The present case is a 40-year-old man who presented to an Accident & Emergency Department with central abdominal pain, which eventually radiated down to his right side. Blood tests were all clear, and over the next few hours his pain settled completely, so he was discharged.

Two weeks later he developed further central abdominal pain, again radiating to the right, and attended his General Practitioner. The notes record he appeared to be very worried about himself, with a past history of anxiety, and a diagnosis of a panic attack was made. The notes also record that he had been to an A&E with abdominal pain several weeks previously, which had settled. There is no mention in the records of further pain when he saw the GP.

He was therefore prescribed some medication for his high anxiety, but was not physically examined.

Seven days later he developed further abdominal pain radiating to the right side, and on this occasion he had a very high temperature. He was taken by ambulance to A&E, where a CT scan revealed an acute perforated appendicitis. He underwent laparoscopic surgery that evening, and the appendix was removed. There was some fluid in the area, but no gross contamination. Postoperatively, he was much better the following day, and on day 2 he was discharged, as he was eating and drinking well.

He was determined to sue the GP because he felt he was not evaluated properly, and certainly there was no evidence of a physical examination. A GP was asked to comment as an expert witness and stated that the doctor concerned was “guilty of gross negligence”, on the basis of which a writ was issued.

When discussions were held with defence, they asked for a Liability & Causation Report. The surgeon indicated that he felt this gentleman’s pain when he was first seen in A&E was due to a blockage in the appendix, called a faecolith, and this may or may not have been the case if he had pain when he saw the GP. However, he did not develop acute appendicitis until one week after he had seen the GP, meaning that this time, on the balance of probabilities, the blockage had given rise to an acute appendicitis. Treatments had been appropriate, and his abdomen settled within a couple of days, with no prolonged difficulty. There is therefore no evidence of consequential damage, and the argument as to whether he had complained of abdominal pain to the GP, which was not recorded, became moot.

The lessons here are two-fold:

1. An expert should understand that in a civil case, their report should indicate a standard of care was reasonable or not reasonable in all the circumstances, therefore the defendant may be liable or not liable.
2. It is very important from the outset to determine whether it is likely that damage occurred consequentially upon breach of the standard of care. Had they done so in this case, they would have found there were no grounds for proceeding, which would have saved a lot of time, effort and wasted costs.

The bottom line is to be very careful whom you rely on to give an expert opinion.

MDU figures for 2023 show that fewer than one in six actions in medical negligence actually succeed, with the vast majority failing on the grounds of causation. It must be remembered that subsequence is not the same as consequence.

Initial screening is therefore essential to manage client expectations at an early stage. This avoids unnecessary effort and costs for all concerned. Too many cases are taken to court with no chance of success. This is stressful for both the client and their legal adviser, and indeed for the medical personnel involved.

For fast and effective screening of all potential medical negligence cases, contact Peyton Medico Legal Services now on +44 (0)28 87724177 or email [email protected]