Delay in diagnosis of spinal abscess

Medical history

A 49-year-old man had a history of cellulitis of the legs and feet associated with arterial insufficiency. In the past he had had several toes amputated.

After a year without any particular problems the patient presented to his GP with a raised temperature, generalised lassitude, headache and cough. Knowing the patient's history the GP specifically looked for evidence of cellulitis in the patient's legs and feet but found nothing abnormal. As the other examinations were normal, the GP made a diagnosis of non-specific viral infection and treated the patient symptomatically.

The patient reattended two days later. His 'flu' symptoms were improved but he now complained of severe pain in the right shoulder and back. This was worse when breathing in and out and there was also some shortness of breath. Again, there were no abnormalities in the chest, though the upper thoracic spine was. tender on palpation. Being uncertain about the diagnosis, the GP prescribed an analgesic and asked the patient to come back the next day.

At this visit the pain remained the same, but the patient then complained of weakness in the right arm, which the GP could not confirm on neurological examination. Because of the patient's history, however, he felt there might be a 'root' element to the pain and arranged for an x-ray.

After another day, the patient reported numbness in the legs as well, but a deputising doctor who visited at 5am presumed a lumbar disc lesion was responsible. He told the patient to call his own GP during the day. By the afternoon, there was increasing paraesthesia and weakness in the legs, and urinary incontinence. The patient was admitted to hospital where he had a cervical laminectomy as part of treatment for an extra-dural spinal abscess - thought to have stemmed from chronic sepsis in the feet.

The claim

A claim followed some three years later, the basis being that the patient's referral for hospital admission should have taken place earlier.

Expert opinion

The MDU sought independent expert advice on the GP's behalf:

'The GP is a competent and conscientious doctor...the patient presented with the type of condition that GPs see most days of the year...he was correct in not giving an antibiotic without making a definite diagnosis...this unfortunate man had a very rare condition develop in an atypical way...the GP cannot accept blame...he acted in keeping with good medical practice throughout.'

The patient's solicitors were not convinced. Their experts were divided about whether the patient should have been admitted to hospital earlier, and if he had been, whether that would have had any bearing on his illness and its consequences. The patient's claim was not withdrawn until five years after the clinical events.

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