Plampin v Havering NHS Primary Care Trust

Whether an artificial limb is functionally too long is determined by dynamic, patient-specific assessment, rather than by comparison with a predetermined measurement or theoretical standard. The assessment requires consideration of the wearer’s experience and gait together with relevant factors including socket fit, suspension and alignment. Where the patient and experienced prosthetist are satisfied after dynamic assessment, and the contemporaneous records support that conclusion, a later difference in static measurements does not establish that the limb was negligently supplied or created a foreseeable risk of injury. A negligence claim dependent on proving that the limb was functionally too long will fail if that foundational fact is not established.

Mrs Christine Plampin, as executrix of her deceased husband’s estate, brought a claim under the Law Reform (Miscellaneous Provisions) Act 1934 against the NHS Trust responsible for supplying and fitting his artificial legs. She alleged that a prosthesis supplied in 1995 was excessively long, created a foreseeable risk of injury and caused Mr Plampin to fall from a ladder in September 2000.

The claim was confined to liability. The principal issues were whether the prosthesis was functionally too long and, if so, whether its excessive length caused or contributed to the fall. Mr Plampin subsequently died from an unrelated ruptured aortic aneurysm.

1. Functional length. The relevant question was whether the prosthesis was functionally too long so as to create a foreseeable risk of injury. That question was not determined by a predetermined engineering or static measurement. The appropriate assessment was dynamic and interactive, involving the patient and prosthetist.
2. Relevant assessment. The assessment included socket fit, suspension, alignment, the wearer’s feedback and the wearer’s gait. A material discrepancy would ordinarily be apparent to the prosthetist and would soon become apparent to an experienced wearer. Minor variations in sock use and cuff tightness could also affect static comparisons.
3. Application. The contemporaneous records showed that Mr Plampin regularly used the 1995 prosthesis, made no significant complaint about its functionality and underwent satisfactory dynamic assessments in 1995 and 1998. The later shortening of the prosthesis during rehabilitation followed neurological injury and did not establish that it had previously been too long.
4. Disposition. The court found that the prosthesis had been functionally satisfactory and appropriately sized until Mr Plampin resumed walking after the accident. The essential allegation of negligence therefore failed. It was unnecessary to determine precisely how the fall occurred. The action was dismissed.

First-instance decision. No prior or subsequent appellate history is stated in the judgment.