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At the heart of general practice since 1960

Claim after 40 years shows need for records

n the bitter winter of 1962 a GP saw a four-week-old baby with a history of vomiting. The parents reported that the baby had always been a poor feeder and had started to lose weight. The vomiting had become more severe in recent days.

The GP, who was a member of the MDU, had extensive paediatric experience having worked in a children's hospital. Although the GP records relating to the patient's early life were lost many years ago, our member's referral letter was in the hospital records. This stated that he had examined the baby and noted hypothermia, mild dehydration and, in view of the history and his findings, suggested a diagnosis of pyloric stenosis.

On admission the baby was found to be extremely cold and was placed in an incubator. The child was noted as mildly dehydrated and given intravenous fluids though no blood tests were performed.

The procedure to correct a pyloric stenosis was uneventful but the baby was still cold. Blood tests were taken and the baby returned to an incubator. Two hours later the baby was found to be cyanosed and fitting. The anaesthetist who carried out the operation thought the curare used to paralyse the child might have become active again as the child was warmed. An endotracheal tube was passed and the baby was ventilated for two hours but the fits continued and the baby remained drowsy and unwell.

A lumbar puncture was found to be normal. Over the next few days the baby improved and it was thought that the child was suffering from hypothermia possibly as a result of severe cold on the journey to the hospital.

The baby made slow progress and was found to have hemiplegia. Global development delay was diagnosed at two and generalised seizures started when the child was 14. Now an adult, the patient requires personal care and cannot live independently. As the claimant is legally defined as incompetent there was no time limit on making a claim.

In the early 80s the MDU was informed of a possible claim against the hospital. Nothing further was heard until 1999 when the GP received a letter of claim .

The letter alleged that because of feeding problems the parents had repeatedly taken the child to see a GP, but no action was taken. It was stated that by the time our member admitted the baby it was so severely unwell that brain damage was inevitable.

The MDU was faced with a number of problems in assisting with a case that was nearly 40 years old. All the records relating to the patient's childhood had disappeared many years before. The MDU had received copies of the hospital records and these were now the only copy of these records in existence. Nursing records and temperature charts were never found. The only GP record available was a copy of our member's referral letter in the hospital records.

Faced with such a lack of documentation, the MDU's GP expert concluded that on the evidence available our member acted reasonably. The MDU's paediatric expert pointed out that the clinical events were difficult to explain. Although bloods were not taken on admission, the hospital records indicated that doctors were mildly concerned with the baby's temperature and did not consider the baby to be severely dehydrated.

The operation was performed the following day, when the baby was judged to be in a good condition. Despite scanty records it would seem that the baby became hypoxic.

The MDU's experts also had to deal with the issue of whether cold injury alone could have caused the damage. Without accurate temperature measurements and blood tests this was extremely difficult. A neuroradiology expert reviewed MRI films taken in 1998 and concluded that they showed evidence of an episode of acute cerebral hypoperfusion, consistent with blood loss or hypoxia. They were not indicative of cold injury.

The MDU experts concluded that the child was not severely ill on admission and that the brain damage occurred during, or shortly after, surgery.

The parents said they had taken the child to the GP on five occasions and had clear recollection of these visits, but they could not recall the doctor's name. In the absence of records, and with strong expert advice concerning the mechanism of the brain injury, the MDU felt strongly that the claim should be defended.

The GP accused of negligence agreed with this advice, despite his understandable reluctance to be involved in a trial so long after his retirement. He made several trips to England to attend meetings. His calm resolve strengthened the MDU's decision to defend the case.

Five days before the trial was due to start, four years after the GP had received the first letter from solicitors and almost exactly 40 years after the events, the claimant discontinued the action, withdrawing all allegations against the GP.

This case illustrates that clinical negligence claims can often occur many years after the event. While it is unusual to receive a claim resulting from advice or treatment you gave four decades ago, it is by no means unique.

If you crash your car into the back of someone else's you can be fairly sure that your car insurance company will receive a claim from the other car owner shortly afterwards. But if you see someone in a consultation today, you may receive a claim of negligence many years later.

We felt confident that our member had acted appropriately and were willing to defend the case at trial if necessary. Fortunately, it didn't come to that and the doctor was able to return to his retirement with his professional reputation intact.

This case illustrates the importance of good record keeping ­ not only as part of good patient care, but because it can help in the event of a claim. In this instance, the full medical records had been lost, but the GP's referral letter found in the hospital records was pivotal to the case. Members often ask us how long they should keep records, and as this case illustrates, the answer is for as long as possible. With computerised records now more commonplace, it may be easier in future to store records for longer periods.

Doctors reading this case might also ask themselves if they are confident that their medical defence organisation would be there for them if they received a claim 40 years after an event occurred.

As the claimant was incompetent there was no time limit on claiming ~

A GP enjoying his retirement abroad was shocked to find that he was at the centre of a

£2 million medical negligence claim relating to a

40-year-old consultation.

Dr Frances Szekely from the MDU explains

If you see someone in a consultation today, you may get a claim

years later~

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