impact on care quality. Temporary or undertrained staff will be used to plug the gap, which is when errors, omissions and neglect can occur.
What can go wrong?
Some of the most serious consequences of misdiagnosis, delayed treatment or inadequate monitoring and aftercare are:
Amputation
Recent data released by Diabetes UK and based on figures from Public Health England reveal 7,370 amputations per year are carried out due to diabetes. It is estimated that 80% of those amputations are avoidable.
It can start with something as simple as a toe infection or eczema. Diabetics must keep a watch for changes in feeling to the lower extremities (diabetic neuropathy). Checks should be made and diabetic ulcers or eczema monitored. If diabetic ulcers or nail and toe infections are not treated the patient can end up losing a toe, or worse.
Studies have revealed that 80% of amputations begin as foot ulcers which are usually treatable if diagnosed and treated promptly.
A severe obstruction of the arteries (critical limb ischemia) can also occur. This can cut circulation off to a limb, which can – if left unchecked and untreated – end with the amputation of the affected limb.
Blindness
Diabetic retinopathy affects blood vessels in the light-sensitive tissue that lines the back of the eye, called the retina. It is the most common cause of vision loss among people with diabetes and the leading cause of vision impairment and blindness among working-age adults.
Controlling diabetes can prevent or delay vision loss but because diabetic retinopathy often goes unnoticed until vision loss occurs, people with diabetes should get a comprehensive dilated eye exam at least once a year.
Early detection, timely treatment, and appropriate follow-up care of diabetic eye disease can protect against vision loss.
Kidney failure
Diabetic kidney disease (diabetic nephropathy) is a complication that occurs in some people with diabetes. The disease is caused by damage to small blood vessels, which can cause the vessels to become ‘leaky’ – or even to stop working – making the kidneys work less efficiently. Keeping blood glucose levels as near normal as possible can greatly reduce the risk of kidney disease developing as well as other diabetes complications.
A diabetic should have regular blood and urine tests. Urine will be checked for protein particles, called ‘microalbumin’. If these are present then it is an indication of the first stages of kidney disease because the kidneys have become ‘leaky’. Early detection is very important because at this stage the disease is usually treatable.
Urinary Tract Infection
People with poorly controlled diabetes can be more prone to urinary tract infections (UTI) because glucose in the urine provides a breeding ground for bacteria. In some cases, if the infection persists, it can cause serious damage to the kidneys.
Protein in the urine is a sign of a potential UTI and a medical professional should be aware of this. It is important for people with diabetes to have a UTI diagnosed and receive adequate treatment quickly, or risk permanent damage to their kidneys.
Strokes and heart attacks
Diabetic patients are twice as likely to have a heart attack or stroke. This is partly because diabetes increases the chances of a condition called atherosclerosis. The condition is a form of hardening of the blood vessels, caused by fatty deposits and local tissue reaction in the walls of the arteries. Diabetes increases inflammation and slows blood flow, which dramatically accelerates atherosclerosis.
As the hardening of the arteries develops is can lead to poor circulation in the legs, and stroke and heart conditions such as angina and heart attack. Coronary heart disease is recognised to be the cause of death for 80% of people with diabetes
If a diabetic patient complains of pain in the chest, discomfort in arms, back or shoulders, shortness of breath, irregular heartbeat, swelling of ankles or other signs of a heart condition, it is unacceptable for a doctor or nurse to send a patient home without appropriate tests and treatment.
Degeneration of the nerves
Diabetic neuropathies are a collection of nerve disorders caused by diabetes. People with diabetes can develop nerve damage throughout the body and in every organ system, including the digestive tract, heart, and sex organs. Diabetic neuropathies are caused by many of the abnormalities common to diabetes, such as high blood glucose.
Some people with nerve damage will have no symptoms but others can suffer from pain, tingling, or numbness—loss of feeling—in the hands, arms, feet, and legs.
