A necessary visit? - medical case study

...Dr A diagnoses gastroenteritis and a possible chest infection and prescribes an antibiotic and anti-sickness medication. But just a few hours later, Mrs B dies...

A 59-year-old woman, Mrs B, has been suffering from abdominal pain and vomiting for two days, prompting her husband to request a home visit from her GP. He is worried because his wife has a number of other health problems including high blood pressure, heart disease and diabetes. She also had bowel surgery 10 years ago with a colostomy.

Mr B tells the GP, Dr D, that his wife’s vomit is dark and foul-smelling and mentions again her abdominal pain and diarrhoea. Dr D diagnoses gastroenteritis over the phone but does not visit Mrs B, instead leaving a prescription for the husband to collect at the practice. Mrs B’s condition worsens overnight so Mr B contacts the out-of-hours doctor, Dr A, who makes a home visit. He notes Mrs B’s vomiting and diarrhoea (“settling”), and that she is drinking plenty of fluids. He also diagnoses gastroenteritis and a possible chest infection and prescribes an antibiotic and anti-sickness medication. But just a few hours later, Mrs B dies. The post mortem reveals a small bowel infarction and obstruction resulting from abdominal adhesions.

The family raises a claim of medical negligence against Dr D, an MDDUS member, and Dr A, who is a member of another medical defence organisation. It is alleged that had Dr D visited Mrs B and undertaken a proper examination leading to an urgent referral, she would have been provided appropriate life-saving treatment. It is also alleged that Dr A failed to properly examine and refer Mrs B: had he referred her urgently, it is claimed she would have survived.

Analysis and outcome

MDDUS, acting on behalf of Dr D, commissions a report from both a GP expert and colorectal surgeon. The GP expert concludes that Dr D’s actions did not depart from usual and normal GP practice. But the surgeon’s report finds that Mrs B should have been referred to hospital where she could have been further assessed for emergency surgery.

Considering the conflicting expert reports, MDDUS decides to agree an early settlement with Mrs B’s family on economic grounds, without admitting liability. The settlement is shared equally with the other MDO.

Key points

  • Consider carefully the need for a home visit in patients with multiple health issues.
  • Have a high index of suspicion in patients having had previous bowel surgery.
  • Be sure to conduct the appropriate examinations and document relevant positive and negative findings.