The index event

Mr X was working as a bathroom installer for the council.He raised concerns that the bathrooms he was removing were unsanitary, and asked his employer for Personal Protective Equipment (PPE).It wasn’t provided, and despite his complaints, he was advised to continue working.

One night, he became acutely unwell. An ambulance was called after he experienced diarrhoea and confusion, and he was diagnosed with septic cardiogenic shock, treated in intensive care, sedated, intubated, and started on Continuous VenoVenous Haemofiltration (CVVH).

Gangrene developed in both his hands and feet.The medications required to maintain his blood pressure caused vasoconstriction that, combined with the gangrene, resulted in avascular necrosis (the death of bone tissue).

The bone damage ultimately meant that bilateral lower limb amputation was required to save Mr X’s life, alongside multiple surgeries to his hands. Initially his fingers were amputated, and later grafts were taken from his arm and thigh to create new digits that enabled some dexterity in his hands.

Why the home visit mattered

With a background of intensive care nursing and having treated patients with sepsis, I was asked to provide an assessment of Mr X’s care needs — comparing his abilities prior to the index event with his current function and ability to carry out activities of daily living.

For a catastrophic multi-injury claim such as this, a home visit isn’t optional. As a care expert, I needed to see how well he mobilised, with and without his prosthetics, and for him to feel comfortable enough to share with me the intricate and uncomfortable truths of his recovery. A remote assessment would have given me the story, but being there enabled a greater depth of understanding.

When I arrived at the home of Mr X, he offered to make tea, which meant I was able to observe how he managed the task whilst wearing bilateral prosthetic lower limbs. Mr X was able to show me around the kitchen, with its adapted cupboards at a height he could reach from his wheelchair on days the prosthetics became too painful to wear. He also showed me the wet room — which had automatic soap dispensers — and how he manages the shower.

There are so many things we as able-bodied people take for granted. Details like these are what a desk-based assessment would have missed entirely.

How the recovery timeline shapes the claim

Mr X was initially provided with NHS care, and was walking outdoors on different terrains two years after the index event. Difficulties with his prosthetic limbs then began compromising how long and far he could walk, at times forcing him to leave his prosthesis off for days. The resulting discomfort and misalignment led to hip pain, muscle weakness and poor gait.

Four years on, he developed hip pain requiring bilateral hip replacements. Bilateral shoulder replacements are expected later in life due to the strain of transferring in and out of his prostheses.

Before the case settled, Mr X required interim payments to facilitate his rehabilitation. NHS provision, while valuable, is often generic and delayed by long waiting times. I recommended private, multi-disciplinary care. This meant faster access to prostheses of higher quality, along with hydrotherapy, personal training and a gym membership to the age of 70 — all aimed at building strength and reducing the risk of further complications.

He’d previously walked his dog and was no longer able to do so.Better-fitted private prosthetics, suited to a variety of terrains, gave him that back.

The importance of multi-disciplinary coordination

Mr X’s case required support across several disciplines:

• ›Orthopaedic surgeons (for the shoulder and hip replacements, hand surgery, and stump revisions)
• ›Prosthetic limb specialists
• ›Case management
• ›Occupational therapy (for assessment and evaluation of aids and equipment)
• ›Musculoskeletal and specialist amputee physiotherapy (to ensure safe use of the prostheses)
• ›Psychological therapy
• ›Couples therapy

Due to that complexity, my own report had to include the opinions of these other experts directly. This ensured that the recommendations reflected Mr X’s needs at every stage of his life, not just the ones within my area of expertise. Assimilating the evidence from the clinical records and other expert reports is a skill every care expert needs.

Why the impact goes beyond the physical

Mr X’s injuries weren’t only physical. He had lost much of his independence, and this had a profound impact on him and the family members caring for him — including his wife in particular, who had transitioned from a romantic partner into a carer role. Aids and equipment that restored Mr X’s independence in personal care reduced the strain and helped rebuild their relationship’s original dynamic.

Mr X had been an intelligent, hardworking man prior to the index event.A vocational occupational therapist helped him retrain into teaching, giving him back a sense of purpose that was separate to his recovery.

In cases like this, surviving sepsis is often only the beginning. Care recommendations must consider the psychological, cognitive and social impact on the individual and their family — not just the physical.

If you're building a catastrophic multi-injury claim, instruct a care expert early to get a well-evidenced picture of what your client is facing, and what support and assistance they will need in the future.