Dickinson v Newcastle upon Tyne Hospitals: Pabrinex failure causes Wernicke's encephalopathy and profound functional disorder, rules High Court

The High Court has found that a hospital trust's failure to administer prophylactic Pabrinex to a known alcoholic patient caused him to develop Wernicke's encephalopathy, which in turn triggered a severe and permanent functional neurological disorder leaving him largely bed-bound and requiring round-the-clock care.

In Liam Dickinson v Newcastle upon Tyne Hospitals NHS Foundation Trust [2026] EWHC 1574 (KB), Charles Bagot KC, sitting as a Deputy High Court Judge, entered judgement for the claimant on liability after a seven-day trial, awarding £185,000 for pain, suffering and loss of amenity and resolving the main disputed quantum issues in the claimant's favour.

Background

Mr Dickinson, now 47, was admitted to the defendant's Freeman Hospital in August 2016 for drainage of a facial abscess. He was a known alcoholic consuming up to 20 cans of lager daily and was appropriately prescribed chlordiazepoxide for alcohol withdrawal. Pabrinex, the intravenous Thiamine preparation mandated by NICE guidelines to prevent Wernicke's encephalopathy in alcohol-dependent patients, was also prescribed but the trust admitted that at most 1/30th of a single vial was administered and no further doses followed. This was accepted as a breach of duty.

Within days of discharge on 31 August 2016, Mr Dickinson became acutely confused and unable to walk in a straight line. His wife, Michelle Dickinson, sat up through the night researching his symptoms, discovered the link to Thiamine deficiency, and telephoned the ward where she was told Pabrinex had not been given. On 1 September, three successive clinicians at a different NHS hospital, from the most junior doctor to Consultant level, independently concluded that the only working diagnosis was Wernicke's encephalopathy. IV Pabrinex was commenced that evening.

Although the acute encephalopathy resolved relatively rapidly with treatment, the claimant deteriorated further over the following weeks, developing a severe functional neurological syndrome and functional cognitive disorder alongside major depression. He has not walked since and his prognosis is bleak.

Causation

The defendant denied that Wernicke's encephalopathy had occurred at all, contending that the claimant's functional symptoms pre-dated the index admission and that his deterioration reflected a coincidental or pre-existing condition exacerbated by accumulated life stressors. The judge rejected both arguments comprehensively.

Preferring the evidence of Dr Goulding, the claimant's neurologist, and Dr Achinivu, his neuropsychiatrist, over that of the defendant's experts, Bagot KC found on the balance of probabilities that the claimant had developed Wernicke's encephalopathy on or around 31 August, caused by Thiamine depletion flowing from his admitted heavy alcohol use, poor nutritional status during his wife's absence from the home in the weeks before admission, and the metabolic demands of surgery and alcohol withdrawal. The tribunal accepted that the condition responded rapidly to Pabrinex, in keeping with a mild presentation, and that functional neurological symptoms only emerged distinctly thereafter as the claimant became aware of the negligent failure and developed a significant psychological stressor that precipitated the disorder.

Expert evidence

The judgement contains pointed observations about the conduct of the defendant's experts. Dr Wills, the defendant's neurologist, was criticised for disclosing for the first time in his evidence-in-chief the existence of an audit he had carried out in his own hospital, and for introducing a new Thiamine storage calculation only in re-examination, after Dr Goulding could no longer be asked about it. The judge applied the principle from his own recent decision in Mew v The General Dental Council [2026] EWHC 1116 (Admin) that experts cannot consciously hold back relevant matters for oral evidence, and declined to place any weight on either the audit or the calculation.

Professor Carson, the defendant's neuropsychiatrist, attracted criticism for factual errors in his report, including misidentifying events as an "accident", recording the wrong age, and apparently attributing to the claimant facts that belonged to his wife. When confronted with the phrase "foredge waste" in his own report, he replied that he had no idea what it meant, a response the judge described as giving "the impression of loftiness" inconsistent with the rigour expected of expert witnesses.

Quantum

On the critical issue of future care, the judge rejected the defendant's case for a modest sessional care package and found that a 24-hour professional regime was reasonably required, given the claimant's profound physical and cognitive disability, unpredictable care needs and serious suicide risk. Life expectancy was agreed to be reduced to 63.5 years. The multiplicand for future care from Year 2 onwards was set at £248,843.40 per annum, with the form of award, whether lump sum or periodical payments, to be determined by the parties in consequential proceedings.

Henry Pitchers KC (instructed by Irwin Mitchell LLP) appeared for the claimant. Nadia Whittaker (instructed by Weightmans LLP) appeared for the defendant.