§ GUIDE · VASCULAR

A cold, painful limb
that nobody took seriously

A blocked artery in a leg or arm is a time-critical emergency, and the judgments here show what happens when it is missed by a GP, a clinic or a ward. Five of eight succeeded. The losses show the limit: even a negligent delay is not compensated if the limb could not have been saved.

Judgments read

8

Claimant succeeded

5 of 8

Largest sum stated

£4.68 million

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GP, clinic, ward

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§ BEFORE YOU GO FURTHER

For a limb ischaemia claim, these things usually need to be true

  • A cold, pale, painful or numb limb, or a non-healing ulcer, was seen by a clinician who did not check pulses or refer urgently.
  • Or a known blockage was diagnosed but surgery to restore blood flow was delayed for hours.
  • Earlier referral or surgery would probably have saved the limb or reduced the damage.
  • It happened within the last three years, or you only recently found out.

Two of the losses here accepted the delay was real but found the limb could not have been saved in time. Timing evidence from a vascular expert decides these claims.

§ 01

Missed by a GP or clinic

JAH v Burne: a woman with learning difficulties lost an arm and a leg to arterial clots after several doctors failed to spot a blocked artery; judgment of £150,000 against one GP for the arm. Raggett v King's: a man with known arterial disease was treated for months for foot pain by an orthopaedic surgeon, a pain specialist and a rheumatologist, none of whom checked for a vascular cause; all three were found negligent and the court held the leg was salvageable earlier.

Marcus v Medway is the caution: findings of a cold, painful foot were recorded on an X-ray request form and never passed on, which was negligent, but the leg could not have been saved and damages were £2,000.

§ 02

Sepsis and diabetic infection

Macaulay v Karim: a diabetic man attended A&E with fever and rectal pain, a possible abscess was noted, and he left before blood results without being properly investigated. He returned in septic shock and lost his lower leg, toes and fingers. Liability was established against the Trust.

§ 03

Delayed surgery on the ward

Lane v Worcestershire and Middleton v Frimley both failed. In each a blocked artery was diagnosed in hospital and surgery happened many hours later, but the court found the timing reasonable and, in any event, that earlier surgery would not have changed the outcome. Beatty v Lewisham failed where an embolism was diagnosed as vasculitis. Riley v Salford Royal is the contrast: compartment syndrome not treated in time led to amputation, with damages of £4.68 million.

§ 04

What a solicitor will want

Every consultation before the amputation, with what was examined and whether pulses were checked. For hospital delays, the exact time of diagnosis and of surgery. A vascular surgeon then advises whether the limb could have been saved at each point.

§ THE JUDGMENTS BEHIND THIS GUIDE

The eight judgments behind this guide.

Every one a published decision of the courts of England and Wales, linked to its source.

Claimant succeeded£150,000

JAH v Burne & Ors

[2018] EWHC 3461 (QB)·2018·Liability decided at trial

A woman with learning difficulties lost her arm and leg to blood clots in 2012 after several doctors and a hospital failed to spot a blocked artery. Martin Spencer J found only Dr Jackson negligent and causative, and only for the arm, awarding the agreed £150,000.

Where several clinicians see a deteriorating patient, the court examines each contact separately. Compensation was limited to the injury that the negligent consultation could actually have prevented.

Claimant succeeded

Raggett v Kings College Hospital NHS Foundation Trust & Ors

[2016] EWHC 1604 (QB)·2016·Liability decided at trial

A man with known arterial disease and prior strokes developed severe foot pain and was treated for months by an orthopaedic surgeon, a pain specialist and a rheumatologist, none of whom checked for a vascular cause or felt for foot pulses. By the time critical ischaemia was diagnosed the leg could not be saved; the court found each of the three consultants negligent and held the leg was salvageable earlier.

Clinicians treating limb pain in a high-risk arterial patient must exclude a vascular cause, which starts with checking pulses. Multiple specialists can each be liable for the same missed diagnosis.

Claimant succeeded£2,000

Marcus v Medway Primary Care Trust & Anor

[2010] EWHC 1888 (QB)·2010·Liability and damages decided at trial

A doctor at a same-day treatment centre in April 2005 examined a man with a cold, painful foot but her findings were recorded only on an X-ray request form and never passed to the GP, who then failed over several weeks to diagnose limb-threatening ischaemia. The court found negligence but held the leg could not have been saved, awarding only £2,000 for extra pain.

Examination findings must be communicated to the next clinician, not left on a request form. Even proven negligence yields little compensation if the outcome could not have been changed.

