January 2022 - Tees Law

Medical negligence: Cauda Equina Syndrome claims

Posted on 28 January 202210 July 2025 by Sarah O'Sullivan

Tim Deeming, Partner in Tees’, Top Tier Legal 500 Medical Negligence and Personal Injury team, highlights ‘red flag’ symptoms and signs, and the importance of urgent medical intervention for patients showing symptoms of Cauda Equina syndrome. Sadly, if the warning signs are missed, it can have life changing impacts for the patient and their family and lead to a medical negligence claim.

In August 2021, the Healthcare Safety Investigation Branch (HSIB) reported their results of a national investigation into the timely detection and treatment of non-malignant spinal cord compression (cauda equina syndrome). The investigation was launched after HSIB identified an event where a patient had several GP and hospital presentations before CES was diagnosed. Once an MRI scan identified the cord compression, there were further barriers to receiving timely emergency surgery to alleviate the compression. This investigation focused on: assessing the resilience, consistency and reliability of the pathway(s) for patients experiencing potential red flags for CES; seeking to understand the context and contributory factors influencing the pathway for patients with CES from their first presentation reviewing the national context surrounding the timely detection and treatment of spinal nerve compression (CES) in patients with back pain.

What is Cauda Equina Syndrome (CES)?

Cauda Equina Syndrome, or CES, is a potentially devastating condition caused by compression of the group of sensitive nerves located at the base of the spinal cord involved in lower limb sensation and pelvic function known as the Cauda Equina. It can result in bowel, bladder and sexual dysfunction as well as lower limb weakness, numbness and pain as the nerves which are often damaged supply such areas.

CES occurs more often in adults than in children. But it can occur in children who have a spinal birth defect or have had a spinal injury.

What are the risks of delayed diagnosis or misdiagnosis of Cauda Equina Syndrome?

The most significant issue is that it is a surgical emergency to release the pressure on the spinal cord to prevent permanent damage. Delayed diagnosis or misdiagnosis of symptoms can mean this condition can progress to an irreversible stage. Research carried out by the Medical Protection Society (MPS) in 2016 found that failure or delay in diagnosis of CES was one of the top five errors leading to the most ‘expensive’ claims against GPs.

The study led to the MPS working with the National Institute for Health and Care Excellence (NICE) to produce revised ‘red flag’ guidelines that were published in 2018. The intention was to help healthcare professionals diagnose the condition and increase referrals for urgent investigation and medical intervention.

It is still too early to say whether the new guidance has made a significant difference to practice. However, it is hoped GPs are becoming more risk averse when providing advice to patients who may be at risk of CES, by referring them to hospital for detailed investigations.

What are the ‘red flag’ symptoms and signs of Cauda Equina Syndrome?

The National Institute for Health and Care Excellence (NICE) lists the following red flag symptom and signs:

Bilateral sciatica – occurs in both legs together. This type of sciatica is rare and may occur due to degenerative changes in the vertebrae and or the disc at several spinal levels or from Cauda equina syndrome
Severe or progressive abnormal function of the legs, such as major motor weakness with knee extension, ankle and or foot movement
Difficulty passing of urine and incontinence
Loss of rectal sensation which if untreated can lead to irreversible incontinence
Loss of feeling, tingling or numbness
Weakness and or numbness in the anal sphincter

What are the most common causes of cauda equina syndrome?

A severe ruptured disk in the lumbar area (base of the spine)
Narrowing of the spinal canal (stenosis)
A spinal lesion or malignant tumor
A spinal infection, inflammation, hemorrhage, or fracture
A complication from a severe lumbar spinal injury such as a car crash, fall, gunshot, or stabbing
A birth defect such as an abnormal connection between blood vessels

The potential long-term effects of Cauda Equina Syndrome (CES) can have a life-changing impact on patients and their families. Some patients with persistent back problems, neurological symptoms or concerns that something has gone wrong with their treatment, often do not realise that they are suffering from Cauda Equina Syndrome. It is therefore important to seek urgent medical advice if you have any of the warning signs.

How is Cauda Equina Syndrome treated?

If you have Cauda Equina Syndrome (CES), it is vital you receive immediate treatment to relieve pressure on the affected nerves. Surgery must be done quickly to improve recovery and prevent permanent damage, such as paralysis of the legs, loss of bladder and bowel control, sexual function, or other problems.

It is often best if this occurs within 48 hours of the onset of symptoms, but this depends on the cause of the compression and severity of the symptoms. Depending on the cause of your CES, you may also need high doses of corticosteroids which can reduce some swelling. If you are diagnosed with an infection you may need antibiotics. If a tumor is responsible, radiation or chemotherapy may be needed after surgery.

