A general practitioner’s failure to refer a premature baby to hospital when the baby had symptoms which justified referral was held to have fallen short of the standard of care expected of a reasonably competent GP – Fallon v Wilson 18.11.10
The Claimant had been born prematurely at 27 weeks. Following her discharge from hospital, her mother attended the Defendant’s surgery to collect a prescription about five days following the Claimant’s birth. During examination by the Defendant, the Claimant’s mother explained that she noticed that the Claimant’s lips were turning blue, that she was blotchy and pale around the face, her extremities were cold and her breathing was irregular and slow and she made a wailing sound on exhalation. The Defendant relied on his medical notes which recorded a low body temperature and his advice for the Claimant to be taken home and kept warm. Later that day, the Claimant was taken to hospital where she suffered acute hypoxia following a peripheral perfusion resulting in severe brain damage.
It could reasonably be inferred from the fact that the Claimant’s mother had only attended the Defendant’s surgery to secure a prescription that something had to have happened after speaking with the receptionist that resulted in a need to consult the Defendant. It seemed very likely that something happened once she entered the consulting room to prompt an examination. There was no reason to suppose this was a matter of routine and no reason for rejecting the Claimant’s mother’s recollection of the Claimant’s presenting condition, with the exception of her remarks about blue lips. On the evidence, the blue lips likely manifested later in the day and were something which would almost certainly have alerted a competent medical practitioner and caused him to make a record. Accordingly, the Claimant should have been referred to hospital straight away and there was a breach of duty on the Defendant’s part.
There would be a low threshold for referral in the case of a premature baby; in particular a baby born at 27 weeks and who had not reached the equivalent of full term by the time of the consultation. As a matter of probability, the likelihood was that if the Claimant had been admitted to hospital earlier the cause of the hypoxic injury might have been avoided or corrected and the damage suffered would not have occurred. Hospital staff would have recognised that the Claimant, having the symptoms recorded on presentation, required specialist and intensive treatment to reduce the risk of significant peripheral perfusion failure. The issues of liability and causation were, accordingly, resolved in the Claimant's favour.
A common cause of litigation against general practitioners is failure to refer patients to secondary care.
This case illustrates the difficult balance of judgment a clinician must adopt between troubling hospital service and preventing injury. Given the catastrophic potential harm and the Claimant’s prematurity, the GP clearly erred on this occasion.