Claim settled against GP for delay in referring patient with age-related macular degeneration

Posted: 01/08/2017

Penningtons Manches LLP’s clinical negligence team has settled a claim against the GP of a client who lost his left-sided central vision as a result of a delay in being referred for suspicion of wet AMD.

The patient, a 76 year old man, attended his GP in late 2014. A few days before the appointment, he had experienced some visual distortion in his left eye while watching television, difficulty perceiving colour and straight lines bending. The visual distortion was a nuisance, but was not disabling. At the consultation, the GP advised him that he suspected wet AMD and would refer him urgently to the ophthalmic unit at Frimley Park Hospital. The GP did not tell him when he would be likely receive an appointment and an appointment letter did not arrive.

A few months passed, and in early March 2015, the patient began experiencing problems with his right sided vision. He contacted the hospital requesting an update on when he would receive his appointment with the ophthalmic team. The hospital advised that they had not received a referral from his GP. Had this been received, he would have received his appointment within seven days. After calling his GP to find out what had happened with his referral, the patient was reassured that it would be sent straightaway.

The following week, when he was visiting the hospital for an unrelated reason, he also went to the ophthalmic outpatients department to enquire about his appointment and was again told that the hospital had not received a referral from his GP. The receptionist at the hospital then telephoned the GP and requested that the referral be sent immediately. It was eventually sent the following day.

The patient finally attended a consultation with the consultant ophthalmologist at Frimley Park in the middle of April 2015, four months after originally visiting his GP complaining of visual distortions. After some investigations, the consultant diagnosed bilateral wet AMD. Treatment began in the form of intra-vitreal anti-VEGF injections. Since diagnosis, the visual acuity in his right eye has stabilised with treatment at between 6/9 and 6/12 on the Snellen scale. His left-sided vision, however, has deteriorated significantly. He has completely lost his central vision and retains only some peripheral vision. The loss of vision in his left eye is irreversible and he has ceased receiving treatment to that eye. He continues to attend the mobile macular unit for anti-VEGF injections into his right eye on a monthly basis.

The NHS guidelines for wet AMD confirm that patients exhibiting symptoms of recent visual loss or disturbance may be developing macular-degeneration. Wet AMD is a rapidly progressive condition and, while treatment cannot repair damage already caused, earlier treatment is associated with a better outcome. The NICE guidelines state, therefore, that patients exhibiting symptoms of AMD should be referred urgently to an ophthalmologist for further assessment and treatment as necessary. It is recommended that they should be seen within one week of referral.

Penningtons Manches pursued a negligence claim on the basis that its client’s GP failed to send a timely referral to the ophthalmology department at Frimley Park Hospital. Expert evidence was obtained which identified failings in the standard of care provided. Investigations showed that, had the urgent referral been sent the day of, or the day following the GP appointment, he would have been likely to receive a hospital appointment within seven days. His wet AMD would have been diagnosed by the middle of December 2014, and he would have received treatment at that point. The damage caused to his vision up to then would have been irreversible, but it would have been minimal. The client’s left sided vision would have been likely to stabilise at between 6/9 and 6/12 on the Snellen scale. He would not have lost his central vision. He would have continued requiring treatment for his condition, but this should have stabilised his visual acuities at that level.

The GP’s defence organisation investigated the allegations of negligence and, while no formal response or admission of liability was made, it was keen to settle the claim. Some protracted negotiations took place over the value of the claim but our client’s offer of settlement was eventually accepted by the organisation.

Arran Macleod, a specialist in ophthalmic claims within the clinical negligence team at Penningtons Manches, comments: “We are always concerned when we are contacted because of delays in patient care. Ophthalmic conditions, such as wet AMD, can progress very quickly and, if treatment is not provided within a reasonable time-frame, the deterioration in the patient’s vision, which is often irreversible, can be devastating.

“In this case our client was fortunate that the condition in his right eye did not progress as quickly as in his left eye, and that the vision in his right eye has stabilised at a reasonable level. This has enabled him to continue living reasonably independently, although he requires additional care from his wife. Other patients may not be as fortunate and the consequences of delays in diagnosis and treatment can often cause serious and permanent loss of sight. So that these types of cases are prevented, it is vital that GPs adhere to NICE guidelines on when, and how quickly, patients should be referred.” 

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