Apology and compensation for man following severe chemical burn injury to his hand during cancer treatment at a London hospital

John (not his real name) had been undergoing treatment for myeloma, a type of blood cancer, for which he was admitted to the Royal Marsden Hospital, London, to receive a stem cell transplant and haemofiltration - a process during which a patient’s blood is passed through a machine to remove waste products and water.

In preparation for the haemofiltration, anticoagulation (blood thinning) therapy was started which saw John given intravenous lines into his body. As well as a central venous line connected near to his heart, he was also given intravenous lines into his right hand and arm for extra medication.

In order to keep his calcium levels steady, John was given calcium chloride - a drug that can potentially be dangerous if it leaks out of the blood vessel and into the surrounding tissue (extravasation). To guard against this issue, the drug is normally administered into a large blood vessel, and any signs of extravasation must be responded to quickly.

However, the calcium chloride was administered through a smaller vein in John’s right hand. He initially reported a stinging pain, but the infusion was continued.

Over the next few hours, John continued to complain to his nurses about the pain in his hand along with skin redness, warmth, and swelling. Despite these complaints, no action was taken in response and the infusion continued.

A while later, the skin on John’s hand started to peel, and the redness and swelling had started spreading up towards his wrist. His hand also felt extremely stiff, and he struggled to flex his fingers. John alerted his nursing team again and, on this occasion, they agreed that there was a problem. It was obvious that John was suffering from extravasation – the calcium chloride was leaking out of the blood vessel into the surrounding tissue. The nurses stopped the infusion and commenced treatment.

Unfortunately, by this time John had already sustained a severe chemical burn from the leaked calcium chloride, damaging the underlying structures in his right hand. As a result, he required multiple operations and skin grafts, along with hand therapy, to preserve hand functionality. Despite some initial improvement, the hand remained significantly impaired.

John continues to experience reduced strength and dexterity in his hand and suffers from numbness and pain. He tries to be as independent as possible, but still needs assistance from friends and family. John’s hobbies and activities have also been restricted, including his ability to enjoy playing golf and music – two of his biggest passions. His daily activities continue to be severely impacted and, as a consequence, there has been a significant negative impact on John’s mental health.

An investigation carried out by the Royal Marsden NHS Foundation Trust (the defendant) identified several care failures that allowed the preventable injury to occur including incorrect line usage, lack of protocol awareness and improper skin assessment scoring.

John instructed solicitor Michael Roberts at Leigh Day to investigate a potential clinical negligence claim. The Royal Marsden NHS Foundation Trust was invited to make an early admission of liability, but its response was delayed, so further investigations were undertaken. Supportive expert evidence was then obtained to confirm that the hospital had breached its duty of care to John and that he had suffered significant injuries as a direct consequence.

The Royal Marsden subsequently made a full admission of liability, stating: “we wish to sincerely apologise for the substandard care that [John] received. The Trust is extremely sorry that this happened”. A number of changes to hospital practice were made, as well as updates to local policies and guidelines, in order to prevent any future occurrence of this injury.

The defendant made a settlement offer that was considered to be too low and, as the full extent of John’s injury was clarified through additional factual and expert evidence, the case was subsequently settled for around three times the original amount offered.

The compensation will assist John with accessing advanced treatment for his hand and specialised equipment to allow him to pursue his hobbies to the fullest extent possible.

Michael Roberts said: 

“We are pleased that the matter could be resolved amicably between the parties in the end, but this was an extremely unfortunate and serious injury that should never have occurred. I hope that the Trust has now learnt important lessons from this event so that it will never reoccur. Above all else, I sincerely hope that the settlement will allow John to focus on his recovery and living his life to the full in future.”

John said:

“Whilst I was initially surprised as to how long the whole process took, this was a testament to all the thorough and diligent work required to be undertaken, borne out by the excellent final result and settlement.”

Leigh Day worked with barrister Christopher Mellor at One Crown Office Row Chambers.