Avoidable amputation in diabetics

The Office for Health Improvement and Disparities, has this month, published its National Diabetes Foot Care Report (National Diabetes Foot Care Report (phe.org.uk)).

Crucially, the report has identified that patients with diabetes make up 69% of the minor lower limb amputations in the UK between that time period, and 51% of all major lower limb amputations.

It has been estimated that of those numbers, 80% of foot amputations could be avoided with better care.

Diabetes UK chief executive Chris Askew said the latest figures were "incredibly concerning".

"The majority of these major amputations are preventable, but many people living with diabetes are struggling to access the care they need - and in areas of higher deprivation, people are experiencing worse outcomes. These inequalities must be addressed."

Key information from the report

During the three-year period of 2017/18 to 2019/20:

• There were 171,759 foot disease-related hospital admissions for patients with diabetes.
• 97,175 individual patients had a hospital admission for foot disease and 34% had more than one admission over the three years.
• There were 7,957 major amputations with a directly standardised rate of 8.1 major amputations per 10,000 population with diabetes per year.
• There were 21,738 minor amputations with a directly standardised rate of 22.1 minor amputations per 10,000 population with diabetes per year.
• Patients with diabetes that are male, from the most deprived areas, aged over 65 or of white ethnicity had greater risk of amputation.

Might I have a claim?

On review of this report, many diabetic patients who have suffered an amputation as a result of the development of a diabetic foot ulcer or foot problem may be left wondering whether they should be considering legal action.

In order to bring a clinical negligence claim for a diabetic foot problem, a clinical negligence solicitor will be considering the following things: -

1. Breach of Duty or ‘negligence’

In order to bring a claim, there has to be a demonstration of a failing of some sort in relation to the care provided by the relevant Health Practitioner. For example, the NICE Guidance for management of a diabetic foot conditions suggests that if the condition is life threatening, an urgent referral to acute services within 24 hours should occur. If it is not life-threatening, then a referral to the relevant diabetic foot protection service should occur within 1 working day, and triage within 1 further working day.

A patient should consider whether they received the appropriate referral at the time of raising their concerns.

2. Causation or ‘outcome’

It is not as simple as just suggesting that there has been some level of failing. It then has to be proved that the outcome would have differed with appropriate care.

For example, if a patient has suffered an amputation because of the progression of their infection, a legal team would have to investigate whether that amputation could have been avoided. If there was a relatively short time between the initial presentation of the symptoms, and the eventual amputation date, this may be more difficult to prove. However, if there was a longer period between the initial presentation of the symptoms and the amputation date, it may be that the infection would have been treatable with a course of IV antibiotics and avoided the need for amputation.