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An unexpected, painful end

01 May 2010

Fifty-five-year-old lorry driver Mr Q was involved in a road traffic accident, sustaining severe injuries to both legs. He was taken to the local hospital where, following initial assessment and stabilisation by the emergency medicine team, he was referred to the orthopaedic department. Mr E, the consultant orthopaedic surgeon on call, took over his care. Following reassessment of the injuries, Mr E confirmed an open fracture of the left femur, a transverse diaphyseal fracture of the right femur and an undisplaced fracture of the left acetabulum. Mr E managed Mr Q’s treatment appropriately.

During his stay in hospital, a CT and special x-ray views of his left acetabulum were taken, which confirmed an undisplaced fracture of the acetabulum without any loose intra-articular fragments. Mr Q was then allowed partial weight-bearing on his right leg and was discharged home.

At his first follow-up appointment in the Outpatient Department six weeks after the accident, Mr Q seemed to have made an excellent initial progress. All the surgical wounds and even the traumatic one had healed and the check x-rays were satisfactory, including that of the undisplaced acetabular fracture. Mr E saw Mr Q at a further review in the outpatient clinic three months later; both his femoral fractures were clinically and radiologically united by this time. The acetabular fracture had also united and Mr E described a normal joint contour in the x-rays. By this time Mr Q was walking unaided and without a limp.

At the request of Mr Q’s solicitor, Mr E provided a comprehensive report for a claim against the other party involved in the road traffic accident. In his report, Mr E mentioned that “Mr Q might have an increased risk of developing osteoarthritis to his left hip as a consequence of the fracture suffered during the accident”. The claim against the other party was settled for a modest sum.

Six years after the initial accident the claimant developed pain in both hips and he was diagnosed with bilateral symmetrical osteoarthritis to both hips. Mr Q then made a claim against Mr E because he felt that he had not been compensated enough at the time of the injury. Mr Q considered that Mr E’s report did not accurately reflect the risk of developing osteoarthritis. The case was taken to Court and, despite the expert opinion of another orthopaedic consultant stating that “the treatment given by Mr E was outstanding”, the judge declared Mr E liable in respect of non-reporting the possibility of severe arthritis.

The cost of settlement was ten times the figure initially awarded six years earlier.

Learning points

  • In this case, the clinical care was outstanding and the outcome of the injuries excellent. However, the treating surgeon still had a claim brought against him in respect of a report that he wrote regarding the prognosis following the injuries he treated. 
  • The doctor’s responsibilities towards a patient are not limited to clinical practice, but also include skill – regarding future prognosis when writing reports as an expert. 
  • Claims can arise many years after the incident giving rise to the claim. Good documentation can make a good defence possible, regardless of the final outcome. 
  • Remember the difference between a professional and an expert report. A professional report sets out the facts of a case, and an expert report will include a statement of expert opinion (on, eg, standard of care, prognosis or causation). Be clear about your duties – whether this is a duty to the patient, or to the court.
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