Mr U, a healthy 30-year-old taxi driver, was on duty when he suffered a minor road traffic accident. He was sitting at the wheel of his car at a red light, when a car hit him from behind. Mr U was wearing his seat belt, and the collision caused the seat belt to impact on his chest, which caused an abrasion and bruising. There was no damage to the other cars involved and Mr U felt no subsequent pain so, after exchanging insurance details, he continued his day as usual.
The following day, Mr U awoke with pains in his shoulder and the upper part of his chest, where the seat belt had restrained him. The pain did not have any worrying features and was very non-specific, but his wife prompted him to visit the local emergency department (ED).
On arrival Mr U had his heart rate and blood pressure checked. They were within normal limits; he was then examined fully by Dr F, a junior doctor. Dr F documented that there were no obvious abnormalities, and the chest examination was normal. As the pain seemed severe, he requested a chest x-ray, and no abnormalities were detected. Dr F reassured Mr U that he had a minor chest contusion, probably caused by the seat belt, and that it would settle down without any further problems. He also advised Mr U to take ibuprofen regularly for the next couple of days.
It is always safe practice to treat each patient as if they are being seen for the first time
During the next five days, Mr U attended his GP surgery with increasing pain to the traumatised area. Mr U was seen by three different doctors. At every visit he was fully examined and his temperature, oxygen saturation and HR/BP were recorded. In spite of the severe pain, there appeared to be no change in Mr U’s condition. There were no bruises, no crepitus and the breath sounds were normal. The entries on Mr U’s records by all the doctors involved were clear and detailed. Each doctor added a painkiller of increased strength in an attempt to make him more comfortable. All doctors agreed that it was a musculoskeletal pain caused by the contusion.
Six days after the accident, Mr U felt dizzy and looked very unwell. His wife drove him to the ED. On arrival he was hypotensive and tachycardic, his oxygen saturation was low and he was feverish. Mr U was seen again by Dr F, who found on examination a large bruise on his chest. Dr F immediately started treatment with fluids and antibiotics, but as he was waiting for the blood results the bruised area seemed to grow larger than an hour earlier. Suspecting necrotising fasciitis, he called the ICU team, where Mr U was admitted.
Mr U was taken to theatre for debridement, but unfortunately he rapidly deteriorated and died from the necrotising fasciitis two days later. Mr U’s widow made a claim against all the doctors who saw her husband following the accident. The experts reviewed all the medical records and gave supportive evidence, so the decision was made to defend the case, since it was felt that the management had been correct and none of the doctors were in breach of their duties. The case was successfully defended.