C brings a claim of clinical negligence against D, a GP [1]
C has type 1 diabetes. The negligence is said to have been by way of a failure to appropriately treat and refer a problem with her left foot. It is claimed that, in the spring of 2014, D should have made an urgent referral to the Medical Foot Clinic, which would have led to a diagnosis of a condition called Charcot foot or Charcot arthropathy… was diagnosed by it at the very end of December 2014. It is claimed that an earlier referral, diagnosis, and ensuing treatment, would have had a critical impact on outcome. [2]
C was born in 1970. She has a longstanding history of type 1 diabetes, having been first diagnosed in 1992. She has for some years had diabetic retinopathy and is partially sighted. In autumn 2012 she had a heart attack. [12]
In summary I conclude that, during the relevant period, C’s foot was visibly swollen, and identified as such by D. Though the discomfort, whilst fluctuating, was persistent and did not go away, C did not report pain beyond something that she described as an ache, and certainly did not report severe pain to D. Though the left foot was probably in fact somewhat warmer than the right foot, this was not to a degree that was, or should have been, detected by D. There was no severe discolouration, either reported, or obviously visible, to D. [58]
the approach of not referring for swelling alone, in a diabetic, reflected a responsible body of GP practice [129]
breach of duty is not established [130]
had I found breach of duty on either 14 March or 30 April 2014, I would have concluded that this was causative of C’s injuries, as they were found to be at the end of December 2014 [150]
there was no breach of duty on the part of D on either occasion when it was, ultimately, maintained that it had occurred, and this claim must therefore fail. [151]
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