Mr P alleged if he had undergone blood tests following all consultations, the results would have been consistent with bacterial infection. This would have led to further investigations, prompting referral for orthopaedic investigation suspecting infected spinal pathology, including an MRI scan. A diagnosis would have been made, Mr P would have been admitted to hospital and treated with intravenous antibiotics, making a complete recovery.
Dr E maintained Mr P would have had to receive antibiotics for a period of 48 hours to have avoided all neurological sequelae, without surgery. Dr K considered antibiotics 24 hours earlier would have avoided onset of neurological deficit. Dr K, crucially, accepted at the experts’ meeting that Mr P’s white cell count and temperature would have been within normal range for each consultation.
This case highlights the importance of obtaining excellent and appropriate experts in relevant fields, at an early stage in the claim
The neurosurgeons agreed Mr P would have displayed no neurological sequelae at any consultation. It was accepted that if blood tests and further investigations had been undertaken after all consultations – save 4 August – Mr P would succeed by one way or another.
It was vigorously denied that even if blood tests had been undertaken on 4 August they would have altered the outcome. For Dr A to succeed at trial on causation in relation to the 4 August consultation, the court had to accept:
- Referral to physiotherapist was reasonable based on his factual evidence
- Referral to orthopaedic surgeon on a “non-urgent” basis was reasonable, based on Mr P’s factual evidence.
Even if the court did not accept referral on a “non-urgent” basis to an orthopaedic/neurosurgeon was reasonable, Mr P needed to establish that referral and appropriate treatment within a five-day window of opportunity (4-9 August) should include referral to an orthopaedic surgeon, MRI scan, biopsy and broad spectrum antibiotics.
Dr A did not assess Mr P until 5.30pm on 4 August. Accordingly, the earliest that blood tests could have been undertaken, based on a fasting sample, was 5 August, with the results available that afternoon. The earliest Dr A could have seen Mr P is 6 August, and an appointment arranged with an orthopaedic surgeon that afternoon.
The earliest an MRI scan could have been arranged is 7 August. The earliest the results could have been available is that same day, with admission to hospital that evening. Mr P was asymptomatic and the appropriate action would have been to undertake a biopsy to identify the pathogen so the appropriate antibiotic was administered.
A biopsy may not have been possible the following day as it was a Sunday and, as Mr P would not have been displaying any symptoms, the need would not have been “urgent” and would have waited until Monday, 9 August. By that stage, even on Mr P’s evidence, administering antibiotics would have been too late. At trial, Dr A’s expert neurologist was an excellent witness who spoke authoritatively and gave his opinion in a non-partisan way.