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Emergency Care and Material Contribution in Dr Sido John v Central Manchester and Manchester Children’s University Hospitals NHS Foundation Trust - Katherine Galza, Kingsley

17/02/17. This case began with Dr John sustaining a serious brain injury having fallen down the stairs to his flat. He remained in an unconscious state for some time before he was reached by paramedics, and when arriving at A&E he presented with a low GCS reading (eye opening, verbal response and motor response). A CT scan, performed seven hours later, revealed that there was a blood clot in his brain. As he was being prepared for transportation to a specialised hospital for brain surgery, he experienced a seizure and his ambulance was cancelled, ordered again one hour later, and then was itself delayed for a further hour. Despite the surgeons’ best efforts in performing a left fronto-parietal craniotomy and the subsequent follow up investigations, care, and surgeries, Dr John was left with a severe form of brain damage.

Dr John’s claim is interesting for a number of reasons. It was clear that he had already injured himself pretty badly in the first place and that the trust, having left Dr John effectively untreated for seven hours, had breached its duty of care towards him. The question was then, to what extent did this delay cause Dr John to suffer the severity of brain damage he ultimately sustained? The particular factual issue to be determined in Dr John’s case was whether he was presenting with intra-cranial pressure (‘ICP’) upon his arrival at A&E. If left untreated, ICP can severely exacerbate brain trauma. The existence of Dr John’s ICP was proven in two ways. First, as one expert argued, although ICP did not appear on the CT scan, the approach should have been “treat the man not the scan”, as Dr John had displayed all the physical signs of ICP (eg. dysphasia). Second, the presence of ICP during the operation, as noted by one of the surgeons, provided conclusive evidence that any delay in Dr John’s treatment would...

Image cc flickr.com/photos/didbygraham/219375981/

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