Common medical negligence claims relating to Cauda Equina Syndrome

Unfortunately, there are still common themes in compensation and settlement case studies such as:

Patients not being advised of the ‘red flag’ warning signs or presenting with worsening lower back pain radiating into their legs being dismissed as sciatica
Failure to pay sufficient attention to a relevant medical history leading to patients not being referred for an emergency MRI scan and emergency surgery
Delay, misdiagnosis and poor treatment in A & E departments
Delay in hospitals performing an MRI scan of the lumbar spine, causing irreversible damage
Following an MRI scan which demonstrates cauda equina nerve compression, an avoidable delay in transferring the patient to a hospital where the required spinal surgery could be carried out, again causing irreversible damage
Substandard medical care – spinal operations such as a lumbar discectomy and decompression being performed in an inappropriate manner
A haematoma (collection of blood) developing during surgery, creating pressure on the nerve roots and causing CES, even where the patient had no CES symptoms prior to surgery

Even with treatment, some patients may not retrieve full function, it depends on how much damage has occurred both given the length of time and severity of the compression. If surgery is successful, you may recover some bladder and bowel function

How we can help

If negligently treated, Cauda Equina Syndrome could ultimately lead to lifelong paralysis and the need for full time support. This in turn may have consequences on mental health, relationships and cause financial hardship.

In these circumstances, the law seeks to award compensation to help you deal with any continuing problems and to maximise your potential rehabilitation and quality of life. While no sum of money can compensate the difficulties you may face, our specialist team are here to help.

We have specialist lawyers within the team including Tim Deeming who has successfully pursued cases on behalf of clients who have suffered CES and often obtained compensation of six/seven figures that will provide the help needed for the client and family’s future.

No win, no fee

We work on a no win, no fee basis, so there’s no need to worry about costs. Plus, our specialist solicitors provide an initial free assessment of your claim.

Ectopic pregnancy: Medical negligence claims

Posted on 22 January 20229 July 2025 by Sarah O'Sullivan

Failure to diagnose, or misdiagnosing an ectopic pregnancy can be very distressing for an expectant mother. If left untreated, an ectopic pregnancy can tear or rupture the fallopian tube, which is not designed to accommodate a growing embryo. An ectopic pregnancy can sometimes lead to severe, life-threatening internal bleeding.

National incident data from the NHS shows that between April 2017 and August 2018 there were 30 missed ectopic pregnancies leading to ‘serious harm’. The Healthcare Safety Investigation Branch (HSIB) carried out a national investigation into the diagnosis of ectopic pregnancy which considered referral from emergency departments to early pregnancy services; the provision of early pregnancy services to diagnose and manage ectopic pregnancy; the information that women receive on discharge from the emergency department and made four safety recommendations.

Caring and sensitive support with Tees

Whatever your situation, our legal specialists are here to help guide you. Our expert clinical negligence lawyers can handle your ectopic pregnancy misdiagnosis claim from the initial consultation through to financial settlement.

Ectopic pregnancy misdiagnosis medical negligence claim

Doctors owe a duty of care to diagnose ectopic pregnancies and provide treatment in a professional and timely manner. An ectopic pregnancy misdiagnosis claim may arise whenever this duty is breached and the patient suffers injury as a result. Here are some examples of events that may give rise to a claim for ectopic pregnancy misdiagnosis:

misinterpretation of pregnancy test results such as blood tests and scans
misdiagnosis, for example, mistaking an ectopic pregnancy for a uterine miscarriage
failure to diagnose the condition when a woman presents with symptoms pointing to a possible ectopic pregnancy
a delay in diagnosing the condition causing a woman to undergo more invasive surgery than would have been necessary.

Gwyneth Munjoma, solicitor in Tees’ clinical negligence team, looks at the risk factors and associated symptoms – and what to do if you suffered from an ectopic pregnancy and believe that the condition could have been managed better by the doctors or nurses who attended to you.

What is an ectopic pregnancy?

An ectopic pregnancy occurs when a fertilised egg (embryo) implants and grows outside the cavity of the uterus (womb). Where an ectopic pregnancy occurs within the fallopian tube it is called a tubal pregnancy. A tubal pregnancy is the most common type of ectopic pregnancy. This happens when a fertilised egg gets stuck in the fallopian tube on its way to the uterus.

