Postponed diagnosis – personal injury damages maintained by the High Court

by howdyheidi on

In Issue 9 of Pulse, we reported on the Queensland Court of Appeal choice of Mules v Ferguson, 1 where the Court of Appeal granted Nancy Mules (patient) $6.7 million in damages versus her general practitioner, Dr Ferguson (medical professional).

The Court discovered that grievous injuries attributable to cryptococcal meningitis arose from the doctor s failure to refer the patient for specialist examination at an earlier point in time, therefore delaying medical diagnosis and treatment of the condition. The judgment represents the greatest injury damages award in Queensland s history.

The medical professional subsequently got special leave to the High Court to appeal the decision.2 In this short article, we evaluate the case and the ultimate result in the High Court.


Cryptococcal meningitis is an extremely uncommon infection with just 20 cases per million people happening each year. The infection comes from the lung, spreading out through the blood stream to the brain, triggering meningitis. Signs generally develop over a 2 to four week period and medical diagnosis throughout the preliminary phase of signs is extremely uncommon, as early symptoms present as a low-grade inflammatory health problem and are not likely to be attributed to such a rare meningeal infection.

In the patient s case, whilst the condition was ultimately detected in time for life preserving treatment to be effective, the treatment was far too late to prevent irreparable neurological damage. The patient was rendered deaf and blind by the condition and later began proceedings versus the doctor.

In early September 2008, the patient provided to a chiropractic specialist for treatment on three celebrations over 6 days, reporting headaches and an aching neck. On 12 September, she consulted the physician who recommended her to continue with non-prescription analgesia and to continue with her chiropractic treatment.

The patient went to on her chiropractic physician once again that day and on a further two events prior to seeking advice from the physician once more on 18 September 2008. The medical professional purchased a CT scan on that date which showed degeneration of the cervical spinal column. The physician reviewed the scan with the patient on 19 September 2008 and detected her problem as musculoskeletal.

The patient declared that at the examinations on 18 and 19 September the doctor ought to have perceived a more ominous condition was involved and urgently referred her for specialist assessment. If recommendation had been made at that time, the patient declared that her condition would have been detected and treated in time to prevent her grievous injuries.

As it occurred, the patient continued to decrease till she was communicated by ambulance to Cairns Base Hospital on 24 September 2008. The physician re-examined the patient on 25 September 2008 by which time she presented in significantly even worse health and the physician arranged her immediate admission to health center.

Choice and Appeal

The Supreme Court held that the physician had actually failed to act with sensible care and skill in not physically examining the patient s neck or making further enquiries about her formerly reported symptoms. The Court concluded that this breach did not cause the patient s injuries, as such an examination would not have found anything to trigger the general practitioner to respond differently.

The Court likewise discovered that the family doctor had actually acted in a way which was commonly accepted by peer professional opinion. In spite of this finding, the Court offered an evaluation of the patient s damages, coming to a figure of $6,727,776.04.

The patient then took her case to the Queensland Court of Appeal, which reversed the Supreme Court s judgment. It found that the Patient would have shown restricted neck movements when she went to upon her family doctor on 18 and 19 September if the doctor had performed an appropriate evaluation at that time.

Particularly, the Court considered that such limited neck movements would have been suggestive of meningeal inflammation. It was the court s viewpoint that referral to a specialist on 18 or 19 September would have, on balance, likely led to medical diagnosis and treatment by 23 September, in time to prevent the severe neurological injuries from developing. Feel free to contact personal injury attorney santa ana california for more advice.

The Court, in identifying that the peer expert defence did not use, held that the general practitioner s professionals (two experienced family doctors) had based their viewpoints on assumptions which were not totally constant with the facts as found by the trial judge, suggesting that the physician had actually cannot develop that her conduct was consistent with qualified professional practice.

The High Court s decision3

The doctor applied for unique leave to appeal prior to the High Court of Australia, saying that the proof did not support a finding that an evaluation of the patient s neck on 18 or 19 September would have demonstrated that a more ominous condition was developing.

The medical professional asserted that as a physical adjustment by a physio therapist on 23 September did not experience an amazing or serious response, it was not likely that if she had actually performed a physical examination of the patient s neck 4 or five days previously it would have provoked a response suggestive of meningism.

Whilst the Court of Appeal was aware of the proof offered by the physiotherapist at trial, it was said that it cannot effectively identify one of the natural benefits of the trial judge, specifically observation of what the physiotherapist showed at the time of offering evidence.

It was likewise recommended that the Queensland Court of Appeal had actually jumped from the possibility that the medical professional might have discovered neck tightness to a finding that diagnosis and treatment would have occurred, without clear proof that the possibility was, in truth, a probability.

The patient argued that there sufficed discussion of symptoms which required even more expedition by health examination. Had a complete range of movement test been conducted it would have revealed a patient who was incapable of carrying out the chin to chest motion, indicative of meningitis, and resulting in a recommendation by the physician to someone who could identify it.

The High Court found that there was no question of principle in this case and unique leave was declined with costs.

Written by: howdyheidi

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