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The Facts
Patient suffers from neck pain and headaches
In early September 2008, a woman, who was then 43, began
suffering from neck pain and headaches. She consulted a
chiropractor, but the pain and headaches continued.
The woman consulted her GP due to worsening neck pain, severe
headaches and facial flushing. The GP advised her to continue with
chiropractic treatment and with the pain medication she was
currently taking.
Patient's symptoms worsen and condition continues to
decline
When the woman next consulted her GP six days later, the neck
pain and headaches had further worsened and she was also
complaining of dizziness and loss of strength in her left leg. The
GP referred her for a CT scan of the spine and prescribed
additional medication.
The following day, the woman was reviewed by her GP with the
results of the CT scan, which revealed five bulging discs in her
cervical spine. The GP advised the patient that her symptoms were
related to her spinal condition and advised bed rest for a
week.
During that time, the patient's symptoms significantly
deteriorated. When she was reviewed by her GP a further six days
later, she was referred to a local private hospital.
Diagnosis of cryptococcal meningitis and development of
catastrophic injuries
By the following day, the patient had developed alarming
symptoms, including neck swelling and profound deafness. Following
tests undertaken at the hospital that day, the patient was
diagnosed with cryptococcal meningitis, which caused her to suffer
a number of permanent disabilities, the most significant of which
were loss of hearing and blindness.
The patient sued her GP for negligence in not undertaking a
proper examination or making proper enquiries in relation to her
symptoms. The patient alleged that her GP should have referred her
for tests and treatment which would have led to an early diagnosis
of her illness and avoided the catastrophic injuries that she
suffered.
case a - The case for the patient
case b - The case for the doctor
I trusted the advice of my GP. She should have been able to
identify the symptoms of cryptococcal meningitis and sent me for
tests or referred me to a specialist by at least the third
consultation.
The GP did not conduct a physical examination of my neck in any
of the first three consultations. Had she done so, she would have
discovered that I could not bend my neck forward and touch my chin
to my chest. This is a symptom of cryptococcal meningitis, a
condition which is emphasised in clinical teaching for general
practitioners.
If I had been referred for tests or to a specialist by at least
the third consultation, I would have acted upon the referral
quickly and would have been treated in time to save my eyesight and
hearing.
I have lost my sight and hearing as a result of my GP's
failure to exercise reasonable care and skill. She should have
performed a physical examination of my neck at the second or third
consultation and she should have enquired about the headaches, neck
stiffness and facial flushing I had complained of previously.
The court should find my GP liable in negligence.
The patient's symptoms at the second and third
consultations were largely consistent with a pre-existing spinal
condition. She did not report that her symptoms had deteriorated or
that her neck pain was severe. She also did not say anything about
a headache, did not report flushing to the face and did not report
nausea or vomiting. The treatment that I provided was reasonable
based on the patient's symptoms as they presented.
Even if I had tested the patient's neck movement in all
directions during the physical examination prior to the last
consultation, it would not have revealed difficulty in movement
such as to require further investigation.
Had I referred the patient to a specialist prior to the last
consultation, it is unlikely that cryptococcal meningitis would
have been diagnosed and treated at that time so as to avoid the
catastrophic injuries that she suffered.
The treatment I provided accorded with the reasonable standard
of general practice. The chances of the patient suffering from
cryptococcal meningitis were only twenty in a million. It is
improbable that any GP would have referred the patient for tests or
to a specialist at an earlier time.
The court should find that I am not liable in negligence.
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