Tort Examination - Part A - Documentation You are a trainee solicitor in the Bristol office of Ulaw LLP. Your supervising solicitor is Paul O'Keefe. Today is 1 May 2024 Paul O'Keefe represents Harry Brown. Harry suffered a severe stroke after an operation on 23 September 2023. Paul O'Keefe has obtained a proof of evidence from Harry. An extract is attached at DOCUMENT A. He has also obtained a medical report. Relevant extracts from that report are attached at DOCUMENT B. Paul O'Keefe has an appointment to see Harry Brown next week. Paul has passed the file to you, and asks you to read DOCUMENT A and DOCUMENT B and research the law that will be relevant to Harry on establishing breach of duty of care in negligence.

Harry establish breach of duty of care in cases of skilled / professional defendants.

DOCUMENT A

DRAFT WITNESS STATEMENT (Extract)

I, Harry Brown, of 3 Avenue Drive,Bristol, BS2 2RR, will say as follows:

1. My date of birth is 2 September 1963.

2. I was until recently a Department Head at the University of Bristol. I worked full- time and lived an independent life.

3. On 12 September 2023 I woke up with a facial twitch and weakness in my right arm. When I told my wife Maureen, I was unable to get my words out clearly. She immediately dialled 999 and I was admitted to Bristol General Hospital with symptoms of a minor stroke.

4. Dr Waters, a consultant neurosurgeon, was assigned to my case. After assessing my condition, he recommended surgery to unblock an artery.

5. The surgery took place on 23 September 2023. However, I remained unconscious for several days following that surgery. I understand that, following the surgery on 23 September 2023, I suffered a second stroke.

6. I remained in hospital until 20 October 2023. I was then discharged home. Since my return home I have been cared for bymy wife. My wife has had to give up her job as a pharmacist to look after me. She was previously earning a salary of 50,000 per year.

7. As a result of the second stroke I am now paralysed on the right side of my body. I frequently suffer from double vision. I am unable to concentrate for longer than a few minutes and my memory is significantly impaired. I am unable to manage to leave the house, unless accompanied and assisted by my wife. I feel very unhappy about the effects of what has happened to me because I lived a very interesting and active life before the second stroke. My doctor has recently prescribed me with medication for clinical depression.

8. I can no longer fulfil my role as Head of the School of Physics at the University of Bristol and I have had to leave a job I loved. My salary was 70,000 per year. I will not be able to draw on my work pension until I am 65 when I had planned to retire. Luckily, an insurance policy will maintain my pension contributions until I retire so I will be able to receive my full pension when I am 65.

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DOCUMENT B

MEDICAL REPORT (Extract)

Mr Neil Wandle, Consultant Neurosurgeon & Neurologist

Royal United Hospital, Bath NHS Trust, BA1 3NG

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Instructions

I have been instructed by Ulaw LLP solicitors to write this report on Mr Harry Brown. I examined Mr Brown for the purposes of this report on 3 April 2024.

I have been provided with copies of Mr Brown's GP records. I have also seen Mr Brown's hospital records relating to his treatment during September to October 2023. These include two MRI scans [magnetic resonance imaging (MRI) is a type of scan that uses strong magnetic fields and radio waves to produce detailed images of the inside of the body] taken on: 12 September 2023 and 23 September 2023.

History

Mr Brown's date of birth is 2 September 1963. At the date of the treatment giving rise to this report he was aged 60.

Mr Brown was admitted to Bristol General Hospital NHS Foundation Trust ("the Trust") on 12 September 2023. On admission he was complaining of symptoms which indicated that he had suffered a minor stroke [a medical condition that happens when the blood supply to part of the brain is cut off].

On admission Mr Brown was referred to the Trust's specialist stroke unit. He was given an MRI scan of his brain. This was carried out within an hour of his admission and so was in accordance with National Institute of Clinical Excellence (NICE) guidelines. Mr Brown was also subjected to electrocardiogram [a test to check the heart's rhythm and electrical activity] and blood pressure tests.

