Please click on the titles to read the following case reports:
H v S (A GP)
K v GP
C v Dr Jennifer Vernon: Failure to recognise diabetes in a 13 year old leading to coma, DVT and scalp pressure sore, compartment syndrome and foot drop
SH v B District Health Authority & Dr J: Failure to diagnose kidney stones leading to nephrectomy
TH v Dr G, Dr P and Dr C: Failure to diagnose kidney stones leading to nephrectomy
S v Dr C and Dr R
Missed Pneumococcal Septicaemia
Harris-v-Bottomley
Counselling/Psychotherapy by unqualified Practitioner – failure of supervision by Mental Health Services – Benzodiazepine misprescription
X v GP and Mental Health Trust
Mr H attended his GP complaining of a mole on his arm that was red and raised. His GP examined him and advised there was nothing to worry about. Over the course of the next 12 months Mr H saw his GP on 3 further occasions as the mole was becoming increasingly red and swollen and, indeed, by the last occasion it had started to bleed on occasions.
Eventually the GP decided to remove the mole and although he sent it away to the local hospital pathology laboratory for testing the GP told Mr H this was as a matter of course and he did not expect there to be anything sinister. However a week later the GP wrote to Mr H advising him that the laboratory had confirmed the mole was in fact a malignant melanoma (skin cancer).
Mr H had to go to hospital for further testing that revealed by this time the cancer had spread to his lymph nodes. Mr H required surgery to remove his lymph nodes under his arms followed by chemotherapy. The case was that if the GP had not delayed in either removing the mole or referring Mr H he would not have needed the lymph node surgery or the chemotherapy. Further, Mr H’s prospects of survival were now significantly reduced. Settlement of £75,000 agreed. This included a claim for “lost years” ie earnings that Mr H would now lose because of his shortened life expectancy.
Given the Claimant’s significantly reduced life expectancy the claim was settled as early as possible to enable him to have the benefit of the money.
This case was handled by Richard Coleman.
The plaintiff, a mother of three, born in 1962, first consulted the defendant GP in 1988, suffering from boils, weakness and lethargy. In 1989 she consulted him again with severe pre-menstrual pain, night sweats and wakefulness, and anxiety. In January 1990 she attended once more, complaining of a left-sided pain radiating across her stomach. No physical examination was carried our: the defendant simply administered a repeat prescription for painkillers.
The plaintiff's pain persisted throughout the next three years. During 1991 she lost weight and suffered from unusual fatigue. In 1993 she began to experience hot flushes and unexplained sweating. In early 1994 the pain in the plaintiff's side became more intrusive and she attended her GP again. Still no physical examination was carried out and the defendant prescribed medication on the basis of a diagnosis of sciatica.
Over the ensuing months the plaintiff consulted the defendant again on several occasions, continuing to complain of pain in her left side, but no further treatment was offered. By mid-1994 she had suffered further weight loss and fatigue, and in August 1994 attended a Well Woman clinic. This resulted in a letter to the defendant, advising him that a "very hard mass" had been felt on the left side of the abdomen and that a scan was thought to be necessary.
This case was handled by Gerry Ferguson. Please click here to read the full case report
Instead, over the next 24 hours, the Claimant’s condition gradually deteriorated and she became comatose.
Please click here for the full case report.
SH reported to his GP on 1st May 1990 that he was passing painless blood in his urine (after sport).
There was a further episode on 30th March 1991. The GP behaved appropriately and referred SH to the Urologists at RU Hospital on 2nd April 1991.
On 28th May 1991, the hospital carried out an Intravenous Pyelogram (IVP), which showed a stone in the left kidney.
Thereafter, the patient was lost to follow-up, which should have been arranged when the result of that IVP became known. Nothing was said to the Claimant or to his GP by the urology team at the RU Hospital, and the patient continued to suffer pain and discomfort from his kidney.
Following that procedure, he underwent a nephrostomy and these procedures caused him a lot of pain. Then, fortunately, he managed to avoid an open operation, because it turned out that the stone was able to be fragmented by extracorporeal shock wave lithotripsy.
The Claimant claimed for the unnecessary pain and suffering that he had to suffer from the middle of 1991 and for the extra and more complex procedures that he had to undergo as a result of the stone having passed into the ureter.
Please click here to view the full case report.TH v Dr G, Dr P and Dr C: Failure to diagnose kidney stones leading to Nephrectomy
Background
In about May 1987, H developed some pain in her right loin area, it was a constant throb. She kept moving around to try and alleviate the pain, but to no avail. The attack lasted several hours; it faded away, and the next day, H didn’t feel too bad. She went to see her GP at FP Health Centre and was told she had a urine infection, which was treated.
This was the first episode of many right loin pain episodes and urinary tract infections between 1987 and 1992.
On 21st May 1992, H was referred to RU Hospital where radiology of kidneys, ureter and bladder, on 1st June 1992, showed a large staghorn calculus in the right kidney, and probably calculus in the left lower renal pole.
H continued to have right flank pain continually for 2 months, and thereafter suffered intermittent episodes of pain until in February 1993 she was admitted to RU Hospital for surgery, but because she had not had a proper history taken, the hospital did not realise she was on a contraceptive depot, and the operation had to be postponed. During March 1993, she was in uncontrolled pain, so that eventually she had to be admitted to hospital and given Diamorphine.
