A GP visited an 81-year old patient who had stumbled in the street and injured his right ankle. The doctor noticed that although the patient was able to fully weight bear, there was mild pitting oedema of both ankles.
The patient reported that he had had gout in his right ankle in the past and that the injury was around 10 days old. He was already taking ibuprofen with no side effects and the doctor prescribed a further supply to help reduce swelling and pain.
The GP questioned whether the pain might be attributable to pre-existing gout or a sprain as a result of the fall. He recommended an x-ray but the patient refused.
A month later, the patient went to see the doctor again. The GP considered osteoarthritis and requested an x-ray. In the meantime, the patient suffered a heart attack and was admitted to hospital where it was noticed that his ankle was swollen. An x-ray was undertaken and the patient was referred to an orthopaedic surgeon.
The x-ray showed that he had an undisplaced fracture of the lateral malleolus. He continued to experience pain in his ankle and a further x-ray confirmed opening of the joint space medially. He was treated with a local anaesthetic injection into his ankle to combat the pain.
Some months later, the GP received notice of a claim alleging that he had failed to provide reasonable care and treatment. It was the claimant's case that the doctor had breached his duty of care by not following the Ottawa Ankle Rules. It was also alleged that there was a five-week delay in diagnosing the fracture, and that earlier diagnosis would have reduced the pain and suffering in the six to eight weeks after the injury.
In the meantime, the patient suffered a heart attack and was admitted to hospital where it was noticed that his ankle was swollen.
The MDU obtained a report on breach of duty from an independent GP expert. The expert noted that while there was a failure to diagnose the fractured lateral malleolus, they did not consider that the GP's care of the patient was negligent. The MDU expert was of the opinion that the claimant was a candidate for low trauma fracture, in light of pre-existing factors including his age and that he regularly smoked and consumed alcohol. However, as the injury was over one week old, the patient was fully weight bearing and the nature of the injury was the result of only a stumble, the expert found it reasonable that the doctor should have diagnosed a sprain or gout, and that the likelihood of fracture was low. The expert also pointed out that the GP had offered to arrange an x-ray, which the patient had declined.
Regarding the second consultation, when the GP reconsidered the diagnosis from gout to include underlying osteoarthritis, the independent expert stated that this was reasonable. In his opinion, it would be most unusual for an attack of gout to last four weeks, whereas osteoarthritis classically causes chronic pain.
Based on these findings, the MDU denied liability on behalf of the MDU member. The claim was subsequently discontinued.
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.