Knott v Leading

In an unwell, febrile child, meningococcal disease must be considered. If three red or purple spots are non-blanching, the child must be referred urgently to hospital. A general practitioner must carefully examine the child’s entire body and confidently exclude meningococcal disease before deciding not to refer. Where the spots are not petechial, the presentation may reasonably be diagnosed as a viral infection, provided the examination and assessment are competent and the other symptoms and signs do not require referral.

The claimant alleged that Knott v Leading was negligently treated by her general practitioner on 19 April 2000. She contended that the defendant failed to recognise three non-blanching petechiae on her neck, failed to consider meningococcal disease and failed to refer her urgently to hospital. The defendant said that he had observed an urticarial rash and one small blanching lesion, with no meningeal signs, and that referral was not required. The central issue was whether petechial spots were present when the defendant examined the claimant.

1. The claim was dismissed.
2. The applicable standard required a general practitioner examining an unwell, febrile child to consider meningococcal disease. If meningococcal disease was suspected, urgent referral was required. The doctor had to examine the child carefully, including the entire body for petechiae, and confidently exclude the disease on clinical grounds before deciding not to refer. Three red or purple non-blanching spots in an unwell child required mandatory urgent referral: paras [79]-[80].
3. The experts agreed that, if the claimant had presented with three non-blanching petechial spots on 19 April, referral would have been mandatory. If, however, the presentation was as described by the defendant, consisting of an urticarial rash and one small blanching lesion, it was within responsible practice to diagnose a viral upper respiratory tract infection and not refer: paras [79]-[80].
4. The judge preferred the defendant’s account. The claimant’s parents were unreliable on the timing of the telephone calls, the severity of the claimant’s condition and the location and persistence of the spots. Their account was inconsistent with the contemporaneous medical records, hospital presentation and expert evidence. The judge found that no petechiae were present on the claimant’s neck when the defendant examined her: paras [81]-[95].
5. The defendant’s assessment was consistent with the subsequent development of meningococcal disease, including the later emergence of petechiae. On the facts found, breach of duty was not established and the claim was dismissed: paras [90]-[96].

Not stated in the judgment.