Normally, a fertilised egg travels down the fallopian tube to the uterus where it embeds itself and grows. An embryo stuck in the fallopian tube will not develop into a baby and your health may be at risk if the pregnancy continues.

In the UK, around 1 in every 90 pregnancies is ectopic. This is around 11,000 pregnancies a year. Depending on the stage at which the ectopic pregnancy is diagnosed, it can be treated using a drug called methotrexate or by an operation to remove the fallopian tube.

What problems can occur with an ectopic pregnancy?

Fallopian tubes can be damaged by inflammation or can be misshapen. Once an egg is fertilised it starts to grow rapidly. If a fallopian tube is damaged or misshapen, the rapidly growing embryo is unable to continue its journey to the uterus and gets stuck within the fallopian tube.

An embryo stuck in the fallopian tube cannot progress to a successful pregnancy, because it is restricted by the lack of space within the fallopian tube. As the embryo grows, the tube stretches and eventually may rupture; this can cause life-threatening internal bleeding, if not treated promptly.

Sometimes, an ectopic pregnancy will occur in other sites of the abdomen such as in the ovary, in the abdominal cavity or in the cervix.

What are the symptoms to look out for?

In most cases of an ectopic pregnancy, a woman will experience the early signs or symptoms of pregnancy, i.e. misses a period, breast tenderness and nausea. A pregnancy test will be positive. The first sign of an ectopic pregnancy may be pain in the pelvic area sometimes accompanied by light vaginal bleeding. Where there is internal bleeding the woman may feel shoulder pain as the pooling blood irritates the nerves. Symptoms may be variable, and a high index of suspicion should be exercised.

When should I seek help?

Seek emergency medical help if you think you are pregnant and experience any of the following:

severe abdominal or pelvic pain
vaginal bleeding
extreme lightheadedness or fainting
other concerning symptoms, especially if you have risk factors for an ectopic pregnancy.

What doctors have to consider

Ectopic pregnancy must be excluded for all women presenting with abdominal pain in early pregnancy. Successive reports into maternal deaths have highlighted the perils of not excluding an ectopic pregnancy in the circumstances.

Some things that make you more likely to have an ectopic pregnancy are:

Previous ectopic pregnancy. If you’ve had this type of pregnancy before, you’re more likely to have another.
Inflammation or infection. Sexually transmitted infections, such as gonorrhea or chlamydia, can cause inflammation in the tubes and other nearby organs, and increase your risk of an ectopic pregnancy.
Fertility treatments. Some research suggests that women who have in vitro fertilization (IVF) or similar treatments are more likely to suffer an ectopic pregnancy.
Tubal surgery. Surgery to correct a closed or damaged fallopian tube can increase the risk of an ectopic pregnancy.
Choice of birth control. The chance of getting pregnant while using an intrauterine device (IUD) is rare. However, if you do get pregnant with an IUD in place, you may be at increased risk of suffering an ectopic pregnancy. Tubal ligation, a permanent method of birth control commonly known as “having your tubes tied,” also raises your risk, if you become pregnant after this procedure.

Cigarette smoking just before you get pregnant can increase the risk of an ectopic pregnancy. The more you smoke, the greater the risk.

What is the treatment for an ectopic pregnancy?

The management of ectopic pregnancies has shifted towards medical rather than surgical intervention. The drug methotrexate has been successfully used for many years now. Methotrexate kills the pregnancy cells and any pregnancy tissue is then progressively absorbed.

In the event that it is too late to use methotrexate, the affected fallopian tube can be removed through keyhole surgery (laparoscopic surgery). However, in cases where it is not possible to successfully remove the fallopian tube through keyhole surgery, the abdomen is opened (laparotomy) and the tube is removed.

Do I need to register my Trust with HMRC?

Posted on 19 January 20229 July 2025 by Sophie Soraf

Changes to the law have significantly expanded the scope of trusts that need to be registered on the HMRC Trust Register. Trusts affected by the new changes must register with TRS by 1 September 2022.

Following the Fourth Money Laundering Directive, a Register of Trusts, maintained by HMRC was introduced, which is known as the Trust Registration Service or “TRS”. This imposed requirements on various trusts, including requirements to provide certain details about the trust for inclusion on the Trust Register and to keep those details up to date. The information to be provided includes details of the trustees and certain beneficiaries and certain information about trust assets.

The rules as to which trusts were required to register with the TRS are complex but, broadly, registration is generally required (with certain exceptions) where the trust has a liability to UK tax.

