Advice line: A sting in the tail

Pip White explains why the CSP has issued new guidance on treating cauda equina syndrome

The CSP regularly reviews the members’ public liability insurance (PLI) scheme and has robust data showing the range of circumstances that give rise to proven clinical negligence claims against CSP members.

A recent trend has been an increase in cases in which physiotherapists failed to manage cauda equina syndrome (CES) presentations properly. The basis of the negligence claim is that the physiotherapist failed to examine the patient properly, act on ‘red flags’ present, refer on, or investigate with sufficient urgency.

The CES PLI claims experience highlights the need for physiotherapists to understand their clinical obligations when managing patients with back pain as, while generally rare, the consequences and permanence of untreated CES mean that associated claims lead to six or seven figure settlement amounts.  The settlement amounts are high because it can take several years for the full extent of a patient’s lasting injuries to be quantified and a patient’s lifetime future care needs must be accurately calculated.

To help our members, and to seek to reduce the PLI notifications related to CES, the CSP has produced a briefing for members called Learning from Litigation – Cauda Equina Syndrome. The information offers members advice about managing CES from an indemnity perspective and highlights the key challenges and how to address them.

Susan Greenhalgh, a consultant physiotherapist and expert researcher in CES management, helped develop the briefing.  She said ‘this is an extremely important area of work because of the impact it can have on patients’ lives’.  The information is available here.

CES claims can come from any sector of practice, but members working in private practice or self-referral NHS clinics should be particularly vigilant for possible CES presentations in their patients, and ensure they can act on urgent clinical findings quickly.  All members are advised to read the CES briefing and use it as a continuing professional development opportunity to reflect on and develop their clinical practice.

Pip White CSP professional adviser

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