Growing pains

A 13-year old boy was brought to see his GP, an MDU member, with a history of left hip and thigh pain on weight bearing. On examination, there was some pain on external rotation. The doctor, who was the second of three GPs at the practice to examine the child, diagnosed ’growing pains’ and prescribed analgesia, advising the patient to come back for review if the symptoms did not settle.

A month later the patient returned with the same complaint. His father pointed out his son’s abnormal gait but on examination the GP detected no abnormalities. The patient returned again several weeks later, still complaining of hip pain. On this occasion, the GP found the boy had a stiff gait and reduced internal rotation and referred him for physiotherapy.

Two weeks later, the boy’s parents took him to A&E and, following an examination and x-rays, it was established that he had a severe slipped upper femoral epiphysis (SUFE). He underwent traction followed by a femoral osteotomy.

Three years post-surgery, the patient’s parents brought a claim against the GP alleging that she had negligently failed to identify the cause of the patient’s problems and refer him to hospital. As a result of the delay in diagnosis, it was alleged that the patient had a massive slip which resulted in the need for traction and osteotomy, and that he would have an increased risk of early onset osteoarthritis.

The MDU obtained an expert opinion from a general practitioner. The expert supported the care provided at the first consultation: it was the patient’s first presentation with hip pain and the advice to return if it didn’t settle was correct. However, the expert advised that x-rays should have been arranged at the time of the second and third consultations in view of the patient’s persisting symptoms. This was particularly the case in relation to the third consultation as there were physical findings. It was the expert’s view that the GP was in breach of her duty of care for failing to investigate the patient further.

An expert orthopaedic surgeon considered that an acute on chronic unstable slip was developing from the time of the first consultation and by the time of the second consultation there would have been apparent abnormality. If x-rays had been taken at the time of any of the consultations, the diagnosis would have been made and the patient would have required less interventional surgery. He observed that the patient now had a shortening of the left leg. Had surgery taken place at an earlier stage, a simple screw fixation might have avoided this.

In view of the expert opinions, the MDU member agreed that the case should be settled. The claimant’s solicitors initially claimed damages of £300,000, which included future loss of earnings to reflect the boy’s disadvantage in the labour market.

The MDU argued that the patient would have required some treatment in any event and would have required a hip replacement in the future, albeit at a later stage.

As the patient was young he would be able to carry out some type of work and would only require a small amount of care.

The MDU offered £75,000, to reflect pain and suffering for the initial events, along with a more extensive operation and the need for an earlier hip replacement. This offer was accepted after further negotiations.

This page was correct at publication on 01/08/2012. 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.