A cyst that was not a cyst

A 45-year old obese architect presented to her GP in 2003 with a pain behind her right knee. The GP, an MDU member, found a swelling though no calf pain or tenderness and the patient had a normal range of movement. The GP diagnosed a Baker’s cyst and arranged an x-ray, which revealed no abnormality.

Some three years later the patient attended hospital as an acute emergency with severe leg pain. She was diagnosised with a thrombosed popliteal aneurysm and underwent an above-knee amputation.

In her claim for negligence, brought two years after the amputation, the patient alleged that the GP’s original misdiagnosis had denied her the opportunity to have an elective procedure to treat the aneurysm. Had the correct treatment taken place, she alleged, she would have avoided the need for the amputation, as a result of which she had chronic pain, poor mobility and was mostly wheelchair bound.

Compensation claimed was in the region of £1million, primarily for future loss of earnings, prosthetics, accommodation, adaptations and future care.

The MDU obtained an opinion from a general practitioner expert who was initially supportive of the member’s actions, saying that the diagnosis of a Baker’s cyst was in accordance with reasonable practice. The patient was known to have degenerative arthritis and was difficult to examine because of the level of her obesity.

The expert considered that the GP’s description of his examination technique was appropriate and advised that whether the claim could be defended was entirely dependent on the size of the popliteal aneurysm at the time of the initial consultation.

An expert opinion from a vascular surgeon confirmed that, on the balance of probability, the aneurysm was likely to have been present at the time of the GP’s assessment.

Extrapolating back, the aneurysm would have been of a sufficient size for it to be palpated and would have been pulsatile. The expert advised that had the patient been referred at that time and operated on, there was an excellent chance of a good outcome.

The case was considered at a consultation with a barrister, the GP and the experts. It was the barrister’s opinion that there was a significant risk that if the case were to proceed to trial the judge would find against the GP.

The GP agreed that the case should be settled. After negotiation, the claimant agreed to accept an offer of £300,000.

The MDU also paid a further £120,000 in legal costs.

This page was correct at publication on 01/08/2012. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.