Claimant succeeded

Macaulay v Karim & Anor

[2017] EWHC 1795 (QB)·2017·Liability decided at trial

A 53-year-old diabetic attended A&E with fever, rectal pain and urinary difficulty; a possible abscess was noted but he left before blood results and was not properly investigated. He returned two days later in septic shock and lost his lower leg, toes and fingers; the court found that proper care at the first attendance would have avoided the amputations.

Diabetic patients with fever and localised pain need prompt investigation for a source of infection. A&E is responsible for ensuring a possibly septic patient is not allowed to leave without a plan.

Claim failed

Lane v Worcestershire Acute Hospitals NHS Trust & Anor

[2017] EWHC 1900 (QB)·2017·Liability decided at trial

After a heart attack and angioplasty, Mrs Lane developed a blocked artery in her right arm; it was diagnosed at 02:30 but she was not transferred to the vascular unit until the morning and thrombectomy was done that evening. The judge found the delays and surgery were not negligent and that, in any event, the arm was successfully reperfused so the later amputation was not caused by any delay.

Delay alone is not enough: a claimant must show both that the delay fell below a reasonable standard and that earlier treatment would have changed the outcome. Deferring surgery for an unstable cardiac patient can be a reasonable clinical judgment.

Claim failed

Middleton v Frimley Health NHS Foundation Trust

[2022] EWHC 2981 (KB)·2022·Liability decided at trial

Mr Middleton's acutely ischaemic leg was diagnosed at lunchtime but bypass surgery did not happen until after midnight, about 14 hours later. The judge found it was reasonable to obtain CT imaging first and that surgery by mid-afternoon was not mandatory, and that earlier surgery would not have prevented the nerve injury in any event.

Obtaining imaging before emergency vascular surgery can be reasonable practice, and a claim fails unless earlier treatment would probably have avoided the injury.

Claim failed

Jacqueline Beatty v Lewisham and Greenwich NHS Trust

[2023] EWHC 3163 (KB)·2023·Liability decided at trial

Ms Beatty, in hospital with severe cellulitis, developed ischaemic toes; a vascular surgeon diagnosed vasculitis rather than an embolism and did not order a CT angiogram, and she later needed a below-knee amputation. The judge found the surgeon's diagnosis was supported by a responsible body of medical opinion and dismissed the claim.

A diagnosis that turns out to be wrong is not automatically negligent; if a responsible body of specialists would have reached the same view on the information available, the claim fails under the Bolam test.

Claimant succeeded£4.68M

Matthew Riley v Salford Royal NHS Foundation Trust

[2022] EWHC 2417 (KB)·2022·Damages assessed at trial

A 20-year-old motorcyclist with leg fractures developed compartment syndrome which the trust admitted it treated too late, so his right leg had to be amputated below the knee. Liability was admitted and the court assessed damages at £4,676,442 covering lifelong prosthetics, care, adapted housing and lost earnings.

Where a hospital admits that quicker treatment of compartment syndrome would have saved a limb, the case becomes about valuing lifelong needs, and prosthetics, accommodation and care can each run to six or seven figures for a young claimant.

Browse the whole case library →

Contains information licensed under the Open Justice - Licence v2.0. Judgments from Find Case Law, The National Archives. Summaries are ours; amounts only where printed in the judgment.

§ QUESTIONS

Common questions

My GP did not check the pulses in my foot and I later lost my leg.

Raggett and JAH both succeeded on this kind of failure. The question is whether the signs at the time called for urgent vascular referral, and whether earlier referral would have saved the limb.

The hospital knew about the blockage but operated hours later.

Lane and Middleton both failed on this. Courts accept that imaging first and waiting for a stable patient can be reasonable, and the claimant must show earlier surgery would have changed the outcome.

Does it matter that the limb might have been lost anyway?

Yes, decisively. In Marcus the delay was negligent but the leg could not have been saved, so damages were £2,000 for extra pain only.

Can more than one clinician be responsible?

Yes. In Raggett three consultants were each found negligent for the same missed diagnosis. In JAH only one of four defendants was held liable.

How long do I have?

Three years from the amputation or injury, or from when you first realised care may have fallen short.

This guide is general information about the law in England and Wales, not legal advice about your case. ClaimGavel is run by Costart Projects Ltd on behalf of Tomlin & Partners, a specialist medical negligence firm regulated by the SRA. The free assessment on this page is an AI overview to show you roughly where you stand; a solicitor confirms the position in a free, no-obligation conversation.