Eastwoods Successfully Defends GP Surgery
May 23, 2019
Stephen Hooper, who instructed Clare Hennessy of Serjeants’ Inn Chambers (jointly-instructed by Hannah Eccles of DAC Beachcroft), has successfully defended a claim for clinical negligence against a GP Surgery. Two individual GPs and the Surgery as a whole stood accused of failing to diagnose and treat Deep Vein Thrombosis (DVT) in a 76-year-old patient who later went on to die of a Pulmonary Embolism, but it was concluded at trial this week that the treatment provided was of a reasonable standard, and that there was no failure to diagnose DVT.
The case went to trial at Central London County Court before HHJ Baucher, who delivered her Judgment earlier this week. The allegations related to treatment provided in February 2014, by two GPs and a nurse practitioner employed by the Surgery, who saw the patient after her daughter raised concerns about the condition of her legs, which appeared swollen, red and hot to the touch. on 18 February 2014 the nurse practitioner attended a home visit with the patient, who was well-known to her as she had a longstanding history of diabetes and Chronic Obstructive Pulmonary Disease (COPD) and therefore had regular nurse-led reviews. After history-taking and examination, the nurse practitioner diagnosed cellulitis and requested a prescription for antibiotics. Eight days later, the patient was seen by a GP at the surgery, who took a history, examined the legs (carrying out specific tests aimed at ruling out DVT in the process) and maintained the diagnosis of cellulitis, concluding that there were no clinical indications that a DVT was present. A further prescription for antibiotics was issued and the patient was requested to come back for a review the following week, but did not do so. On 27 March 2014, the patient’s daughter attended her at home and discovered her to be acutely unwell. She was admitted to hospital, where she was diagnosed with a pulmonary embolism and died two days later.
The case was pursued on the basis that (a) it was inappropriate for the surgery to have allowed a nurse practitioner to attend the initial consultation with the patient instead of a GP; (b) the signs and symptoms presented by the patient should have given sufficient reason to suspect and/or diagnose the presence of DVT; (c) that in accordance with the relevant NICE guidelines, the patient should have been referred to hospital for D-Dimer testing which would have confirmed the presence of a DVT; and (d) that had the DVT been diagnosed and treated at that time, the patient would not have gone on to suffer a Pulmonary Embolism and would have survived.
Following three days of evidence at Central London County Court, the Judge concluded that it was appropriate for the nurse practitioner to have conducted the initial home visit, that her history-taking and examination were competently-performed and that it was reasonable to have ruled out DVT and diagnosed cellulitis. The Judge reached the same conclusions in respect of the consultation with the GP eight days later, and having considered expert evidence from experienced vascular surgeons at trial, found on the balance of probabilities that the patient did not in fact have a DVT at the time of the consultations in February 2014. The Judge therefore concluded not only that the actions of the nurse practitioner and GPs were of an acceptable standard; she also considered that their diagnosis of cellulitis was correct, and that although the patient did die of a Pulmonary Embolism, that resulted from a DVT which developed sometime later.
It is rare for clinical negligence cases to be taken all the way to trial (most are either abandoned by the Claimant or settled by the Defendant), but this case highlights that there are cases which quite rightly should be contested. Eastwoods always has in mind not only the cost of proceedings (which is always a factor, given that costs often outweigh the amount being sought in compensation), but the need to protect our clients’ reputations and fight their corner when they have a stout defence.