Which case won?

casea
The case for the patient
  • I trusted the advice of my GP. She should have been able to identify the symptoms of cryptococcal meningitis and sent me for tests or referred me to a specialist by at least the third consultation.
  • The GP did not conduct a physical examination of my neck in any of the first three consultations. Had she done so, she would have discovered that I could not bend my neck forward and touch my chin to my chest. This is a symptom of cryptococcal meningitis, a condition which is emphasised in clinical teaching for general practitioners.
  • If I had been referred for tests or to a specialist by at least the third consultation, I would have acted upon the referral quickly and would have been treated in time to save my eyesight and hearing.
  • I have lost my sight and hearing as a result of my GP’s failure to exercise reasonable care and skill. She should have performed a physical examination of my neck at the second or third consultation and she should have enquired about the headaches, neck stiffness and facial flushing I had complained of previously.
  • The court should find my GP liable in negligence.
caseb
The case for the doctor
  • The patient’s symptoms at the second and third consultations were largely consistent with a pre-existing spinal condition. She did not report that her symptoms had deteriorated or that her neck pain was severe. She also did not say anything about a headache, did not report flushing to the face and did not report nausea or vomiting. The treatment that I provided was reasonable based on the patient’s symptoms as they presented.
  • Even if I had tested the patient’s neck movement in all directions during the physical examination prior to the last consultation, it would not have revealed difficulty in movement such as to require further investigation.
  • Had I referred the patient to a specialist prior to the last consultation, it is unlikely that cryptococcal meningitis would have been diagnosed and treated at that time so as to avoid the catastrophic injuries that she suffered.
  • The treatment I provided accorded with the reasonable standard of general practice. The chances of the patient suffering from cryptococcal meningitis were only twenty in a million. It is improbable that any GP would have referred the patient for tests or to a specialist at an earlier time.
  • The court should find that I am not liable in negligence.

So, which case won?

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How people voted
a53%
b47%

Expert commentary on the court's decision

Phil GriffinManaging Director
“The court found that with proper care, the patient could have been diagnosed and treated in a timely fashion, so that her catastrophic injuries probably would have been avoided.”
Queensland Court of Appeal finds GP to be negligent

In February 2015, the Queensland Court of Appeal in the matter of Mules v Ferguson [2015] QCA 5 determined that the GP, Dr Kaylene Ferguson, was negligent in her treatment of the patient, Ms Nancy Mules, and that her negligence was the cause of Ms Mules’ injuries.

In arriving at this decision, the Court of Appeal overturned the decision of the Brisbane District Court, which had held that while Dr Ferguson had breached her duty of care to Ms Mules, that breach did not cause her injuries.

Defence against medical negligence claims in Queensland

A defence commonly relied upon in medical negligence claims in Queensland is set out in section 22 (1) of the Civil Liability Act 2002 (Qld), which states:

A professional does not breach a duty arising from the provision of a professional service if it is established that the professional acted in a way that (at the time the service was provided) was widely accepted by peer professional opinion by a significant number of respected practitioners in the field as competent professional practice.

Brisbane District Court finds catastrophic injuries probably could have been prevented

The trial judge in the Brisbane District Court found in Ms Mules’ favour in relation to two points. First, the judge found that if Dr Ferguson had referred Ms Mules to an appropriate specialist at the second or third consultation, Ms Mules would have promptly acted on that referral and arranged an appointment with the referring specialist immediately.

Secondly, the judge found that with proper care, Ms Mules could have been diagnosed and treated in a timely fashion, so that her catastrophic injuries probably would have been prevented.

District Court finds doctor’s breach of duty did not cause patient’s injuries

Despite finding that the catastrophic injuries suffered by Ms Mules probably could have been prevented with proper care, the District Court found that Dr Ferguson’s breach of duty did not cause Ms Mules’ injuries. The reasoning behind this decision was that even though Dr Ferguson had failed to act with reasonable care and skill in not conducting a physical examination of Ms Mules’ neck or enquiring about the progress of her previously recorded headaches and facial flushing, this breach did not cause Ms Mules’ injuries.

The finding of the primary judge was that such an examination and enquiries would not have detected anything to cause Dr Ferguson to respond any differently. In arriving at this decision, the District Court found that Dr Ferguson had a defence under section 22(1) of the Civil Liability Act.

Queensland Court of Appeal considers whether doctor’s negligence caused patient’s injuries

The two key issues that the Queensland Court of Appeal had to determine were whether Dr Ferguson’s breach of duty caused Ms Mules’ injuries and whether Dr Ferguson had a defence under section 22 (1) of the Civil Liability Act.

The court found that most of Ms Mules’ symptoms at her first three consultations with Dr Ferguson were consistent with her spinal condition. It also found that Ms Mules had a history of such injury and that the CT scan of her neck disclosed such an injury capable of causing most of the symptoms she described.

However, the court found that the symptom of facial flushing was not consistent with her spinal condition and that her reported symptoms of headache and neck stiffness were also possible symptoms of cryptococcal meningitis.

The court found that there was no doubt that Ms Mules’ symptoms worsened between her first consultation with Dr Ferguson regarding neck pain and the critical second and third consultations.

Catastrophic injuries might have been avoided with timely diagnosis

The Queensland Court of Appeal further found that if Dr Ferguson had conducted a physical examination of Ms Mules’ neck at the second or third consultation, it would have revealed that Ms Mules was unable to place her chin on her chest. This, combined with a history of facial flushing, headaches and increased distress, required Dr Ferguson to refer Ms Mules for specialist treatment to exclude the possibility that she had contracted cryptococcal meningitis.

The court found that given that Ms Mules had conscientiously attended various medical and health practitioners for treatment since the onset of her ailment in early September 2008, she would have attended a specialist as soon as possible and her cryptococcal meningitis would likely have been diagnosed and treated in time to prevent the grievous injuries that she suffered.

Doctor could not rely on section 22(1) defence

Further, the court found that Dr Ferguson could not rely upon the section 22(1) defence because there were assumptions put to the medical experts who gave evidence in favour of Dr Ferguson which were not consistent with how Ms Mules presented at each of the consultations.

The court found that Dr Ferguson was negligent and that her negligence caused the catastrophic injuries that Ms Mules suffered.

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