A delay in diagnosis

A 12-year old girl saw her GP complaining of right knee pain after slipping during a netball game the previous day. No abnormality was detected on examination and the GP suggested painkillers and rest.

Six months later the girl was seen by another GP with a new complaint of knee joint pain. Some joint line tenderness was found on examination but a knee x-ray showed nothing abnormal. The GP referred the girl for physiotherapy.

Two months later she saw another GP who noted that the patient was now suffering from hip and knee pain and wrote to ask that her physiotherapy appointment be expedited.

Two weeks later she consulted a fourth GP who conducted a careful examination of her hip and knee joints. The doctor found a full range of movement but some lateral hip tenderness. She arranged for the patient to be seen by the physiotherapist in three days' time.

After several weeks of physiotherapy, the physiotherapist telephoned the GP and suggested that the girl have an x-ray of her hip. This showed a widening of the growth plate on the right femoral head. While the epiphysis appeared normal, the radiologist suggested that the patient undergo further evaluation.

She was referred to an orthopaedic surgeon who performed an open reduction and fixation of a right slipped upper femoral epiphysis. The patient later underwent fixation of the left upper femoral epiphysis.

A claim was subsequently received alleging negligent delay in diagnosis and referral. Allegations were made against all the GPs involved in the patient's care. Expert reports were obtained on behalf of the MDU members from an independent GP expert. He was not critical of their management as he felt that a careful evaluation had been performed each time the patient had been seen. When the physiotherapist had alerted the GP to the possibility of a hip problem, he felt that appropriate action had been taken.

A further expert report was obtained from an orthopaedic surgeon. He considered that the epiphyseal slip had occurred shortly before the girl had been seen for the first time. He considered that the surgical treatment would have been the same whenever she had been referred for surgery and any delay had not altered the management or outcome.

A letter of response was served, denying liability on behalf of the MDU GPs. Shortly afterwards, the claim was withdrawn.

Dr Frances Szekely
Senior medical claims handler

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