An 80-year old woman rang the GP out of hours service stating that she had diarrhoea and vomiting.
She was the main carer for her husband who suffered from dementia. She had previously been diagnosed with type 2 diabetes, polymyalgia rheumatica, for which she was taking prednisolone, and had a past history of a myocardial infarction. An out of hours doctor rang back and advised her to take lots of clear fluids and to call back if she became worse.
She called back that evening and spoke to the MDU member, also an out of hours GP. The service was under great strain as there was a widespread outbreak of norovirus. The patient told him that her diarrhoea and vomiting were worse, with very profuse diarrhoea, and that she was feeling very tired. The GP advised her to continue to take frequent small sips of water and to phone back if she was not better by morning.
The GP phoned in the morning to check on her, but there was no answer. The following day the patient's son rang his mother and was alarmed as she seemed very unwell. He called an ambulance. The paramedics found that the patient was cyanosed with a GCS of 9 and a blood pressure of 80/45. Her temperature was 40°C. She was admitted to intensive care and ventilated.
Campylobacter was isolated from her stool sample. She deteriorated and died ten days later.
All clinicians need to be alert to the difficulties which can arise when working under stress.
A claim was received. This alleged that the patient should have been admitted after the first telephone call and that she would have made a full recovery after admission at that time. Since her death, her husband had been admitted to a nursing home and the family was claiming the costs of nursing home fees as well as a payment for the patient's pain and suffering.
An independent GP expert report stated that the MDU member should have asked the patient more questions. If he had realised that she was a diabetic and taking steroids, then he should have arranged to see her or for another doctor to visit her at home. In retrospect, the member accepted that his judgment had been affected by the fact that there was a norovirus outbreak. The member had experienced considerable pressure at the out of hours service to avoid visits whenever possible.
The MDU also asked a geriatrician to comment on the claim. This expert agreed with the claimant that the patient would probably have lived had she been admitted 48 hours earlier. However, the expert noted her very poor health, and observed that it was highly unlikely that she would have been able to look after her husband for much longer. After a period of negotiation, the claim was settled for 10% of the sum originally claimed.
The MDU member was very distressed by this case. He was a highly experienced GP. He agreed that the pressures caused by the norovirus outbreak had caused him to be hurried when speaking to this patient. All clinicians need to be alert to the difficulties which can arise when working under stress
Dr Frances Szekely
Senior medical claims handler
This page was correct at publication on 04/12/2013. 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.