Health & Aged Care News Alert: Queensland Supreme Court finds in favour of GP
Mules v Ferguson & Anor  QSC 51
The Queensland Supreme Court dismissed a claim against a GP by a former patient who had sued for damages for failing to refer her to a specialist.
Ms Mules had consulted her GP, Dr Ferguson, with headaches, neck pain and flushes to the face. Ms Mules was treated for a probable musculoskeletal disorder, including arranging a CT scan, rather than a potentially more serious neurological condition which would warrant referral to a specialist. Ms Mules was later diagnosed with a very rare infection, cryptococcal meningitis. The diagnosis did not come in time for her to avoid being rendered blind and deaf.
There was conflict as to what symptoms Ms Mules displayed at each consultation with Dr Ferguson. The “true state” of the symptoms was of critical importance in this case. The Court made the important distinction that in cases alleging medical negligence, a causal connection between a breach of a duty of care and the medical outcome must be established. The Court noted
“...Even if the defendant conducted professionally incompetent consultation that would not be to the point if competently conducted consultation would not have identified symptoms suggesting a need to refer....”
A professionally incompetent consultation by a GP will not automatically mean a claim is successful, if a professionally competent examination would not have identified symptoms that would give cause for a referral to a specialist.
Ultimately, the Court found the GP’s duty to exercise reasonable care and skill in the provision of professional advice and treatment had not been breached by not referring the patient to a specialist. As in many medical cases, the GP did not provide treatment in isolation. The Court looked to the interactions between Ms Mules and her chiropractor and physiotherapist during the relevant period of time to determine her symptoms did not seriously decline as early as she or her mother had asserted.
The Court also looked to the evolution of the expert evidence to make its finding. If Dr Ferguson’s version of what symptoms were displayed during the relevant consultations was more accurate than the history given by Ms Mules, several independent expert witnesses considered Dr Ferguson’s examinations were of a reasonable standard.
His Honour Justice Henry summed up what can often be the problem for medical practitioners defending claims of medical negligence as “hindsight bias”. When more is made of symptoms which were present before a diagnosis, but could have had another cause, when a patient later suffers a catastrophic condition.
Following complaints of neck pain, headaches and flushing at an earlier consultation, the Court found Dr Ferguson should have physically examined Ms Mules' neck and enquired as to her previous flushing and headache. However, the Court found that such an examination would not have altered her clinical course in any event and therefore was not causative of her injury.
The Court determined that a GP exercising proper care and skill will not necessarily diagnose a rare condition such as cryptococcal meningitis. However a GP should undertake a sufficiently thorough examination so as to identify whether a referral to a specialist is required.
While Ms Mules' case failed, the Court assessed the significant award she would have received if her claim had succeeded at $6,727,776.04.
Katharine Philp, Partner