A man had to have an amputation after a blister developed on his little toe.
Robert Pendlebury, 50, went to the NHS Widnes Urgent Care Centre on March 2, 2017 having noticed the blister on the little toe of his right foot. Those treating him were aware that he was a type 2 diabetic and that ulcers were developing on his other toes, but they did send him to a specialist diabetic foot clinic.
He was seen on numerous occasions over a four-week period and his wife Carol says that the situation worsened continually over that time, with the blister developing into an open wound which was "constantly seeping" with a "horrendous smell". Carol said that she stressed the need for specialist treatment at numerous appointments, as she herself is diabetic and had supported her husband for more than a decade with managing the condition.
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She said: “I wasn’t listened to at all. Rob’s diabetes had always been difficult and had never been successfully managed so I was worried as I was aware of how things like this can develop quickly. I was saying we needed to see a specialist but I was ignored.
“It went on for a few weeks, having to go back and forth to change his dressings, and as it was weeping so often I had to change them at home too. It was really awful. His dressings needed changing one day by me and then the next day at a clinic. He was just given antibiotics, but all they did was make him horrendously sick.”
The blister developed into an infection by the end of the month. Due to the amount of dead body tissue around his little toe, it had to be amputated in hospital.
Carol added: "I can remember a nurse coming to see us in hospital and she was so shocked at how bad it was and how bad it smelled. We were told there and then that it needed amputation, so he lost his little toe and part of his foot in the operation.
“Doctors pretty much suggested to us that due to Rob’s diabetes, he was always likely to have an amputation, but I think that’s rubbish. It’s all about appropriate management and treatment."
Carol said that her husband became a "shadow of himself" before dying of heart failure in November 2019. She said: “It all had a huge impact on him, and in fact, it did on us all as a family,
“It was hard after the amputation and he suffered a lot more infections. There were times when his foot was so bad you could see through to the bones. It caused him a lot of pain.
“I lost the man I fell in love with and married well before he died. Before his amputation he was so full of life and loved his work in security, but afterwards, I’d go to work and when I returned home he’d be sat in the dark not doing anything. He gave up on life to be honest, and that was very sad as we have six children who saw him go through this.
“He died in his sleep and that was such a shock to us all, but he’d said to me after all the stress of the amputation that I’d be left a young widow. I think it was all too much for him. It was heart-breaking for us as a family as he was in so much pain for so long.”
A case was led on behalf of Carol, stating that Rob should have referred to a specialist diabetic foot clinic. Shauna Page from Hudgell Solicitors, said: "Diabetics are much more likely to need an amputation than someone without the condition, but many can be avoidable if a wound is treated and monitored correctly. In this case we alleged negligence in that the failure to refer to a specialist clinic meant the blister was being treated without any swabs being taken to determine what kind of bacteria it was, which would have identified appropriate antibiotics.
“X-rays could also have been conducted to look for bone inflammation, and a vascular review should have been conducted to assess whether the blood supply to his feet was sufficient to help the wound heal. The decision not to refer to specialists removed all these possible investigations.”
Bridgewater Community Healthcare NHS Foundation Trust, which was responsible for the care provided, admitted breach of duty of care for not referring to specialists not only on Mr Pendlebury’s first assessment in March 2017, but also five other occasions where his condition was reviewed and treated.
Damages of more than £26,000 were agreed, but Carol added: “A million pounds wouldn’t be enough to compensate for losing my husband, or for how he suffered physically and mentally, but it was peace of mind for me in that I’d fought for him and they’d admitted their failings.
“I look back now and wish I’d fought more at the time for specialist review. I thought I was being insistent but I now regret not doing more. I’d advise anyone else who has an experience like this with a diabetic loved one to be strong-willed and insistent. Demand a second opinion and specialist reviews. Don’t be fobbed off like we were."
A Bridgewater Community Healthcare NHS Foundation Trust (BCHFT) spokesperson said: “On the very rare occasion when treatment falls below our usual high standards, it’s important we acknowledge this and learn from our mistakes.
“The Trust admitted a Breach of Duty of Care back in 2017 for the time it took to refer this patient to a specialist clinic.
“As part our own internal learning, steps were immediately taken to feed back to staff and offer further training to prevent something similar happening in the future.
“Regrettably cases involving legal representation will often take many months, or in this instance years to resolve. We sincerely apologise if this extended period of time has caused unnecessary distress to the Pendlebury family, and our thoughts remain with them.”
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