Ismail v Joyce [2020] EWHC 3453 (QB) (16 December 2020)

C has brought a claim in clinical negligence against a GP D. In short, it is alleged that when D saw C on 10 August 2011, he should have referred her for a chest x-ray because there were signs that she might be suffering from TB. In the event, the correct diagnosis was indeed TB infecting her lung and then spreading to other organs including the brain and the spinal cord. It is C’s case that if D had referred her for a chest x-ray at the time of, or shortly after the consultation on 10 August 2011, the TB would have been diagnosed much earlier, with a better outcome. [1]

C (was born on 29 May 1995 and is therefore now aged 25 years) has made an incomplete recovery from the TB. She has some residual brain damage, albeit mild, coupled with more marked spinal cord damage… [2]

scope of the hearing… was confined to the issue of breach of duty. [3]

the focal point of the claim, namely the consultation with D on 10 August 2011… D noted that C had had a cough for the last three weeks and that she was sweaty at night. He noted that she was fasting. He prescribed an antibiotic, Clarithromycin (250mg). It emerged during the trial that the prescription period was five days… [19]

on 30 August 2011 C was taken to hospital… It was noted that she had been unwell for a month, the main complaint being headaches but also shivering in the morning and evening. She was admitted… By 1 September, the provisional diagnosis was TB but it was decided that C was well enough to be discharged from hospital on the basis that she should return on the following Monday, 5 September for a bronchoscopy. [22]

She duly returned to hospital on 5 September, but by this time, her condition had deteriorated… [23]

With a history of a cough of 3/4 weeks’ duration and sweating at night, I am confident that it would have been D’s usual practice to enquire further about the night sweats but, on this occasion, there was a negligent omission to do so. Had he explored further the history of night sweats, he would have ascertained the extent and duration of the sweats. Given the significance of drenching night sweats, in the context of a persistent cough, a different outcome would have eventuated in that arrangements would have been made for a chest x-ray within approximately 7 days of the consultation. [79]

On that very narrow point, this claim succeeds. [80]