A right Nephrectomy took place on 22nd March 1993. H developed a wound infection, which was treated appropriately, and she required a blood transfusion.
This case was handled by Gerry Ferguson. Please click here to view the full case report.
S v Dr C and Dr R
On 30 November 1998 the deceased attended her GP Surgery with a 4 day history of headaches and dizzy spells. She returned to the surgery on 16 October 2000 and it was noted she had a rare type of migraine. No further investigations were instigated.
On 11 January, and 19 February 2001, the deceased made further visits to the Surgery complaining of persistent headaches and dizzy spells and explained that she had also passed out on 3 occasions and the medication was not helping.
On 26 February and 19 March 2001, the deceased was reviewed by her GP and prescribed Ibuprofen as the headaches continued. She did not seek further medical advice until 11 November 2002 as a result of a 5 day history of pain in her forehead. She was prescribed a further course of Ibuprofen and advised to return in the event of deterioration.
The deceased returned on 18 November 2002 and was told that analgesia failed to help. She was advised to use a relaxation tape and return in 10 days for review. It was noted that if there was no improvement, a paediatric referral should be considered. On 28 November she returned and said that the relaxation tape had been of little help. She was advised to take paracetamol as well as Ibuprofen and return the following week.
On 2 December 2002 the Claimant telephoned the surgery to report that the deceased had been unwell. The deceased was then referred to the Paediatric team at the Hospital. On 3 February 2003 she was assessed by a Consultant Paediatrician who could find no evidence to suggest raised intracranial pressure or any other significant pathology. She was reviewed on 17 March and neurological examination confirmed no abnormalities. She was diagnosed with a migraine and advised to return in 6 weeks for review.
On 21 April 2003 the deceased became suddenly unwell. She was admitted to hospital but died despite emergency attempts to resuscitate her.
The post mortem concluded cause of death was a haemorrhage into a vascular malformation of the cerebellum.
The Claimant alleged that the Defendant had failed to investigate the deceased’s symptoms and failed to refer her to a paediatrician or request a CT scan or other investigation within a reasonable time. The claimant argued earlier prognosis and treatment would have prevented the death of the deceased.
Court proceedings were issued and expert reports obtained. It was the opinion of experts that the deceased should have been referred earlier and that the referral would have led to a CT scan which would have shown an abnormality. This would then have been treated and protection against a haemorrhage achieved. The Defendant denied liability and maintained that management had been reasonable.
The Claimant was awarded damages in the sum of £12,218.32 in full and final settlement of her claim.
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Mr C, aged 37, consulted his doctor with a 36 hour history of vomiting, diarrhoea, fever and general malaise. He was diagnosed has suffering from gastroenteritis.
Just three hours later, Mr C ‘s condition deteriorated and he was admitted to the local hospital's accident and emergency unit where he received rehydration therapy.
Later clinicians became aware that Mr C was suffering a condition known as haemophilus influenzae septicaemia, however, by this stage Mr C was suffering from multi-organ failure and died shortly afterwards in intensive care.
We pursued a claim in negligence against Mr C's GPs on the following ground:
Several years previously Mr C had been stabbed at a football match and consequently received an emergency splenectomy. Mr C's GPs had negligently failed to advise Mr C that splenectomy patients require immunisation against haemophilus influenza type B.
Liability was found to lie with Mr C's GPs for failure to immunise and the claim was settled for £327,500.
This case was handled by Simon Elliman , a Partner in our Bath office.
Missed Pneumococcal Septicaemia
Harris-v-Bottomley
The Plaintiff, a 45 year old man, pursued a claim for damages for medical negligence against the Defendants General Practitioner claiming negligent treatment on the 21st June 1992.
On 20th June 1992, the Plaintiff became ill. On Sunday 21st June 1992, the Defendant acting as a locum for the Plaintiff’s General Practitioner twice visited the Plaintiff’s home, once in the afternoon and again at midnight.
It was alleged that the Defendant twice failed to diagnose that the Plaintiff was profoundly ill, believing instead that he was suffering from a viral infection.
The Plaintiff’s girlfriend asserted that she had explained the nature of the Plaintiff’s symptoms to the General Practitioner and in essence there was a dispute of fact as to the extent of the physical examination that took place on both occasions and the nature of the symptoms displayed by the Plaintiff.
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Counselling/Psychotherapy by unqualified Practitioner – failure of supervision by Mental Health Services – Benzodiazepine misprescription
X v GP and Mental Health Trust
X sought assistance from her General Practitioner following bereavement. In 1989, Mental Health Services were unable to offer support, because of lack of resources, and so a regime was agreed whereby the patient would be offered informal counselling by the General Practitioner, supposedly under the supervision of a Psychotherapist from the Mental Healthcare Trust.
Because the General Practitioner had had no formal training, nor experience of counselling, he carried out no adequate initial assessment, and embarked upon a wide-ranging and damaging treatment regime, under the fond impression that he was providing a useful service until formal psychotherapy could be put in place by the Mental Healthcare Trust.
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