By Ken Thomas, medical negligence specialist at Harding Evans Solicitors

I am regularly instructed to pursue cases where a fracture has been missed by Accident & Emergency staff at local hospitals. Whilst A & E Departments on the whole provide high quality care, such errors do occur. One published study in 2001 found an average of 250 diagnostic errors per annum in just one English Casualty Department, most of those being fractures missed by junior doctors.

Sometimes, the doctor may not have carried out a sufficient examination. He or she may not have correctly interpreted the symptoms complained of. Or a junior doctor may not have sought senior assistance or guidance when they should have done. Unfortunately many Trusts simply do not have enough A & E Consultants.

In other scenarios, the patient may not have been referred for an x-ray when really they should have been. Alternatively, an x-ray may have been carried out but not correctly analysed and reported upon.

Sometimes the situation can be righted after a few days, perhaps when the patient returns to the Casualty Department still in pain and the correct diagnosis is belatedly made. A few days’ delay may not adversely affect the long-term outcome.

However, many other patients do somehow manage to struggle on. I have acted on several cases where the fracture has gone undiagnosed, and therefore untreated, for several months. Where there has been such a delay, then the long-term prognosis can be significantly worsened. Surgery may be necessitated when it could have been avoided had the diagnosis been made on the initial attendance.

Over the last few years, I have acted on behalf of young children through to pensioners. Cases settled on their behalf have included missed fractures of the skull, neck, back, leg and so on.

Other accident injuries that can be missed include shoulder dislocation and knee tendon/nerve damage. There again, the consequences can be significant and, for example, mean the difference between being able to return to work or not.

Of course, we are all acutely aware that A & E staff face a very difficult job. The Royal Gwent Hospital in Newport has one of the busiest A & E Departments in Wales, seeing over 70,000 new patients a year. Inevitably there may be situations where a full history of the injury and how it happened cannot be obtained, perhaps because the patient may be unconscious or inebriated.

Where an obvious fracture has been missed and the patient has suffered significant and avoidable pain and suffering as a result, these cases can be relatively straightforward to pursue which in turn means that they are capable of resolution quite speedily.