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Reconstructing the past

01 February 2004

Dr Y died in 1997 and the following year one of his patients, Mr D, was diagnosed with an adeno-carcinoma of the bowel.

This was resected and he made a good recovery from the surgery.
Though adjuvant therapy was necessary because of lymph-node involvement, there were no distant metastases detected and Mr D was reported to be doing well three years after the surgery.

A claim was brought against the estate of Dr Y, who had been an MPS member at the time he was alleged to have been negligent. We therefore took on responsibility for handling the claim.

Mr D claimed that he had told Dr Y he had noticed dark and fresh blood mixed with his motions. He said this was during a consultation four years prior to his eventual diagnosis. The entry in the medical records stated only: ‘Burning sensation in epigastric region on and off for 2 years. Non-smoker. Barium meal. Mist. Mag. Trisilicate [the next two words were hard to decipher, but probably said ‘and Belladonna’].’ There was no mention of rectal bleeding.

Mr D attended for the barium meal, which revealed a hiatus hernia and gastrointestinal reflux.

On the advice of the radiologist, Dr Y referred Mr D to Dr T, a consultant physician, for endoscopy. Dr T wrote to Dr Y to report his findings of a grade I–II peptic oesophagitis and hiatus hernia. One of Dr Y’s partners discussed the diagnosis and treatment with Mr D. Again, no mention was made in the notes of rectal bleeding.

Opinion about causation was pretty clear: had Mr D been investigated for rectal bleeding four years earlier, it was likely that a polyp would have been discovered and removed via an endoscope. Mr D would have avoided intrusive surgery and his prognosis would have been excellent.

The crucial question was that of liability – did Mr D tell Dr Y that he had been bleeding PR? All we had to go on were Mr D’s statement and Dr Y’s note of the consultation, which wasn’t much help. Rather than agreeing to settle, we decided to investigate further.

We managed to get hold of the notes taken at the gastroenterology clinic when Mr D attended for the gastroscopy.

There was no mention of rectal bleeding in these notes either. We took this as confirmation (or at least suggestive evidence) that Mr D was mistaken about the date on which he started bleeding PR.

When we put this to his solicitors they were eventually persuaded to recommend that Mr D abandon the claim.

The claim was dismissed.