As a result of the Fifth Money Laundering Directive, the scope of trusts that need to register with TRS has been significantly expanded and now includes most UK trusts (even if they don’t pay UK tax) and non-UK trusts with certain UK connections. There are some exceptions, but these are limited. Trusts affected by the new requirements must register with TRS by 1 September 2022.

It should be noted that the definition of a “trust” for the purposes of these requirements is very wide: for example, the registration requirements apply to most fixed trusts (trusts fixed for the absolute benefit of certain individuals) and to properties where not all the beneficial owners are registered as owners at the Land Registry (subject to certain exemptions).

Example:
Cathy’s late husband, Derek, died in 2001. In his Will he left a gift of his available Inheritance Tax “nil rate band” to a discretionary trust and the rest of his estate to Cathy. The trust, which is still in existence, was funded by a charge over Cathy and Derek’s home. No income has been generated from the trust fund and the trust has never triggered any liability to UK tax.

The trust is now required to register with TRS and should do so by 1 September 2022.

Financial and other penalties may be applied against trustees who fail to register on time, and, in extreme cases, criminal sanctions may apply.

Further information about the trust registration requirements can be found on the gov.uk website.

What should I do?
Trustees of trusts not already registered with TRS should review the new rules and consider whether they need to register.

If you would like us to advise you on the new rules or assist with registration of the trust, please contact our Trust Team on the details shown below.

Call our specialist solicitors on 0800 013 1165

Family mediation: A complete guide

Posted on 13 January 202225 June 2025 by Sarah O'Sullivan

Family mediation can be a practical and effective way to resolve disputes when a relationship breaks down. It provides a structured environment for couples to reach an amicable agreement, often avoiding the stress and expense of a lengthy court battle.

Understanding family mediation

Family mediation is a voluntary process where a neutral mediator helps couples negotiate and resolve issues arising from separation or divorce. It’s designed to promote respectful communication, enabling both parties to find mutually agreeable solutions.

When is family mediation helpful?

Family mediation can assist when couples face challenges agreeing on matters such as:

Division of assets and finances
Property arrangements
Child custody and visitation schedules

It’s a preferred alternative to court proceedings, often resulting in quicker and more cost-effective resolutions.

How does family mediation work?

Step 1: Initial assessment (MIAM)

Your mediation journey typically begins with a Mediation Information and Assessment Meeting (MIAM). This one-on-one session allows the mediator to understand your situation, explain the mediation process, and determine whether it’s a suitable option.

Step 2: Joint mediation sessions

Once both parties agree to proceed, joint mediation sessions commence. The mediator facilitates discussions, helping both individuals communicate effectively. Key areas of focus may include:

Finances: Dividing savings, pensions, and debts fairly
Property: Deciding on ownership, sale, or buy-out arrangements
Children: Establishing custody schedules and parental responsibilities

Step 3: Resolution and documentation

After productive discussions, the mediator will draft a Memorandum of Understanding detailing the agreements reached. While this document isn’t legally binding, it can be converted into a consent order by a solicitor, making it enforceable by law.

Benefits of family mediation

Choosing mediation offers numerous advantages, including:

Cost-effective: Typically more affordable than court litigation
Faster resolution: Agreements can often be reached within weeks
Control over decisions: You remain in control rather than relying on a judge’s ruling
Reduced conflict: Encourages respectful dialogue and compromise

Is mediation legally required?

In most cases, couples must attend a MIAM before pursuing court action. However, exceptions apply in instances involving:

Domestic abuse or safety concerns
Child protection issues
Bankruptcy
International jurisdiction matters

Costs of mediation

The cost of mediation varies depending on the complexity of your case and the number of sessions required. However, it remains significantly cheaper than court proceedings.

What happens if mediation fails?

If mediation doesn’t lead to an agreement, you can explore alternative dispute resolution options such as arbitration or proceed to court. Seeking legal advice from a specialist family law solicitor is recommended.

Family mediation case study

Case overview: Abigail and Graham faced disagreements over child custody, financial settlements, and property division after their separation. Mediation was recommended to avoid court intervention.

Resolution: Through five mediation sessions, both parties identified their priorities. The mediator facilitated financial disclosure, ensuring transparency. Ultimately, a fair financial arrangement allowed Abigail to remain in the family home while Graham accessed liquid savings to purchase a new property. Child custody arrangements were also amicably agreed upon.

Outcome: Mediation enabled Abigail and Graham to reach a mutually beneficial agreement without resorting to court, reducing stress and legal costs.

