The claim

The patient's wife subsequently brought a claim against the GP, alleging that the history and examination taken at the first consultation were inadequate, that a DVT should have been suspected, and that a Wells score should have been calculated – which would have been at least 1, given the recent onset of unilateral ankle swelling without a clear explanation. It was further alleged that if this had been done, a DVT would have been diagnosed and treated, which would have avoided the later PE and prevented the patient's death.

Responding to the GP's request for assistance in dealing with the claim, the MDU obtained independent expert evidence from a GP, who was fully supportive of the member's management of the patient. The expert considered that the member's history and examination were appropriate, and that the documentation of the findings was in accordance with a reasonable body of competent GPs.

The expert GP's view was that the GP did consider a possible diagnosis of DVT, even though the patient didn't present with typical symptoms, but there was no evidence in the history or examination to support a diagnosis of possible DVT. The expert further noted that the diagnosis of osteoarthritis was a reasonable one to make in the circumstances, giving a clear explanation for the unilateral ankle swelling. A Wells score was not appropriate, as it should only be used in those patients with a provisional diagnosis of a suspected/possible DVT.

The MDU's claims handler also obtained expert evidence on causation from a haematologist, who confirmed that the clinical presentation at the initial consultation was not suggestive of DVT, and that even a haematologist would not have considered DVT as part of the likely differential diagnosis, and would not have performed a Wells score.

Furthermore, on the balance of probabilities, asymptomatic 'silent' calf vein DVT developed at the very earliest one month before the patient's collapse, and this DVT silently extended proximally in the leg, embolising to fatal PE. Therefore DVT was not present almost three months before the patient's death when he first consulted his GP with right ankle pain and swelling.

Alleged failure to diagnose DVT, resulting in fatal PE

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Alleged failure to diagnose DVT, resulting in fatal PE