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GP is held entirely responsible for brain damage of child who was discharged from hospital after head injury

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7883 (Published 20 November 2012) Cite this as: BMJ 2012;345:e7883
  1. Clare Dyer
  1. 1BMJ

The Medical Defence Union (MDU) has lost an unusual High Court battle it launched to try to get back from the NHS some or all of the £4.5m (€5.6m; $7.2m) it had to pay in compensation and costs as a result of a young GP’s mistake nearly 20 years ago.

The case dates back to June 1993, when 2 year old Aaron Blain’s pushchair became tangled in the reins of a panicking horse on a farm visit and tipped him over on to his head.

Aaron was treated at the Royal Manchester Children’s Hospital, where he was found to have a slight leak from his nose that tested positive for glucose, indicating that it was cerebrospinal fluid (CSF). He was started on antibiotics and discharged two days after admission when the leak had stopped, with the expectation that it would heal itself.

The notes show that his parents were told to bring him back to the hospital if there were any problems. The general practice records included a note that he had been admitted to hospital “with head injury +csf leak.”

On Sunday 29 August he was seen on a home visit by the GP, Sean Maguire, who diagnosed a cold and failed to refer him back to hospital, although the notes show that Aaron’s father was concerned that the runny nose might be related to his head injury. Another GP in the practice also saw Aaron on 30 September and again diagnosed a cold.

At a hospital follow-up appointment on 5 October Aaron again had a runny nose and was seen by a neurosurgeon, who arranged for a cisternogram on 13 October with a view to surgery on 15 October. However, he developed pneumococcal meningitis between 5 and 13 October and had to be treated by antibiotics before he could undergo surgery. He was left with brain damage and epilepsy as a result of the meningitis.

His parents sued the GP in 2004 on Aaron’s behalf but made no claim against the hospital. In 2005, in an out of court settlement without admitting liability, Maguire’s defence body, the MDU, agreed to pay 65% of the value of Aaron’s claim. The insurers of the second GP who diagnosed a cold also agreed to pay a contribution.

In 2009 it was agreed that Maguire should pay £3 737 500 in damages and £571 000 for Aaron’s legal costs. But in an unusual move, backed by the MDU, Maguire sued the North West Strategic Health Authority, representing the hospital, for £4.5m, the full sum paid out plus his own costs.

He argued that the hospital doctors were negligent in failing to arrange for an earlier follow-up of Aaron and failing to tell his parents to take him back to hospital straightaway if there was any suspicion of leaking from his nose. If either had happened, he contended, he would not have had to visit Aaron and would not have made a mistaken diagnosis.

But Judge Barry Cotter made a factual finding that Aaron’s parents had been told by the hospital either to bring him back there or to take him to his GP if there were further concerns. And the judge said that he did not accept that the hospital doctors fell below the standards to be expected in setting a follow-up date in October.

Cotter said that the allegation by Maguire’s lawyers that the parents should not have been given the option of seeing the GP and should have been told only to take him back to hospital “relies upon a damning indictment of the competency to be expected of doctors in general practice . . . The medical system would have ground to a halt and would do so now if the proper working assumption was that a GP could not be trusted to adequately evaluate the risks in a case such as this.”

He said that none of the hospital’s employees was negligent and that it was “the all too familiar scenario in a clinical negligence action of the patient, or here the patient’s parents, having a very real and reasonable concern that there may be a serious problem and being wrongly reassured that little was amiss after a clearly inadequate assessment by a visiting GP.”

Notes

Cite this as: BMJ 2012;345:e7883