Conclusion

Family mediation is a constructive way to navigate the challenges of separation or divorce. By fostering communication and collaboration, it offers a path toward amicable resolutions that prioritise the well-being of all parties involved. If you’re considering mediation, contact a qualified family mediator to explore your options.

ROP Retinopathy of prematurity – delayed diagnosis claims

Posted on 7 January 202210 July 2025 by Sarah O'Sullivan

Premature babies are at risk of an eye disease called Retinopathy of Prematurity (ROP), which may, in serious cases lead to blindness. This is why premature babies should be regularly screened in line with the 2008 National Guidelines.

In most cases, even if a baby does develop ROP, it will resolve spontaneously and treatment will not be needed. For a small number of babies, ROP worsens, often very rapidly, but with timely treatment the prognosis is good.

What is retinopathy of prematurity?

Retinopathy of prematurity (ROP), also called retrolental fibroplasia (RLF) and Terry syndrome is where the blood supply to the retina does not develop normally as a consequence of being born prematurely. The retina is the layer of tissue that lines the back of the eye and makes it possible to see.

Your baby’s eyes begin to develop around the 16th week of pregnancy. If he or she is born very early, this process is cut short. The blood vessels in the inner retina do not develop a blood supply until much later in the pregnancy and this process does not complete until the end of the pregnancy. Therefore, if your baby is born prematurely, the inner retina has an incomplete blood supply. The more premature the birth, the less complete the blood supply present.

In most cases, the premature baby’s eyes will develop normally. However, in some cases, the blood vessels in the inner retina do not grow normally. They may grow into other parts of the eye such as the clear gel that fills the space between the lens and the retina of the eyeball and cause bleeding/leaking. The vessels may also change physically, to pull the retina, and, if extensive enough, cause the whole retina to detach from the eye.

Over time, these blood vessels and the associated scar tissue can cause other serious vision problems, such as:

Crossed eyes (strabismus)
Increased eye pressure (glaucoma)
“Lazy eye” (amblyopia)
Near-sightedness (myopia)

The good news is that with early diagnosis and treatment, most babies will retain a normal structural eye, with good vision.

Retinopathy of prematurity medical negligence claims

Sadly, ROP occasionally gets missed and by the time it is detected, the baby has suffered permanent visual loss. Janine Collier, Head of the Medical Negligence team at Tees, has specific expertise in helping families whose child has suffered permanent visual impairment because of a failure to detect and treat ROP. If your baby has suffered visual loss as a result of late diagnosis you may be eligible for compensation. Read on to find out more about this condition or click below to speak to a specialist solicitor.

What are the risk factors for ROP?

The risks increase with increased prematurity and the smaller your baby is at birth, the greater the chance of her or him having ROP. There are other factors which contribute to the risk including:

Ventilation
Bronchopulmonary dysplasia
Chronic lung disease
Other inter-current illnesses such as infections, cardiovascular instability
Poor post-natal weight gain

How do I know if my baby has ROP?

All infants who are at risk for it should be screened in line with the 2008 National Guidelines. The timing of the first screening examination will depend on your baby’s gestational age at birth.

The baby is given eye drops to make her or his pupils larger ahead of the examination. This helps the doctor see all the parts of the eye better. It doesn’t hurt.

As the screening is not an especially comfortable examination, local anaesthetic eye drops are usually used alongside comfort care techniques, such as swaddling, oral sucrose or expressed milk, a dummy / pacifier. Experienced ophthalmologists can usually undertake the examination in 2-3 minutes. Each eye is fully examined to check for ROP.

Screening is usually carried out two-weekly, and, if no cause for concern, stops at around 36 weeks gestational age.

If the ophthalmologist identifies early signs of ROP, the interval may be shorter as the doctor will watch to see if the condition requires treatment, or if it resolves spontaneously. Most babies with ROP will resolve spontaneously.

If my baby has ROP, what treatment will he or she need?

In the UK, approximately 4% of cases require treatment. The purpose of treatment is to preserve the anatomy of the retina, by preventing retinal detachment.

If the doctor recommends treatment, this is usually given within 48-72 hours and most commonly, it is treated with laser to the affected part of the retina.

Your baby may suffer some side effects, including inflammation (typically treated with a short course of steroid eye drops and pupil dilating eye drops for 1 to 2 weeks). Rarely, other side effects may occur. Your baby’s doctor should explain these to and discuss these with you prior to treatment.

I am worried about the care my baby is receiving – what should I do?

You might already have tried to talk to doctors about your baby’s condition but sometimes it can feel like you’re on your own. With Tees by your side, you are not. We understand what you’re going through, and we’re here to give you a voice.