Mr Brown was placed under the care of Dr Waters, a consultant neurosurgeon employed by the Trust. Dr Waters' medical notes record the results of the MRI scan taken on 12 September 2023. The scan showed that Mr Brown had suffered a minor stroke. An internal carotid artery [ major blood vessels that provide the brain's blood supply] had become blocked by a blood clot of undetermined origin.

Dr Waters' notes record that he decided to treat Mr Brown by operating to unblock the artery.This surgery is called a carotid endarterectomy [a surgical procedure to remove a build-up of fatty deposits which cause narrowing of a carotid artery]. The appropriate permissions were obtained from Mr Brown and the surgery was carried out on 23 September 2023.The medical records for the period following that surgery show that Mr Brown unfortunately suffered a further stroke two hours after completion of the surgery. This is confirmed by the MRI scan of 23 September 2023.

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Opinion

From my examination of the records of Mr Brown's treatment, including the MRI scan of 12 September 2023, I am satisfied that the correct treatment was given to Mr Brown on his admission to the Trust. I am also satisfied that the initial diagnosis of a minor stroke was correct.

Having examined the records for the carotid endarterectomy surgery, I would also conclude that Dr Waters appears to have performed the surgery competently and in accordance with standard procedures.

However, I do consider it likely that the severe stroke suffered by Mr Brown on 23 September 2023 was a direct result of the carotid endarterectomy surgery. I also consider that the continuing symptoms from which Mr Brown now suffers are a result of this second and more serious stroke. It is my opinion that, after a period of correct medical treatment, physiotherapy and speech therapy, it is likely that Mr Brown would have made a full recovery from the minor stroke he suffered on 12 September 2023.

In my opinion the decision to carry out carotid endarterectomy surgery may not have been the most appropriate form of treatment for Mr Brown in the circumstances.

A patient suffering from a stroke may be treated in one or more of the following ways:

• Administration of Alteplase [a drug used to break up blood clots];
• Prescription of Aspirin and/or Warfarin [drugs used to reduce risk of further clotting];
• Surgery to remove blood clots or fatty deposits - carotid endarterectomy.

The choice of an appropriate treatment depends upon all the circumstances including the patient's age and condition.

If the patient has significant blockage in the carotid arteries, a carotid endarterectomy (surgery) is sometimes appropriate. During this procedure, a surgeon removes plaque [fatty deposits] build-up in the carotid arteries to reduce the risk of a stroke.

The benefits and risks of this surgery must be carefully weighed, because the surgery itself may cause a stroke. Using the carotid endarterectomy procedure is not unusual, but is most often used on patients under the age of 50. This is because the risk of this procedure causing a further stroke increases with the patient's age.

From my examination of Mr Brown's medical records, I have concluded that he did have a significant blockage in the carotid artery. This would normally make him a suitable patient for an endarterectomy. However, his age would possibly render this treatment inappropriate.

In my view, standard medical practice would indicate that, for stroke patients over the age of 50, surgery should be used only as a last resort, and is to be avoided unless absolutely necessary because of the high risks that surgery involve. Under this approach, it is difficult to justify Dr Waters' decision to carry out the surgery on Mr Brown.

However, I accept that views on this issue are not uniform. Some recent medical literature has challenged this view. Dr Theissen of University Medical Centre Hamburg-Eppendorf wrote in the Journal of Neurology (September 2022) that overall lifestyle factors should be given as much credence as age in assessing patient suitability for endarterectomy.According to this school of thought, Dr Waters' decision to operate might be justified in some circumstance, for example, if the patient was very active and healthy prior to their need for treatment. However, in my opinion Dr Theissen's views are relatively recent and still need to be tested.

In conclusion, it is my view that the likelihood of Mr Brown suffering a severe stroke was significantly increased by the use of the endarterectomy procedure, and that the choice of such procedure may not have been justified in the circumstances.