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.

So, which case won?

Cast your judgment below to find out

Phil Griffin
Medical negligence
Stacks Law Firm

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