A GP registrar with some experience in tropical medicine was asked to visit a 39-year-old man who had recently returned from Ghana. The patient had a history of three days of vomiting and headache and looked '...moderately ill...' The doctor established that malaria prophylaxis had at best been irregular, and that the patient did not know exactly what drug he had taken. There was, however , no abnormality on clinical examination, and in particular no fever. As it was Saturday morning, there would have been some difficulty in getting blood films examined. The doctor therefore wrote '...viral infection; if not settling, think of malaria...' on the patient's record card for the benefit of any doctor who might have to see him again.
A day later, the GP registrar's principal was asked to revisit because the patient was '...very yellow...' and had black urine. On examination the patient was found to be significantly jaundiced, and his liver was enlarged to 5 cm below the costal margin. The principal elicited the information about the recent trip to Ghana, but he did not ask and was not told about malaria prophylaxis. Nor did he consult the clinical record made the previous day. Instead, he made a diagnosis of infectious hepatitis and advised that the patient would be better nursed at home rather than in hospital.
Three hours later the patient's wife rang again because her husband was worse, more feverish, with erratic breathing and had a blood spot on the sole of his foot. The principal did not revisit, but another doctor had to do so within a further five hours. The patient was by then moribund and died in hospital shortly after admission. The final diagnosis was falciparum malaria, 'black water fever'.
Complaint and claim
The family of the dead man complained to the local family health service authority (FHSA) and a service committee found the GP principal in breach of his terms of service for two reasons: his failure to admit a seriously-ill patient to hospital at the time of his visit on the Sunday morning, and his failure to revisit later in the day. The doctor appealed to the secretary of state but the appeal was dismissed: 'The doctor's failure to exclude the possibility of malaria, knowing that the patient had recently been in a malaria endemic area, was not consistent with the standard required from him as a general medical practitioner... he had not put himself in a position to reach a reasonable clinical judgement.'
A High Court claim followed, on behalf of the widow and two infant dependants. Settlement was negotiated for £155,000 (70 per cent by the MDU on behalf of the principal; 30 per cent by another defence organisation on behalf of the the GP registrar).
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