Healthy lifestyle choices with good care and monitoring can prevent or delay the onset of these nerve conditions. The alternative can lead to a diverse range of problems, including gastroparesis, dizziness, incontinence and sexual problems.
Foot care is particularly important. Diabetics should have a comprehensive foot exam each year to check for neuropathy. People diagnosed with neuropathy need more frequent foot exams to assess the skin, muscles, bones, circulation, and sensation of the feet. Loss of feeling in the feet means that sores or injuries may not be noticed and may become ulcerated or infected. Circulation problems also increase the risk of foot ulcers. If these conditions go undiagnosed and untreated then ultimately it can lead to amputation.
Diabetes UK has called for the NHS and the government to improve treatment for diabetics in order to reduce the number of amputations required after it was revealed that over 20 amputations per day were being performed in England.
The symptoms of diabetes
Some of the common signs of diabetes are excessive thirst, frequent urination, hunger, weight loss, fatigue, irritability, and blurred vision.
If a person’s diabetes is not managed appropriately then low blood sugar levels (hypoglycaemia) can lead to a loss of consciousness. Symptoms of hypoglycaemia include trembling, sweating, anxiety, blurred vision, tingling lips, paleness, mood change, vagueness or confusion.
If the worst does happen
Medical (or clinical) negligence is a serious breach of the duty of care that doctors, nurses and medical professionals ethically and legally owe to their patients.
It happens when serious errors in a person’s medical diagnosis or treatment are made. The breach of care will have caused, or materially contributed to, a person’s injury.
It is important to seek expert legal advice as quickly as possible to check a person’s legal rights and whether they have been a victim of medical negligence. A successful claim for compensation, if the person has been injured, can be important to the future quality of their life. Settlements can help fund private medical treatment, speed up rehabilitation, pay for extra care, changes to the home and car, replace earnings of a family carer, and help with the practical everyday expenses that inevitably come with illness.
The medical negligence team at Birchall Blackburn Law knows how negligence or abuse can cause untold upset and damage for everyone involved. The team is experienced in diabetes neglect and mistreatment, and can help deal with both the technical and emotional side of a complex area of law.
Health think-tanks, the Nuffield Trust, the King’s Fund and the Health Foundation, have warned that social care is in a ‘critical state’.
Lady Altmann, former pensions minister, says that Britain is in danger of sleepwalking into a social care crisis and care has been left to cash-strapped councils who keep cutting services.
Care homes and community health services have an increasingly challenging role in society but this area of healthcare is underfunded and understaffed. Social care services run by councils are widely regarded as out-dated for an aging population that is living longer with multiple conditions and dementia. These pressures will impact on care quality.
The winter will only bring with it further strain on care home and community services, with staff shortages due to sick leave and the Christmas holidays. Temporary or undertrained staff will be used to plug the gap, which is when errors, omissions and neglect can occur.
The Serious Injury Helpline is making family members, friends, neighbours and carers aware of five conditions that are a sign that a vulnerable adult is not receiving the care that they deserve.
Pressure Sores
Pressure sores develop where a patient’s skin is in contact with the bed or chair for extended periods of time. Regularly changing the body’s position is an effective way of preventing pressure ulcers, as well as eating healthily and checking the skin on a daily basis. These are basic care standards that should not be neglected. Elderly patients who are ill, immobile, diabetic and have poor skin condition are vulnerable to this serious condition, which can lead to infection and permanent pain.
Medication errors
Elderly people will usually suffer from a number of different illnesses each requiring multiple prescriptions. This makes them vulnerable to medication errors and omissions. Lack of trained staff and dementia symptoms will compound the issue and old people will be more vulnerable to the effects of a wrong medication or dosage.
Falls
Fractures from falls and handling errors within a care home environment are common. This is especially the case when staff are undertrained and without experienced supervision, and residents do not have the right mobility aids, such as a wheelchair. Elderly people are vulnerable to slips and trips, and not all injuries are cause by neglect, but some injuries can be avoided with good care.
