DVT in a post-operative patient

The scene

A woman in her 70s underwent a total right hip replacement, and was discharged two days after surgery with surgical stockings and a prescription for rivaroxaban.

Six days later the patient requested a home visit from her GP, an MDU member, complaining that her leg was hot, bruised and sore.

At the visit the GP found that the entire leg was swollen but not hot, red or tender. She compared the patient's legs but did not take circumferential measurements.

She made a note in the records of mild post-operative oedema in the upper and lower right leg, but believed there was no sign of a deep vein thrombosis (DVT) and that the symptoms were consistent with post-operative recovery.

Around a month later the patient collapsed while out walking and was taken to hospital, where she sadly died. The cause of death was given as a pulmonary thromboembolism caused by a DVT.

The claim

The patient's widower bought a claim on behalf of his deceased wife. The letter of claim alleged that the member's examination hadn't been adequate, and that if the patient had been appropriately managed she would have been referred, the DVT would have been successfully treated and the death avoided.

A GP expert gave a report saying that if the MDU member's version of events was accepted, he would be supportive of the examination undertaken and the advice provided. However, he also noted that the clinical records were very brief and didn't include all the information needed to support the member's account.

A report from a haematologist confirmed that had the patient been referred, it was more likely than not that the DVT would have been detected and treatment started, which would probably have prevented the death.

The response

The MDU's letter of response denied liability on the basis of the GP's account of events, but the claimant's solicitors didn't accept this and issued court proceedings.

The MDU met with the member to discuss the vulnerabilities in the case – notably the brevity of the clinical notes – and served a defence, seeking advice from a barrister before the exchange of any expert evidence. A decision to settle the case was made on the basis of the clear vulnerabilities, and an offer was made to the claimant's solicitors. The claim was settled for £40,000 without any admissions being made, as well as nearly £30,000 in legal costs.

Learning points

This was an unfortunate case where the member was confident that she had assessed the patient properly and given the right advice, but the brevity of the notes meant that it couldn't be defended further.

Record keeping is extremely important, and while the time pressures put on clinicians can be restrictive, doctors can help to protect themselves by writing as full a note as possible, including positive or negative findings and follow up advice.

This guidance was correct at publication 14/03/2017. 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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