In early September 2011 C was 35. He came from the Gambia but had lived in England for some years… He appeared to be fit and well. (paragraph 1)
…in early September 2011 he woke with severe pain across his upper back. It is now known that C was infected with spinal tuberculosis (‘spinal TB’). Over the next four months or so, C consulted a great many doctors. None of them identified spinal TB as the cause of his pain. On 9 January 2012 C returned to the Gambia. He came back to the UK in May 2012. On that occasion he had to be taken immediately to the hospital. By then the disease had progressed to a point where it could not be effectively treated. The C is now paraplegic and unable to walk or to work. (paragraph 2)
C alleges that some of the doctors he consulted were negligent… Had they not been negligent… prompt and appropriate further investigation would… have led to the diagnosis of the cause of his pain and its treatment. He would not… have suffered paraplegia or had to endure the operations which he underwent following his return to England in May 2012. (paragraph 3)
[There was a history of consultations with various doctors.]
Dr Wadman consultation 5 October 2011 (paragraph 24): Dr Wadman’s notes (again with abbreviations expanded) said:
‘Subjective report: Ongoing right chest / back pain. Worse on movement and inspiration (i.e. breathing in). No cough. No significant shortness of breath. No haemoptysis (i.e. coughing up blood).
Objective report: Afebrile (i.e. normal temperature). Pulse 70 (which was normal). Sr chest clear. Chest wall pain on rib springing (a technique for pressing the front and back of the chest).
Plan: Physiotherapy and Chest X ray.
Blood Pressure recorded as 133/67 mm Hg (which was normal).’
The notes also recorded that Dr Wadman had completed the referral forms for physiotherapy and for an X ray.
The physiotherapy referral form described the reason for referral as
‘Thoracic back pain radiating around chest.’ (paragraph 25)
[The chest x-ray on 17 October 2011 was reported: ‘The heart is normal. The lungs are clear.’ ; the ESR on 19 October 2011 was 11; the CRP was 3.]
C has emphasised that it is not his case that Dr Wadman should have diagnosed spinal TB [on 5 October 2011]. It is his case that Dr Wadman should have referred him for an x-ray or MRI of his thoracic spine following that consultation. Had that occurred, then the parties are agreed that the x-ray or MRI would have shown sufficient evidence of abnormality to warrant further investigation and the diagnosis of spinal TB would have been made promptly. (paragraph 113)
…the reason for considering an x-ray of the thoracic spine was because thoracic back pain radiating around the chest could be a sign of serious pathology, whose elimination ought not to be delayed. (paragraph 131)
Accordingly, I find that there was a breach of duty by Dr Wadman on 5 October 2011 since, having identified thoracic back pain radiating around C’s chest, he did not refer C for an x-ray of his thoracic spine. (paragraph 132)
The causation agreement records that if I find that on 5 October 2011 Dr Wadman was in breach of duty and that with appropriate care…C would have avoided paraplegia and instead would have made a full recovery… (paragraph 134)
Dr Wadman had not included the critical phrase ‘thoracic back pain radiating around his chest’ in his medical notes (paragraph 144)
Dr Wadman was in breach of his duty of care on 5th October 2011… (paragraph 215)
Claims against D3, D4, D5 dismissed (paragraphs 216, 217, 218)