Vance v Taylor

A general practitioner is not negligent merely because a serious condition is later diagnosed. The question is whether, on the information reasonably available during the consultation, the doctor exercised reasonable care and skill and responded appropriately to signs requiring investigation or admission.

Symptoms must be assessed individually and in combination. Severe pain alone may not require hospital admission where relevant neurological function has been assessed and an appropriate treatment and review plan is given. Vomiting may be addressed as a medication side effect where the clinical evidence supports that explanation. A claimant must also prove causation on the balance of probabilities. An unusual medical history requires cogent evidence before an uncertain reconstruction of disease progression can be accepted.

Gareth Vance claimed damages from Dr Graeme Taylor for alleged negligence during a general-practice home consultation on 21 August 2001. Mr Vance had severe back pain, vomiting and restricted movement, and alleged that Dr Taylor should have physically examined him and arranged immediate hospital admission.

Mr Vance was later diagnosed with a staphylococcus aureus infection, a psoas abscess and consequential hip damage. The parties agreed quantum at £500,000, leaving liability for determination. The central issues were whether the consultation fell below the standard of reasonable care and skill and whether the infection had developed sufficiently by 21 August to make earlier admission causally significant.

1. Liability. Judgment was given for the defendant. The claimant failed both on breach of duty and on causation.
2. The relevant question was whether Dr Taylor should have recognised, from the history and presentation available on 21 August 2001, that the earlier diagnosis of back strain was wrong or had been overtaken by a further development. The doctor was entitled to take account of the recent hospital diagnosis and did not have to approach the consultation entirely afresh.
3. Severe pain, considered alone, did not establish negligence. Dr Taylor had elicited leg movement and had touched the claimant’s feet to assess sensation. He prescribed a stronger analgesic regime and advised review when examination became possible, with emergency admission if the condition required it.
4. The vomiting was reasonably treated as a side effect of the earlier medication. The revised prescription stopped the vomiting. The evidence indicated that vomiting caused by staphylococcal infection would occur at a later stage, when the body was conserving blood supply for vital organs.
5. The claimant had not drawn the sweating to Dr Taylor’s attention, and the appearance during the consultation did not provide a fair basis for finding that the doctor should have recognised fever. The symptoms, taken together, added nothing materially to the separate analysis.
6. The causation case depended on reconstructing an unusual and uncertain progression of infection from the chiropody treatment on 11 August. The claimant had to prove that account on the balance of probabilities. In view of the absence of fever or swelling, the abrupt onset of severe pain, the improvement in vomiting, the later deterioration and the contrary expert evidence, the necessary cogent evidence was absent.
7. The claim was dismissed on liability. The judge directed that an agreed order be provided.