The Facts
Patient suffers from neck pain and headaches
In early September 2008, a woman, who was then 43, began suffering from neck pain and headaches. She consulted a chiropractor, but the pain and headaches continued.
The woman consulted her GP due to worsening neck pain, severe headaches and facial flushing. The GP advised her to continue with chiropractic treatment and with the pain medication she was currently taking.
Patient’s symptoms worsen and condition continues to decline
When the woman next consulted her GP six days later, the neck pain and headaches had further worsened and she was also complaining of dizziness and loss of strength in her left leg. The GP referred her for a CT scan of the spine and prescribed additional medication.
The following day, the woman was reviewed by her GP with the results of the CT scan, which revealed five bulging discs in her cervical spine. The GP advised the patient that her symptoms were related to her spinal condition and advised bed rest for a week.
During that time, the patient’s symptoms significantly deteriorated. When she was reviewed by her GP a further six days later, she was referred to a local private hospital.
Diagnosis of cryptococcal meningitis and development of catastrophic injuries
By the following day, the patient had developed alarming symptoms, including neck swelling and profound deafness. Following tests undertaken at the hospital that day, the patient was diagnosed with cryptococcal meningitis, which caused her to suffer a number of permanent disabilities, the most significant of which were loss of hearing and blindness.
The patient sued her GP for negligence in not undertaking a proper examination or making proper enquiries in relation to her symptoms. The patient alleged that her GP should have referred her for tests and treatment which would have led to an early diagnosis of her illness and avoided the catastrophic injuries that she suffered.
Expert commentary on the court's decision
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:
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.