A woman developed diabetes at the age of 53, and was controlled thereafter on oral hypoglycaemic agents. She was looked after primarily by her GP, but with occasional attendances at the local hospital's diabetic clinic. By the age of 59 diabetic retinopathy and vitreous haemorrhages had supervened and she became virtually blind.
When the patient was in her late sixties, her neighbour reported that she had ulcers on the toes of her left foot. The GP initially delegated treatment to a district nurse - without having assessed the lesions himself.
The nurse visited on a number of occasions to change dressings. The GP examined the foot a month after the original diagnosis, and noted ulcerated infected toes and poor circulation. He elected to clear up the infection with antibiotics before seeking a specialist opinion.
A week later the patient's pain became more severe and she was prescribed stronger analgesics. She was referred "urgently" to an orthopaedic surgeon, but the GP did not take down the dressings and look at the lesions again.
A week later the orthopaedic surgeon noted: "five ulcers on the left foot and the third toe is gangrenous" and he arranged admission on the likelihood that the patient would need to have her leg amputated. In the event, her condition deteriorated rapidly and she died a week later.
When a claim was pursued on behalf of the deceased patient, the MDU's expert advice received was critical on three points:
- Delegation of the treatment of a diabetic foot ulcer to a district nurse without prior assessment and examination.
- At the first consultation the GP had elected to treat with oral antibiotics when the only real hope of saving the leg was by intensive in-patient treatment (probably with IV antibiotics).
- Failure to examine the foot a week later and to arrange urgent admission.
While accepting that earlier surgical intervention might not have altered the outcome, the expert concluded that there had in fact been a greater than 50 per cent chance of saving the leg and the patient's life if earlier intensive in-patient treatment had been offered. Settlement was negotiated for a small sum, with the patient's sole beneficiary, who was a friend rather than a relative.
This page was correct at publication on 22/01/2002. 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.