Clinical telephone services legally liable when symptoms are misdiagnosed

Posted: 15/05/2014

In an era when many GPs contract out their out-of-hours obligations to a telephone advice service, patients are often deprived of a doctor’s visit should they fall ill in the night. This is what happened to Chantelle Pringle, a two year old child, in November 2004. Her sad case took nearly ten years to be resolved with a judgment in her favour at the High Court earlier this month (May 2014).

Chantelle Pringle became unwell with symptoms of high fever and vomiting. By midnight, her mother became so concerned that she telephoned her GP. The call went through to an answerphone and she was directed to call the out-of-hours telephone service operated by Nestor Prime Care Services. She had a 15 minute telephone conversation with a triage nurse during which she described Chantelle’s symptoms. The nurse did not think it was necessary to arrange for a doctor to visit nor for the child to be admitted to hospital.

While the nurse assessed the child as “lethargic”, he failed to record this on Nestor’s computer system. Had he done so, the system would have alerted him to arrange a hospital admission which would have taken place by around 1.30am. The nurse expressed a view that Chantelle was probably suffering from an upper respiratory chest infection.

Chantelle’s condition did not improve and in the morning her mother observed a non-blanching rash. An ambulance was called and the child was admitted to hospital at 11.10am. By this time, meningitis had become so advanced that, despite aggressive treatment, the child developed sepsis which resulted in the amputation of one foot and partial amputation of the other. The claimant sued Nestor for damages.

Liability was denied but the court held in favour of the claimant. The court concluded that, had the nurse arranged for a doctor’s visit, a competent GP would have arranged admission to hospital and treatment would have commenced by around 4am so that the amputations would have been avoided.

Unfortunately the facts of this case are all too familiar. Warren Collins, partner in the clinical negligence and personal injury teams at Penningtons Manches LLP, has come across similar cases in the past. Warren commented: “I am aware of an increasing number of cases where the real risk of meningococcal infection - and its severe complications if not treated quickly - is being ignored by healthcare professionals. I am currently representing a child who presented to hospital with symptoms of fever and vomiting as well as a non-blanching rash. The child was sent home and, by the time he returned, sepsis had developed to such an extent that a below-knee amputation of his leg was unavoidable. These cases must be taken more seriously.”

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