A self-employed haulier in his early fifties visited his GP with a history of pain in the left shoulder of sudden onset, left facial numbness, and left-sided weakness. The GP saw him again the next day and noted persisting left-sided weakness. Sensation returned two days later, and the patient was referred to a consultant physician.
Five weeks later, the patient was seen and examined by both an SHO and the consultant physician. Persisting left-sided weakness was recorded and, on the basis of the patient's history and findings, a diagnosis of a small cerebrovascular accident (CVA) was made. At follow-up one month later, the patient's symptoms had disappeared, and the physician confirmed the original diagnosis.
The patient was advised to inform the Licensing Authority about these events and, as a result, his Heavy Goods Vehicle Licence (HGV) was revoked. The patient applied for a reconsideration of the decision and, to support his application, he consulted the physician privately. A report was submitted confirming the original diagnosis, but emphasising that the patient was now entirely symptom-free. The patient's licence was not restored, with inevitable consequences for his business.
Over the next two years the patient continued to complain of intermittent shoulder pain, and was referred to another consultant physician. This time the patient gave a history of having fallen from a lorry while he was loading grain in the rain. He had slipped and landed on his left shoulder causing pain in his shoulder and numbness in his face and left arm. He denied that there had ever been any weakness in his left leg. The report from the second consultant was submitted to the Licensing Authority, but the patient's HGV Licence was not restored.
Nearly five years after the initial event, a third GP referred the patient to a consultant neurologist. Again the patient gave a history of falling from a lorry in the pouring rain, landing on his left shoulder and flexing his neck. On the basis of this history and a further examination, the neurologist concluded that the patient had not suffered a CVA, and eventually the patient's HGV Licence was restored.
The patient obtained legal aid and proceedings were issued, seven years after the initial event, against the first consultant physician (the MDU's member) and the hospital Trust. It was alleged that the consultant and the hospital had been negligent in diagnosing a CVA and the patient claimed, among other things, for his loss of earnings.
Expert advice was obtained from a consultant physician and a consultant neurologist, both of whom supported the initial diagnosis. The most significant discrepancy between the patient's and the consultant's case was the history of the fall. The patient saw his GP three times and the consultant twice before the diagnosis was made. Both the GP's and the hospital's notes were of a good standard. All three doctors involved were quite certain that they had never been given a history of a fall, which had been described in such detail at the subsequent referral nearly two years after the event.
The patient's statement included a description of the weather at the time of his fall, including a thunderstorm, heavy rain, and strong winds. This description was supported by a witness for the patient. It was decided to obtain advice from a meteorologist who confirmed that there was no appreciable rain in the relevant area on the day in question. Helpfully, there was a weather measuring station within 500m of the alleged incident. This evidence was disclosed to the patient, who obtained his own meteorological report. Though this did not differ materially from that obtained for our member, he did not withdraw his claim.
Less than a week before the trial was due to start, the patient's legal aid was withdrawn. As the patient did not formally discontinue his claim it was necessary to obtain judgment for the consultant and the Trust on the first day of the trial. Since the patient had legal aid until the very last moment it was impossible to recover the not insubstantial costs of our member's defence. The case was vigorously defended throughout by both the MDU and the hospital Trust concerned. Unusually, the turning point was meteorological rather than medical evidence.
This page was correct at publication on 15/04/2003. 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.