Penningtons settles claim against GP for mismanagement of ear infection leading to permanent visual loss

Posted: 15/05/2013

Philippa Luscombe, a Penningtons Solicitors LLP clinical negligence partner, has recently settled a substantial claim for damages against a GP for a client who suffered a delay in the management of an ear infection resulting in permanent visual damage.

Our client’s claim was for damages for personal injury caused by the negligence of her former GP in 2004 when she was 11 in the management of her acute right otitis media [middle ear infection] and mastoiditis [infection of the mastoid bone behind the outer ear]. As a result, she suffered a right-sided venous sinus thrombosis (VST), a rare form of stroke resulting from blood clotting. The VST led to papilloedema, a swelling of the optical disc caused by raised intracranial pressure, producing an extensive loss of peripheral visual field in both eyes.

Our client had come from home from school in November 2004 suffering from earache with discharge of wax and fluid from her right ear. She was seen by her GP who noted an ear infection but did not prescribe antibiotics and did not arrange any follow up.

She felt increasingly unwell with headache, fever, lethargy, general malaise and continuing discharge and pain from her right ear. By early December, she was suffering from pain and stiffness in her neck, shoulders and upper back. Her mother took her back to her GP a few days later and told him about her daughter’s continuing symptoms including the onset of double vision and the pain, redness and swelling behind the right ear.

The defendant examined the claimant, took her temperature and commented that it was 'a little high'. He also examined her ears and commented that the left now looked slightly infected. He said that he was 90% sure that she had glandular fever but that he did not want her to have to go through a blood test. He prescribed antibiotics for the left ear infection and said that she should stay off school for the rest of the week. He did not note the further symptoms reported.

Our claimant’s case was that, given the swelling and redness behind the right ear, the defendant should have suspected that the right otitis media had progressed to acute mastoiditis. Further, given the neck stiffness and the double vision, the defendant should have suspected meningeal irritation or other serious intra-cranial pathology. On either basis, our client should have been referred to hospital that day for urgent investigation, either by the ear, nose and throat specialists or by the paediatricians.

Three days later, she was physically weak, having difficulty walking and her vision had begun to deteriorate. Her mother spoke to a practice nurse employed at the GP surgery and explained the history of ear infection and the defendant’s diagnosis of glandular fever. The nurse advised that glandular fever could affect the muscles; that she should not worry too much; and that she should take the claimant back to the surgery within the next week if things did not improve.

On behalf of our client, we alleged that the advice was completely wrong and misleading and the nurse should have arranged an emergency appointment that morning with the GP or another surgery GP. At that appointment, the defendant or other GP would or should have suspected serious intra-cranial pathology and referred the claimant to hospital for emergency investigation.

When our client was seen again by her GP four days later, he noted her visual problems and arranged her urgent admission by ambulance to the local Paediatric Unit where she was diagnosed with VST from the right sigmoid sinus and secondary to acute suppurative otitis media. She underwent extensive treatment on an emergency basis but, while she responded well to treatment, she has been left with significant permanent visual disability.

Our case against the GP and the nurse adviser alleged that both of them had failed to take heed of the symptoms reported and to assess her condition properly. Had they done so, she would have been admitted to hospital, investigated and diagnosed and received treatment in time to avoid most, if not all, of the visual damage she sustained.

The case was denied throughout with the defendant alleging that those symptoms were not present and/or reported and that, even with alternative management, the outcome would not have been significantly different. The extent of the claimant’s day to day limitations was also disputed.

The matter proceeded until shortly before trial when a negotiated settlement was reached.