Diabetes – avoiding amputation and lessons from successful claims

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The number of people in the UK living with diabetes is now more than 5 million people according to a report from Diabetes UK. 4.3m have been diagnosed and 850,000 are living with it but have not yet been diagnosed. 13.6 million people are thought to be at risk of developing the condition and 2 million are likely to do so. The NHS spends as much as 10% of its budget on diabetes care. This is a major health issue.

Diabetes can lead to various complications. Two of them put the foot at risk. One of these complications is poor blood supply, which makes it harder to fight infections and for wounds to heal. Another is altered sensation from neuropathy (damage to nerves). This means that people are not always aware of injuries to their feet and can make them worse, for instance by wearing shoes and walking.

A common source of medical negligence claims is poor diabetic foot care leading to avoidable amputations.

What can we learn from these claims?

Here are 5 lessons learned from our specialist practice.

Make sure your feet are checked regularly

Guidelines from NICE (National Institute for Health and Care Excellence) requires adults to have at least an annual check. People whose feet are at higher risk should be checked more regularly. Both feet should be examined (with shoes and socks off) to check for sensation, signs of poor blood flow, ulcers, calluses, infection, deformities and Charcot arthropathy (see below). Poor quality or infrequent checks allow problems to develop ‘under the radar’. Delays can mean problems are not dealt with in time.

Any diabetic foot injury should be referred to specialists

NICE Guidelines say all active diabetic foot problems should be urgently referred to a specialist team. That team should be ‘multidisciplinary’, which means it includes a range of different specialists. The team may include an endocrinologist (specialist in diabetes), vascular surgeon (specialist in blood supply), orthopaedic surgeon (specialist in the bones and structures of the foot) and podiatrist (foot specialist).

The referral should be made within 1 working day. Triage should take no more than 1 further working day. Some teams are only available one day per week. This is not ideal but it is important not to miss the next clinic.

People with life-threatening or limb-threatening conditions should be referred urgently to acute services. Such conditions include ulcers with fever or signs of sepsis, ulcers with limb ischaemia (where blood supply is obstructed), deep-seated or bone infection and gangrene.

One of the most common failures giving rise to diabetic foot claims is the failure to refer to a specialist team. There have unfortunately been numerous cases. In many of them, GPs, practice nurses or podiatrist have tried to manage problems without the help of a specialist team. By the time they referred it was too late to avoid amputation.

Avoid pressure sores

Well-fitting shoes are important. So is good management of pressure areas, particularly when confined to bed. For hospital patients, nurses should carry out a careful assessment of the risk of pressure sores. They should then take steps to protect any vulnerable skin. Pressure sores can easily deteriorate very quickly.

In RC v University Hospitals Bristol NHS Foundation Trust, a woman in hospital developed pressure sores in her heels. These led to a below-knee amputation. Sadly, the stump also became infected and she eventually alsohad an above-knee amputation.

Make sure infections are properly managed

Poor blood supply can make it harder to fight infection. Managing the infection correctly is important. Perkins v Hywel Dda Local Health Board was one case where a man with diabetes was mismanaged. He developed infection after an operation to his knee. Because of a mistake, he was given the wrong antibiotics. He ended up with an above-knee amputation.

Be alive to Charcot arthropathy

Charcot foot is uncommon but can cause disability and amputation where it is not managed quickly and correctly. The signs of Charcot include a hot, swollen foot.

Patients with diabetes can suffer fractures to the bones of their feet, or other injury. Because they have limited feeling, they may not realise quickly enough and end up  accidentally doing more damage by walking on an injured foot.

The foot gradually collapses, often leading to a ‘rocker-bottom’ deformity. It is important to treat the condition before there is structural damage to the foot. Deformed feet can sometimes lead to the need for amputation.

LL v Dr O’Reilly was a case where a four-month delay in managing Charcot led to amputation. In our experience, a much shorter delay can in some cases be just as catastrophic.

Key points

Diabetes is a very common condition that will only become more common in the future. It can have an enormous impact on people’s lives. Managing it takes up a lot of the NHS budget.

It is important to manage it well. In particular, managing at-risk feet is crucial, to avoid the disabling effects of amputation.

Claims for damages give us a window into what can go wrong. Whilst no one can turn the clock back for each of these injured people, we can learn from mistakes to make sure the same doesn’t happen to others.

Why should I explore making a claim?

Choosing whether to make a claim can be a difficult decision. You may not want to be a burden to the system or not even be sure you are entitled to making a claim so not want to waste anyone’s time. If you are even considering it, it means that there are things about the care you received that you are not sure about. Receiving negligent care can have a massive impact on you and result into you needing to make very big changes to your lifestyle. For example, you may need to change your employment or stop working all together. You may need to move house to be in a wheelchair friendly environment or need additional help to be able to continue doing things you enjoy in the community.

Even though making a successful claim can not turn he clock back and stop your injury from happening, the compensation you receive will help you put the support you need in place to adapt to a new lifestyle as well as possible. It will also mean that if you have people that depend on you like young children or elderly parents you will be able to put the right support in place for their needs to continue being met even if you won’t be able to help them as directly as you were before your injury.

If you suffer an amputation because of the mismanagement of your diabetes or other condition and decide to explore making a claim, it is important to speak to a specialist lawyer that has a proven track record of bringing diabetes related claims. This area of law is very complicated and having the right expert in your corner can make a really big difference in both the support you get from them but also the outcome of your case.

If you want to have an initial free discussion with one of our specialist colleagues give us a call on 0800 044 8488 (freephone) or fill in our form here Contact Us – Enable Law  so we can give you a call back

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