Late referrals for treatment
Delays in referrals to hospital and treatment can have serious consequences for vulnerable elderly residents. For temporary or untrained care home staff, it can be hard to recognise serious symptoms when a resident has many illnesses. Or, in some extreme cases a person’s concerns or protests about pain and discomfort are simply dismissed.
Dehydration and malnutrition
In rare cases it can be wilful neglect but where a person is unable to communicate their needs – due to illness or dementia – and the care home is mismanaged and understaffed, a resident can go without something as basic as a glass of water. Symptoms of a lack of food and water include headaches, extreme tiredness, lack of concentration, dizziness, confusion, constipation, diarrhoea, strong smelling urine, and dry or sore mouth, tongue or gums.
It is vital to seek expert legal advice to check an elderly person’s legal rights and whether they have been a victim of medical negligence. A successful claim for compensation, if the person has been injured, can be important to the future quality of their life. Settlements can help fund private medical treatment, speed up rehabilitation, pay for extra care, changes to the home and car, replace earnings of a family carer, and help with the practical everyday expenses that inevitably come with illness.
The standard of care in a home or community setting has a huge impact on both the elderly person and their family. The Serious Injury Helpline knows how negligence or abuse can cause untold upset and damage for everyone involved. The helpline specialise in care home neglect and mistreatment, and can help deal with both the technical and emotional side of a complex area of law.
Anyone who needs confidential advice or help in the aftermath of medical negligence is advised to contact the Serious Injury Helpline on FREEPHONE 0800 230 0573.
The Health Secretary, Jeremy Hunt, has acknowledged that this winter could be “very, very challenging” for the NHS, which means already stretched services will be tested to the limit.
He made the comments on the BBC’s Andrew Marr Show and it is reported that throughout the winter the Department of Health will be monitoring the situation closely.
While relatively mild winters have helped the NHS cope over the past few years, the Met Office recently warned of periods of very cold weather between now and Christmas. It may only take an extended period of bad weather and flu for hospitals to be pushed beyond capacity.
NHS England figures have already revealed that attendances at A&E units and emergency admissions are up nearly 4% over the past 12 months. Demand on A&E services will only increase as the winter draws in.
What could be of bigger concern is the impact on social care. During the Christmas holiday period community healthcare tends to shut down. This can cause delays in transferring patients out of hospital beds and into social care in the community, which puts more strain on hospitals and creates a backlog.
The health think tanks, Nuffield Trust, the King’s Fund and the Health Foundation, have warned of the “critical” state of social care. Funding cuts and the availability of accessible care have resulted in “significant human and financial costs on older people, their families and carers”. This has left people stranded in hospital and it will only get worse during the winter.
The impact on hospitals this winter is a worry – staff are already under severe pressure and the winter strain on a busy, underfunded and short staffed NHS can lead to errors and missed diagnosis – but social care is often the invisible casualty.
Social services run by local councils are widely regarded as out-dated and unfit for an aging population with people living longer, often with multiple conditions and dementia. Dementia and Alzheimer’s have overtaken heart disease as Britain’s biggest killer.
Care homes and community health services now have a more challenging role in society but this area of healthcare is underfunded and understaffed. This will affect quality of care and the winter will only bring with it further staff shortages with sick leave and the Christmas holidays. Temporary or undertrained staff will be used to plug the gap, which is when errors, omissions and neglect can occur.
The most common consequences in social care cases of negligence that we deal with are pressure sores, medication errors and falls. We’ve also dealt with cases of late referrals for treatment, dehydration and malnutrition. Family members, neighbours, friends, carers and others should be vigilant over the winter period and report any concerns to their local council social services.
The standard of care in a home or community setting has a huge impact on both the elderly person and their family. We know how negligence or abuse can cause untold upset and damage for everyone involved. We specialise in care home neglect and mistreatment, and we can help deal with both the technical and emotional side of a complex area of law.
