Delayed referral

The scene

A patient who was scheduled to undergo a left inguinal hernia repair had her operation cancelled because of a suspected heart murmur. The patient's GP, an MDU member, was advised by the hospital that the patient had been referred to cardiology, but in fact no referral had been made.

The GP saw the patient the following week and they discussed the significance of the finding, with the patient agreeing to contact the GP if she didn't receive an appointment from the cardiology department within two weeks. The GP also gave her smoking cessation advice.

Several months later the patient contacted the GP about urgent and unrelated family problems, and her heart murmur was not considered or discussed at this consultation.

Five years later the patient presented with a cough associated with shortness of breath. She was given antibiotics and referred for an echo, but two weeks later her condition had not improved and arrangements were made for a chest X-ray and ECG followed by review. The X-ray was reported as abnormal, and the other investigations were outstanding.

The patient was assessed by the GP, who made arrangements for an urgent hospital review, but sadly the patient died two days later, with an autopsy confirming severe aortic stenosis.

The claim

The patient's family brought a claim, criticising both the initial hospital arrangements, and the GP for failing to follow up at the later consultation on whether the cardiology appointment had taken place. The claimants argued that with an earlier referral to cardiology, the ECG and echo would have shown evidence of aortic stenosis and the patient would have been referred for aortic valve replacement well before her death, resulting in her living many years longer.

Responding on behalf of the member, the MDU obtained GP expert advice which was supportive of the member's care, particularly given that the focus of the later appointment was in relation to urgent, unrelated family problems. The GP expert advised it was entirely reasonable for the member to focus on that matter.

The MDU denied liability while the trust admitted breach of duty at an early stage. The claim progressed and the claimant's solicitor issued proceedings. The MDU maintained the denial of breach of duty but accepted that a referral around the time of the later consultation would have meant the patient would have been kept under surveillance, and would therefore have undergone an aortic valve replacement, with the associated greater life expectancy.

The trust eventually agreed to settle the claim, with no contribution being sought from the GP.

Comment

While an earlier diagnosis of the aortic stenosis may have affected the patient's outcome, this claim was defended as the MDU's expert evidence supported the actions our GP member had taken. Ultimately, both the patient's family and the trust agreed that the MDU would not be asked to contribute.

This guidance was correct at publication 10/07/2019. It 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.

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