CASE FILES CLAIM SUDDEN DECLINE


BACKGROUND Mr P is a 43-year-old father of two children – slightly overweight but otherwise in good health. Just after Christmas he complains to his wife that he feels “off” and must be coming down with something. Over the next few days he develops a sore throat with a cough and fever. His condition grows worse and Mrs P phones her local GP surgery. A receptionist says a GP will phone back


and later that afternoon Dr J rings and speaks with Mr P regarding his symptoms. The GP tells Mr P that he is likely suffering from an upper respiratory tract infection (URTI) and that it should clear up soon. He advises him to take paracetamol and come into the surgery if there is any concern. Later that night Mrs P phones an


out-of-hours service and reports that her husband is “burning up” and having trouble breathing. A locum Dr K attends the patient at home and notes some tightness in the chest, pharyngitis and mild wheezing. The patient is found to be “warm” but no vital signs are recorded. The diagnosis is viral URTI with a slight wheeze and Dr K advises Mr P to see his regular GP if the symptoms do not improve. The next day Mr P’s condition further


deteriorates and his wife calls for an ambulance. He is breathless and panicky with a tight chest and tachycardia. A senior registrar in A&E examines the patient and takes his vitals. He notes decreased breath sounds on auscultation and a chest X-ray confirms parapneumonic pleural effusion. Mr P is commenced on intravenous


16 / MDDUS INSIGHT / Q1 2018


antibiotics but his condition further deteriorates overnight. He is transferred to the intensive care unit and an echocardiogram reveals severely impaired left and right ventricular function. A few hours later Mr P suffers cardiac arrest and dies. A post mortem records the cause of death as multi-organ failure, sepsis and bilateral lower lobe pneumonia and pleurisy. Solicitors acting on behalf of Mrs P issue


letters of claim for clinical negligence against both GPs involved in her husband’s care.


ANALYSIS/OUTCOME It is alleged that Dr J breached his duty of care to Mr P by failing to make a home visit or urge the patient to attend the surgery for an examination – in which case the seriousness of his condition would have been recognised and appropriate antibiotic therapy prescribed, preventing his sudden deterioration. The locum Dr K is accused of failing to carry out an adequate examination. No vitals were recorded (BP, pulse, temperature, respiratory rate, capillary refill time). It is further alleged that


KEY POINTS ●Be aware of the limitations in telephone or online consultations. ● Take and record vital signs as part of routine assessment. ●Ensure adequate safety netting in patients with acute illness.


he failed to prescribe appropriate medication (antibiotics) and urgently refer. MDDUS instructs a primary care expert


to offer an opinion on the alleged breach of duty. She concludes that Dr J’s management approach was reasonable given the reported symptoms and high seasonal prevalence of URTI. Dr K might be criticised for not recording vital signs but given that the patient looked well and at that point was suffering only from a sore throat and a mild wheeze – a reasonable body of general practitioners might have taken the same approach. In regard to Dr K’s failure to prescribe an


antibiotic she does not find this unreasonable given the obvious symptoms of viral URTI and considering the general advice to doctors to be sparing in the use of antibiotics. A referral to hospital at this stage would not have been warranted nor would Mr P have likely been admitted. Her overall view is that such a sudden


progression to severe sepsis is rare and not something either GP could have predicted. A respiratory physician is also instructed


to comment on causation (consequences of the alleged breach). He concludes that had an antibiotic been administered on the first day Mr P spoke to his GP it is more likely than not the patient would have survived – but he agrees that such treatment would not have been indicated at this stage nor would referral to hospital. A letter of response is drafted denying


clinical negligence. MDDUS later receives notice the case has been discontinued.


These case summaries are based on MDDUS files and are published here to highlight common pitfalls and encourage proactive risk management and best practice. Details have been changed to maintain confidentiality.


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