The Serious Injury Helpline will be with you every step of the way if you decide to take action on behalf of a loved one who did not receive the standard of care they deserved.
Contact us on 0800 230 0573 to speak to one of our Clinical Negligence specialists.
In the right experienced hands, laparoscopic procedures can be beneficial to patients as they reduce the extent of surgery required and shorten the recovery period.
There are many benefits of these types of procedures including smaller surgical scars, reduced blood loss during the surgery, less pain due to the smaller incision, a reduced risk of infection as well as a shorter stay in hospital and a quicker recovery.
Laparoscopic surgery, more commonly known as keyhole surgery, is when an operation is performed via one or several small incisions to the skin. Once the incisions are made, a tiny camera is fed into the body and the image is transferred on to a screen for the surgeon to see. The surgeon can then insert his laparoscopic surgical tools and carry out the necessary procedure, using the camera for guidance, and all without the need to make a large incision in the patient’s abdomen.
Unfortunately, there are instances where keyhole surgery can go wrong and these incidents have increased in the past few years as the keyhole technique has become more popular.
In 2014, three NHS surgeons were banned from using a keyhole technique to operate on cancer patients after the procedure led to at least five deaths. The three surgeons worked for Maidstone and Tunbridge Wells NHS Trust, which referred itself to the Royal College of Surgeons (RCS) after a number of “unexpected” and “potentially avoidable” deaths following keyhole surgery in 2012 and 2013. The RCS held an investigation and warned that the surgeons had “not been able to demonstrate sufficient attention to the detail of surgical outcomes or clinical decision-making to provide a safe service to patients” with regard to keyhole procedures.
While such cases are rare, there are different ways in which keyhole surgery can go wrong and the risks depend on the type of procedure. For example, the surgeon may miscalculate the location of an organ or artery on the screen in front of him when in reality there are organs close by at risk of perforation.
Mistakes are most commonly made as a consequence of a surgeon’s heavy handedness or errors in judgement when calculating the location of nearby organs and arteries.
In our experience, most laparoscopy claims arise out of damage to the gall bladder, urinary tract, bowel and bladder during surgery. In some of the most serious cases we have seen, some patients have been left incontinent as a result of negligence during a laparoscopic procedure, which is of course completely life changing for the patient.
Another common risk of a laparoscopic procedure is herniation at the wound site. When the incision is made, part of the abdominal wall is cut through which, even once healed, leaves the area in a weakened state and means that person is more susceptible to protrusion of an organ and formation of a hernia in future. Developing a hernia post-laparoscopic procedure is usually not life threatening and can be managed with a further surgical procedure to repair the hernia, usually placing a mesh insert to the area to prevent the protrusion occurring in future.
Whether a laparoscopic procedure is right for a patient will be decided by a medical professional in consultation and their decision will be based on the patient’s previous medical history, current health condition, the nature of the procedure and the patient’s wishes. While a laparoscopic procedure has many benefits, like all medical treatments, it must be balanced against the risks and a patient should be made aware of the risks to be able to make an informed decision. A patient should also ask who their surgeon will be, what is the surgeon’s experience, how many laparoscopic procedures has he or she performed and what are the alternative treatments.
A patient should make it clear as early as possible if they do not wish to have a laparoscopic procedure.
There are many reasons a patient may wish to pursue a claim for clinical negligence following a laparoscopic procedure. They may feel like the medical professional responsible for their care nominated them to undergo a laparoscopic procedure which was not the appropriate method of treatment for them and has caused them to suffer post-operatively. A patient may feel like the surgeon who performed the laparoscopic procedure did not have the sufficient skill and experience to perform it and in doing so has made a mistake and caused injury to them. A patient might not even realise something is wrong until hours, days or weeks post-operatively and may feel there was a delay by the medical professionals in diagnosing and treating the problem, which may cause them further injury.