We’ve handled many medical claims and have a particular expertise in supporting families with babies and young children, so our team of lawyers really do have the practical experience to support you. We’re persistent, and we’ll fight to get answers for you and you may be eligible for compensation.

Retinopathy of prematurity: Case studies

Baby A: Rentinopathy of prematurity due to inadequate care

Baby A was born prematurely at 25 weeks and 4 days gestation by caesarean section. He suffered respiratory distress, was intubated and transferred to the NICU for a period of intensive care and specialist support. He remained ventilated for 9 days, spent 22 days in Intensive Care and 7 days in the high dependency unit. During his admission, he received antibiotic treatment for sepsis, insulin for hyperglycaemia and two blood transfusions.

Baby A’s parents understood that he was at risk of ROP. However, his parents also understood that their baby would be regularly screened, so that if there were signs of ROP, he could receive treatment, significantly reducing the risk of loss of vision.

Five weeks after birth, Baby A had his first screening for ROP. At the time of the exam, Baby A was still small and in an incubator. When screened, each eye examination took around 10 minutes. Parents were advised that he would be screened every two weeks.

Baby A was transferred to a Special Care Baby Unit at a local hospital. Parents felt that the care at the local hospital was very different to what they had experienced at the previous hospital. They felt the staff treated them as over anxious young parents and did not encourage them to be a part of their baby’s care, which was unlike their experience at the previous hospital.

Whilst at the local hospital, Baby A was screened twice for ROP over a six-week period. Prior to being discharged, the Ophthalmologist spent an extended period of time examining Baby A’s eyes. During the exam the Ophthalmologist cut the white part of Baby A’s eye. After a time the despite the Ophthalmologist being unable to get a clear view, Baby A was discharged from hospital.

At a paediatric follow up the following month, Baby A’s parents told the Paediatrician that they were worried about his eyes as he would not look, follow or track. The Paediatrician said that it was just because he was a young premature baby and that they should not worry.

One month later, Baby A was referred to Great Ormond Street (GOSH) for assessment. Baby A’s parents were told that he had suffered significant and severe visual loss, equivalent of Stage 5 ROP / retinal detachment in the left eye and Stage 4a ROP in the right eye.

Baby A had surgery on the right eye at GOSH. The estimate is that post-operation he may have 2% vision in his good right eye since having the operation. It was not possible to offer Baby A any treatment for his left eye.

The outcome

The hospital that treated Baby A has admitted that the diagnosis of ROP should have been made several weeks earlier and that laser treatment should have been offered within 48-72 hours of diagnosis. Now that liability has been admitted, we are seeking an interim payment to put in place some immediate support for Baby A and his family (aids, appliances, accommodation, educational support).

As a result of a review, the hospital has changed their process and procedure for ROP screening. The Ophthalmologist no longer undertakes ROP screening and the Paediatrician no longer reviews premature babies.

Baby C: Late diagnosis of retinopathy of prematurity

Baby C was born at 24 week’s gestation, weighing c. 600 grams. She suffered several complications because of her extreme prematurity including Respiratory Distress Syndrome, Chronic lung disease, Hypertension, a patent ductus arteriosus, sepsis, hyperglycaemia and necrotizing enterocolitis.

Due to her prematurity and low birth weight, C was at high risk of suffering from ROP.

Baby C was examined by an ophthalmologist at, 7 weeks old, 8 weeks old, 9 ½ weeks old

On all occasions, it was noted that there was no ROP.

At ten and a half weeks of age, Baby C was again examined. The ophthalmologist found and recorded a “definite progression of ROP stage 3 zone 2 in both eyes, + disease”.

Treatment by both laser and cryotherapy was undertaken, but, the disease being so extensive now, was unsuccessful.

ROP behaves in a highly predictable manner and, we were, therefore, able to infer that at the time of the examination when C was 9 ½ weeks of age, it is implausible that there was no ROP present. The examination must, therefore, have been substandard. With a competent examination, C would have been referred for urgent laser treatment and, on the balance of probabilities, she would have retained good functional vision in both eyes.

Baby C lost all vision in her left eye, and has a shrunken eye. She has lost most useful vision in her right eye. She is at risk of retinal detachment, retinal degeneration, the need for surgical treatment of the band keratopathy, glaucoma and shrinkage of the right eye.

C also suffers from learning, behavioural and social difficulties because of her extreme prematurity. Her visual impairment has compounded her other developmental problems.

This case has now settled for a six figure sum.