Claim failed
[2025] EWHC 1907 (KB)·2025·Liability decided at trial
A 27-year-old flight attendant saw her GP with severe back and leg pain, having mentioned perianal numbness in a message two days earlier; she had emergency surgery for cauda equina syndrome four days after the consultation. The judge accepted that the GP asked the right red-flag questions and that the patient answered no, so there was no breach of duty.
In cauda equina cases the court looks closely at what safety-netting questions the GP actually asked and what the patient answered on the day. Contemporaneous notes and messages matter greatly for both sides.
Claim failed
[2024] EWHC 2011 (KB)·2024·Liability decided at trial
Ms Spellman alleged a hospital radiologist missed cauda equina compression on an MRI scan taken the day after her fall, delaying diagnosis until private surgery six days later. Damages had been agreed at £300,000 if she won, but the judge found the scan showed only mild stenosis with no compression to be found, so the claim failed.
Parties sometimes agree the damages figure in advance and fight only liability, so a claimant who loses on breach of duty recovers nothing. Expert evidence on what the scan actually showed was decisive.
Claim failed
[2021] EWHC 323 (QB)·2021·Liability decided at trial
A teacher with a back injury attended A&E and was referred for a routine MRI; the scan two weeks later showed a disc prolapse and she had emergency surgery but was left with permanent damage. The court found the registrar was not negligent in not suspecting cauda equina at that visit, and that her condition had not materially worsened during the delay.
Not every back-pain patient with some red-flag features must be scanned urgently; the court looks at the full picture presented at the time. Claimants must also prove the delay itself made the outcome worse.
Claim failed
[2018] EWHC 1345 (QB)·2018·Liability decided at trial
A man with back pain and new groin numbness phoned his GP, who told him to go to A&E rather than ringing the hospital orthopaedic team directly. Master Cook found the GP had credible expert support for that approach and struck out the claim against him.
Sending a suspected cauda equina patient to A&E by ambulance can be a defensible GP response. A GP claim will fail at an early stage if a responsible body of GPs would have done the same.
Claim failed
[2016] EWHC 331 (QB)·2016·Liability decided at trial
A teenager with back pain had a lumbar microdiscectomy and afterwards developed cauda equina syndrome. She argued the surgeon should have sought a second opinion and consented her properly; the court rejected the criticisms and found the CES was a non-negligent complication.
Cauda equina syndrome can be a recognised complication of spinal surgery rather than evidence of negligence. Consent claims fail if the court accepts the surgeon gave adequate advice.
Claimant succeeded
[2019] EWHC 520 (QB)·2019·Liability decided at trial
Two days after a back injury, Mrs Shaw attended an out-of-hours GP with severe low back pain, numbness and tingling in both legs, difficulty walking and a urinary accident. The judge found these red-flag signs of cauda equina syndrome were present and were missed, so the GP should have sent her straight to hospital.
An out-of-hours GP who fails to pick up cauda equina red flags (bilateral leg symptoms, bladder problems, leg weakness) and does not refer to hospital falls below the standard of a reasonable GP. A doctor's belief that he would not have missed it carries little weight if the records do not support it.
Mixed outcome
[2018] EWHC 2715 (QB)·2018·Appeal decision
A man with a disc problem developed cauda equina symptoms and the out-of-hours GP told him to go to A&E rather than arranging direct orthopaedic assessment; surgery came many hours later and he was left with permanent bowel and bladder problems. A Master had struck out the claim against the GP by summary judgment, but the High Court allowed the claimant's appeal so the claim against the GP could go to a full trial.
Clinical negligence claims should rarely be disposed of by summary judgment before the expert evidence has been exchanged. The ruling did not decide whether the out-of-hours GP was negligent, only that the question had to be tried.