Goby (A Child) v Ferguson

A general practitioner must take a sufficiently careful history before diagnosing a viral or post-viral illness. Where a child has been unwell for an unusually long period and the clinical findings do not positively support a viral illness, the doctor must revisit the history and explore material symptoms, including headache. Persistent or daily occipital headaches in a young child, particularly where they are worse on sitting up and relieved by lying down, may require urgent hospital referral even without fever or other classic signs. Causation is established where competent investigation would probably have led to earlier treatment and the evidence shows that the delay caused the injury.

This was a clinical negligence claim brought on behalf of a child against his general practitioner. The claimant alleged that, during a consultation on 19 January 2000, the defendant failed to act on, or properly elicit, a history of headaches and failed to refer him to hospital. The claimant subsequently deteriorated and was diagnosed with tuberculous meningitis, suffering permanent neurological and cognitive injuries.

The issues were whether the claimant had been experiencing significant headaches, whether they were mentioned or should have been elicited at the consultation, whether referral was required, and whether earlier treatment would have avoided the injuries.

1. The claimant had suffered daily occipital headaches from 5 January 2000 until admission. They worsened shortly before admission. The medical records, viewed as a whole, supported rather than excluded the family’s account.
2. The defendant’s consultation note was incomplete. It omitted earache and stomach ache, which she accepted had been raised. Its omission of headache therefore did not establish that headache had not been mentioned. The court found that headache had probably been mentioned, although not expressly as continuous headache.
3. Even if headache had not been mentioned initially, the duration of the illness, the previous consultations, the absence of fever, cough, cold or catarrh, and the lack of positive signs of viral illness required a competent general practitioner to revisit the history and ask further questions. Those questions would have elicited the daily occipital headaches, their duration, severity and postural features.
4. That history, particularly in a young child and in the absence of positive viral symptoms, required referral to hospital. The failure to undertake the necessary further enquiry and referral was a breach of duty. The claimant therefore succeeded on both the primary and alternative formulations of breach.
5. Earlier admission would probably have led to investigation, transfer to a specialist hospital and advice from infectious disease doctors. Anti-tuberculous treatment would have commenced by 23 January 2000. The court rejected the suggestion that commencing treatment on 26 January would have been within the appropriate range.
6. On the medical evidence, treatment on 23 January would have resulted in complete recovery and avoided the injuries. Liability and causation were established, and the claimant was entitled to damages.