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GP is found guilty of negligence in failing to spot meningitis in 42 year old patient

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3751 (Published 06 June 2014) Cite this as: BMJ 2014;348:g3751
  1. Clare Dyer
  1. 1BMJ

An artist who was left blind and with significant hearing loss at age 42 will receive substantial damages after the High Court ruled that a GP was negligent in failing to treat her for suspected bacterial meningitis and refer her urgently to hospital.

Julie Coakley had a 12 minute consultation with her GP, Henrietta Rosie, at her practice near Winchester in January 2009, after nine days of feeling unwell during which Coakley had self medicated with Lemsip Max. Her symptoms included headache, nasal congestion, lethargy, loss of appetite, “enormous pressure in my head,” and difficulty in concentrating, and she had developed a rash on her arms, left hand, and midriff. She asked the GP for a sick note to excuse her delay in finishing a dissertation for her degree course, which was due at the end of that week.

Rosie diagnosed a respiratory infection, gave Coakley the sick note, and sent her home at 5:22 pm with no medicine but with advice to go to bed and rest. Coakley was well enough to drive home, but when her husband returned home later that night he found her unresponsive with her eyes open, swallowing vomit. An ambulance was called and she was given intravenous penicillin at 11 pm. At 11:28 pm, when she arrived at hospital, Coakley had a Glasgow coma scale score of 3, indicating deep unconsciousness.

Rosie’s lawyers argued that she had not been negligent and, even if she had, her acts or omissions had not caused or contributed to Coakley’s injuries. But Stephen Oliver-Jones, sitting at the High Court in London, ruled in Coakley’s favour on both points.

The GP’s notes described the patient’s rash as “itchy”—indicating that it was not a meningitis rash—but Coakley denied having said that it was itchy. The judge said that he was not satisfied that Rosie could distinguish between different types of rash and said that she had “formed a fixed view” that the rash was an allergic reaction to Lemsip.

Coakley told the court that Rosie had asked whether Coakley had a stiff neck, to which she had replied that she often had a slightly stiff neck so it was difficult to tell. That response “distracted” the GP from performing an actual examination, the judge said—although Coakley asked her if she was checking for meningitis, because her son had had viral meningitis three years earlier.

The judge concluded that the damage Coakley had experienced would probably have been avoided if she had been given penicillin by the GP at around 5:30 pm and had been referred to hospital urgently.

Notes

Cite this as: BMJ 2014;348:g3751

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