The case of Anderson v Milton Keynes General NHS Trust and another  EWHC 2249 (QB)
The events of the case
On the 11th November 2000, John Anderson suffered from what was considered a severe injury to the left ankle obtained during an accident at work. The injury, put simply, consisted of a severe break to the lower area of the shinbone.
Mr Anderson was admitted first to the Milton Keynes General Hospital, where he was given an immediate diagnosis of compartment syndrome, which is a painful condition due to a drastic change of pressure in the muscles, causing a restriction in blood flow to the area. The following day a necessary four compartment fasciotomy was performed (essentially a treatment for the pressure that had built up as a result of the compartment syndrome) and an external fixator was applied to the ankle, from this point onwards an unavoidable open wound was left on the leg.
A brief period after the operation Mr Anderson was transferred to Radcliffe hospital (13th November) to receive specialist orthopaedic and plastic surgical treatment. It is important to note at this stage, that Mr Anderson was informed of the full extent of his injuries, including details of the significant risk of deep infection and that his leg itself may be at risk, due to the lack of any protective barrier of skin and poor supply of blood to the bone.
The main concerns of the case
The main concern raised by the Mr Anderson during this case was the development of a deep-rooted infection known as MRSA which is an infectious bacterium typically resistant to a wide variety of antibiotics and notoriously difficult to treat without the specific medication.
On arrival at Radcliffe hospital, routine swabs were taken in order to test for any infections. However, the results of the swabs would not be accessible until the 17th November, four days after the initial admission. During this period, it became apparent that Mr Anderson underwent major orthopaedic reconstructive surgery carried out by Mr Keys, an orthopaedic surgeon, without knowledge of the swab results.
Following this, Mr Anderson was then moved to the infirmary to await plastic surgery where Mr Keys, overseeing the treatment process, reiterated the real risk of serious infection whilst again sampling another set of swabs to clear for infections. On that same day (17th November) the original results were notified and highlighted that Mr Anderson’s wound had been colonised with the MRSA bacterium (it is important to take note that the term colonised refers to the indication of a bacterium on the skin and does not mean that it has penetrated the wound, therefore it remains harmless until entering the body).
This newfound information, however, was not communicated clearly with the plastic surgery team. As a result, once again the claimant underwent further surgery in the form of a reconstructive skin graft (on 19th November). Two days later, the early signs of infection began to develop. Unfortunately, the results of the previous swab results (highlighting the MRSA infection) were not provided to those responsible for choosing the course of antibiotics most appropriate for Mr Anderson.
Actions of the hospital following signs of infection
Over the next week, Mr Anderson’s treating doctors discussed alternative antibiotics, including vancomycin, which is known to be most effective against MRSA. However, as the state of the infected wound began to improve, and by the 1st December the dressings remained clean, no further action was taken to ascertain whether there was any further infection in the wound.
However, once the antibiotics were withdrawn, there were some signs that infection was still present: an elevated temperature and an aspiration of pus from the wound. The pus was reported as positive for MRSA and Mr Anderson was reviewed and observed but, with general improvement in all areas, his request to be moved to a hospital located closer to home was granted, and on the 16th December he was transferred to Crosshouse Hospital with no sign of deep infection in his leg.
Complications following Mr Anderson’s treatment
Unfortunately, Mr Anderson faced further complications following his discharge from the hospital. He was later readmitted due to swelling within the leg and by the 16th January was receiving intravenous vancomycin and fusidic acid, which are drugs specifically related to treating MRSA.
Mr Anderson was admitted again on 12th February. Further surgery took place but no sign of healing of the original injury was seen. Throughout the following year of 2001, Mr Anderson faced many issues with debilitating pain and the shortening of his leg.
Mr Anderson began a claim for clinical negligence against the trusts of Milton Keynes and Radcliffe hospitals.
In response, the Hospital trusts (the defendants) made two admissions;
- They had failed to communicate the results of the first swab results, which had found the presence of MRSA, to Mr Anderson’s plastic surgeons
- They had allowed Mr Anderson’s treating doctors to decide upon a course of antibiotics before the knowledge of the swab results had been made available to them.
However, the defendants denied that these breaches of duty had caused Mr Anderson any additional harm or unnecessary injury. And, as such, the defendants argued they were not legally responsible to compensate him. In the end, the case had to be resolved at trial.
Issues for the court
One of the key issues raised was whether Professor Willett, who was the specialist orthopaedic and plastic surgeon overseeing the vast majority of Mr Anderson’s care, had been correct to stop all antibiotic treatment on the 1st December.
Connected to this, and perhaps the most prominent issue, was whether a course of vancomycin, commencing in early December, would have prevented Mr Anderson from suffering the same outcome as he did.
Mr Anderson’s case
Mr Anderson and his solicitors put forward that the MRSA bacterium was both present and colonised in the wound from the date of the 14th November but had yet to penetrate to the bone until a much later date.
In support, they relied upon the evidence of Professor Goodwin (an orthopaedic expert witness) who suggested that the MRSA had entered the bone around late December and thus a 7-to-10 day course of vancomycin on the 21st November would have been sufficient to eradicate any infection present. Essentially, they argued that, had the appropriate antibiotics been given after Mr Anderson’s initial operation, the injuries and disability he suffered would have been substantially reduced.
The defendants’ case
The defendants relied upon expert medical opinions from Mr Briggs and Professor French. This was that there was nothing to prevent the MRSA from invading both the tissue and bone and so they considered that the infection had already penetrated and begun colonising within the bone on and after the 14th November 2000.
According to Professor French’s evidence the MRSA was colonising the bone from the date of the initial surgery but showed no signs of active infection until mid-January 2001. It was agreed that the use of the correct antibiotics may have been effective, but not if the bacteria lay between the metal and the bone. Professor French thought this was the case and that it would therefore have been immune to any antibiotic treatment.
The court’s judgment
The court decided that Professor Willett’s decision to stop the treatment of antibiotics was based upon evidence suggesting that there was no active infection at the time. However, the court noted that a more thorough observation could have taken place to support the decision.
On the second question, as to whether vancomycin administered in early December could have reduced the harm suffered by Mr Anderson, the court preferred the evidence of Professor French. It was found, for much of the case, that his evidence remained impartial and balanced within the arguments presented. Whereas the court found Professor Goodwin’s evidence appeared to lack objectivity.
The court accepted that even if Mr Anderson had been given the correct drug earlier, any improvement would have been relatively small. The need for further surgery appeared to be common ground for both sides in the case.
As such, the court found, on the balance of probabilities, that by the time the correct antibiotics should have been administered, the bacteria had, in fact, already entered the bone and thus would have remained immune to any treatment provided at the time. Accordingly, the defendants’ breaches of duty were not responsible for the harm Mr Anderson suffered as a result of the MRSA infection.
If you have developed an infection whilst in hospital, your legal position may be different from Mr Anderson’s. Contact our specialist clinical negligence solicitors today for expert advice on whether you can claim compensation.
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