On 13 January 2011, C was admitted to hospital having suffered an acute ischaemic stroke. The cause of the stroke was infective endocarditis of the mechanical aortic valve with which he had been fitted in 2006. (paragraph 1)
In November 2010, C had consulted D general practitioner. The question that arises in this case is whether D should have appreciated that he was, or might have been, suffering from infective endocarditis and urgently admitted him to hospital. (paragraph 2)
The central allegations of negligence were as follows:
(1) Failing on 29 November 2010 to suspect infective endocarditis as part of the differential diagnosis, particularly in light of the Claimant’s abnormal ESR [34] and CRP [35] and cardiac history as well as his recent attendances…
(2) Failing to refer the Claimant to hospital for further investigations on an urgent basis. (paragraph 22)
There are few, if any, “red flags”, symptoms that point to infective endocarditis and which in themselves demand immediate hospital admission. In its sub-acute form this disease is both indolent and insidious; the condition can persist for weeks or months (as happened here) without reaching a crisis point. It is difficult to recognise and easy to overlook… (paragraph 51)
It was common ground that the trigger for mandatory referral is “suspicion” of infective endocarditis, and there was no real challenge to the suggestion that this disease merited “a high index of suspicion and a low threshold for investigation”… (paragraph 52)
I conclude that on 29 November 2010 Dr did have infective endocarditis on her mind as a possible, if unlikely, diagnosis, and that it was the response of a competent GP to direct another routine appointment rather than immediate admission to hospital. (paragraph 73)
Claim failed
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