In mid March 2011 Lyne Smythe attended her GP complaining of pain in her left foot. He GP diagnosed an infection and prescribed antibiotics.
About a week later Ms Smythe returned to the GP with two problems: a perianal abscess and pinkness and tenderness in her left foot. The GP prescribed another round of antibiotics.
Another week past and Ms Smythe returned to the medical centre but instead saw her husband’s GP (her own GP was unavailable). She was referred to the Tweed Hospital the next day where an ultrasound was performed. It revealed an arterial clot in her left leg. Within a few weeks the left leg was amputated below the knee.
Ms Smythe alleged that her GP was negligent for failing to diagnose the arterial ischaemia (restricted blood supply from the artery) and that had she done so at either of the two visits her leg would probably have been saved. The GP contested that: she contended that she had acted appropriately.
The matter came before the courts. An examination of the various clinical notes made by the GP was undertaken. As was the methodology adopted by the GP.
The experts involved agreed it was reasonable for the GP to consider infection as a likely cause of the problems at the first consultation.
But it was also necessary to consider alternate possibilities such as venous thrombosis or arterial disease. Each such condition could be tested by palpating the patient’s calf and foot pulses.
The GP’s notes were silent on the existence or otherwise of the foot pulse. Ms Smythe argued that tended to prove that no pulse check was performed. The GP’s explanation was that she only tended to record abnormal findings. There was evidence that that was common practice for GP’s. The court accepted that and accepted the GP’s evidence that she did in fact perform the foot palpation and check for a pulse.
Ultimately, the court found that the GP had acted appropriately and had not been negligent. The court went further and said that even if the GP had wrongly failed to perform the relevant pulse tests then there was still insufficient grounds to find that the amputation would have been avoided.
Ms Smythe lost her case.
This case highlights the need to carefully explore the sequence of events, the usual practices of medical practitioners and to find compelling evidence to establish not only that a wrongful act occurred but that that wrong actually caused the ultimate outcome.
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For more details read the full version of the court judgment: