A tragic but defensible case

A mother brought her 18-month old son to see their GP. The child had a history of congenital heart defect. The mother reported that he had been suffering with a cough and runny nose for one week, and now also had a fever.

The doctor carried out a full examination, including removing all the child's clothes to check for rashes. The GP noted that he was alert and did not have a rash, and that his temperature was 38°C.

The GP identified a systolic murmur, which was in accordance with the paediatric cardiologist's recent letter. He recorded a pulse of 118bpm and noted that the child was not in respiratory distress, nor was he dehydrated. He prescribed amoxicillin and advised the mother to return immediately if her son's condition deteriorated, or within 48 hours if he did not improve.

Later that day, the mother took the child to the park. He was initially babbling and moving but then he suddenly became quiet and stopped moving. An ambulance was called and the child was taken straight to hospital. Sadly, despite cardiopulmonary resuscitation, he died.

The boy's mother brought a claim for clinical negligence against the GP. It was alleged that he failed to carry out an adequate assessment of the child and failed to diagnose pneumonia. It was also alleged that in light of the child's known cardiac history, the doctor should have had a low threshold for arranging an emergency hospital admission. Had the child been admitted, he would have received IV fluids, IV antibiotics and ventilation if necessary. On the balance of probabilities, it was alleged, the child would then have survived.

On the balance of probabilities, even if the GP had arranged for an emergency admission, the child's death could not have been prevented.

The MDU obtained expert evidence from a GP and a paediatric cardiologist.

The GP expert was supportive of the doctor's management in keeping a full and accurate contemporaneous note of the child's assessment. The expert also considered that it was reasonable for the doctor to treat the child with oral antibiotics and that he had provided good safety-netting advice.

The paediatric cardiology expert noted that the child had a complex congenital heart abnormality, for which corrective surgery would not have been possible. He was at high risk of dying from an acute pulmonary hypertensive crisis. On the balance of probabilities, even if the GP had arranged for an emergency admission, the child's death could not have been prevented.

A Letter of Response was drafted denying liability in full. The claim was discontinued.

Dr Grace Cheung
Senior medical claims handler

This page was correct at publication on 17/02/2016. 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.