Conflicting accounts

A patient claimed her GP should have diagnosed unstable angina. She suffered an ST-segment-elevation myocardial infarction nine days after her GP consultation.

The 35-year-old patient alleged she presented to her GP, an MDU member, with classic cardiac symptoms, including chest pain radiating to the jaw and face. She stated that she had experienced an episode of such pain at rest while in the waiting room just before the consultation.

The GP's account of the consultation differed substantially from the claimant's version of events. He denied that the claimant complained of breathlessness or other exertional symptoms. Rather, she reported fleeting aches and pains bilaterally which were worse at the end of the day. He considered that the patient's symptoms were likely to be attributable to stress. In addition to being left to cope with small children whilst her partner worked abroad, her younger sister, to whom she was close, had recently been badly injured in a road accident.

The doctor asserted that if he had been confronted with a classic presentation of ischaemic heart disease, including rest pain of apparent cardiac origin while in the waiting room, as alleged by the claimant, he would have arranged for urgent hospital admission.

The GP expert instructed by the claimant's solicitors was critical of the fact that the MDU member had conducted no physical examination and had inappropriately diagnosed the claimant's symptoms as stress-related. It was alleged that the claimant should have been referred to A&E immediately. The claimant sought to recover £550,000 in damages plus several hundred thousand pounds in legal costs.

The MDU obtained expert evidence from a GP who noted that the doctor's version of events was supported by the consultation notes, which made it clear that the claimant had been significantly stressed. He also noted that the claimant did not have a high absolute risk of cardiovascular disease. However, the amount of information recorded in the available medical records was insufficient for him to form an adequate view of whether the claimant did or did not merit emergency hospital admission.

It was the claimant's case that if she had been referred to A&E, troponins would have been positive and she would have undergone coronary angiography soon after admission. Had this taken place, an angiogram would have shown multi-vessel coronary artery disease for which she would have had an angioplasty and stent insertion.

By contrast, the independent cardiology expert commissioned by the MDU advised that if the claimant had been admitted to hospital on the day of the consultation, she would have been sent home again, since the history was atypical and because both ECG and blood troponin would have been normal. Her myocardial infarction nine days after the consultation therefore could not have been avoided.

After consultation between the member, the experts and a barrister, it was decided that the defence case was strong enough to take it to trial. We therefore rejected the claimant's solicitors' offer of settlement in the sum of £50,000 plus legal costs, made three months before trial. Just a month before the trial date, we offered to the claimant's solicitors that they would not have to pay the MDU's costs should they discontinue the claim prior to trial. This offer was accepted, and the case was discontinued.

Joe Schmid
Senior 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.