Clinical negligence update, part one

In FB (by her Mother and Litigation Friend WAC) v (1) Sohail Rana (2) Princess Alexandra Hospital NHS Trust [2015] EWHC 1536 (Mr Justice Jay), the claimant failed to establish that a GP and a senior house officer (SHO) working in A&E had been negligent in failing to diagnose pneumococcal meningitis, which had led to significant brain damage.

On the facts, there had been insufficient clinical features (a high temperature, not eating properly, and a heat rash) based upon which the defendants should have suspected meningitis, and both the history taking and examination for each defendant had not been substandard, notwithstanding that the SHO had failed to elicit the history of eye rolling that had prompted the calling of the ambulance and the A&E attendance.

In another case involving an A&E doctor, Anthony Mulholland v Medway NHS Foundation Trust [2015] EWHC 268 (QB), the claimant (M) claimed for a three-month delay in the diagnosis and treatment of his brain tumour, asserting that an A&E doctor should have considered M as at risk of stroke, whereupon he would have been sent to a specialist stroke clinic, a CT scan would have diagnosed his tumour, and surgery would have followed. M initially had seen his GP, who felt his symptoms were of anxiety or cannabis use. The next day, M was readmitted and seen by the stroke team for his dizziness, blurred vision, and loss of arm control; they concluded he was not having a stroke and referred him on to A&E. The A&E doctor also considered his symptoms were due to cannabis use.

In finding for the defendant Trust, Mr Justice Green considered that the A&E doctor could not be criticised for relying on the prior opinions of a GP and specialist stroke team, since she was one part of a chain of decision making; further, the symptoms were confusing, possibly masked by cannabis use, and her decision was consistent with that of the stroke team. In any event, an A&E doctor's standard of care had to reflect the reality of what could reasonably be expected in a pressurised emergency department without ready access to leading experts or time to conduct research of their own.

In another case involving GP care, the claimant (M) succeeded against one of three defendant GPs in the case of McCabe v Moore and others [2015] EWHC 260 (QB), in which M had suffered a stroke caused by undiagnosed infective endocarditis. Sir Robert Nelson held that the third defendant (D3) had breached her duty of care by failing to ask M further questions having elicited a history of night sweats despite cessation of menopause, but issues of leg pain and renal colic elicited by the first and second defendants respectively had not required further questioning. Further questions by D3 would have resulted in referral to hospital within 24 hours and antibiotic treatment, which would have prevented M's stroke.

In Cooper (by her litigation friend, Julian Harrington) v Royal Berkshire NHS Foundation Trust [2015] EWHC 664 (QB), Mr Justice Jeremy Baker considered that the claimant was able to establish that the cause of her cardiac arrest and consequent hypoxic neurological damage had been a cerebral venous thrombosis (CVT) resultant upon the defendant's admitted breach of duty of a lack of consistent post-natal provision of heparin. Accordingly, the claimant succeeded in establishing liability.

David Pittaway QC, sitting as a judge of the High Court in Baker and others v Cambridgeshire and Peterborough NHS Foundation Trust [2015] EWHC 609 (QB), concluded that a specialist psychiatrist had not breached her duty of care in either her conduct of consultations with a man with bipolar affective disorder or by not referring him to community mental health services before he committed suicide: she had been entitled to conclude that there was insufficient evidence of suicidal intent and there were insufficient risk factors to mandate the involvement of the community mental health services, and she had not been in breach in deciding to discharge the deceased back to his GP. In any event, the claimants had failed to establish that the involvement of the mental health community services would have avoided the deceased's suicide.

The defendant succeeded in a case, Barnett v Medway NHS Foundation Trust [2015] EWHC 440 (QB), involving the rare condition of congenital hypophosphatasia, which was a cause of deficient bone mineralisation. The instant claim concerned the management of L5/S1 vertebral discitis with abscess formation and spinal infarction causing paraplegia at T7. While Brian C Forster QC, sitting as a High Court judge, considered that the defendant had failed to take blood cultures prior to giving antibiotics and should have monitored the claimant (B) more closely, B had failed to establish that the cultures would have been positive or that closer monitoring would have avoided the ultimate outcome.

In Richard Griffiths v Secretary of State for Health [2015] EWHC 1264 (QB), Mr Justice Turner considered that, but for significant manhandling that resulted from admitted serious errors by a paramedic in assuming that the claimant (G) had had a stroke when he had fallen down stairs at home and consequently in not immobilising his neck before moving him, G's spinal cord injury from the original fall would not have deteriorated as it in fact had done, such that the manhandling was indeed the cause of the deterioration in G's tetraplegia.

Jock's full clinical negligence update will be published next week in SJ 159/29.

To read the full update and to start your free Solicitors Journal two-week trial, visit www.solicitorsjournal.com/user/register.

Dr Jock Mackenzie is a partner and solicitor-advocate at Anthony Gold