Penningtons Manches’ clinical negligence team has settled a claim against a GP for failing to act on an ECG result which showed that its client had experienced a myocardial infarction (heart attack) and was suffering from ongoing myocardial ischaemia.
The claimant attended his GP surgery on three separate occasions, complaining of pain in his arm which was initially intermittent but then began to worsen on exertion.
The GP initially suspected a cardiac cause for the pain, and took an ECG. However, despite clear signs of a myocardial infarction on the ECG, including the computer interpretation highlighting an infarction, the GP read the ECG result as normal. The test was repeated on two further occasions, and the GP interpreted the ECG as normal both times. The claimant was then referred for an orthopaedic assessment as the GP considered that the problem could be orthopaedic.
Fortunately, the orthopaedic surgeon recognised that there was likely to be a cardiac cause for the pain, and immediately suggested a referral for a cardiac assessment. At the rapid access clinic, the abnormal ECG was correctly diagnosed, and extensive investigations were carried out on the claimant which revealed very narrowed coronary arteries. He underwent urgent bypass surgery and recovered well.
After having reviewed the claimant’s clinical notes, the clinical negligence team at Penningtons Manches obtained expert evidence from a GP and cardiologist to determine what would be expected from a GP in this scenario, and what the effect of any negligence could be. The expert GP decided that it should be well within the GP’s ability to interpret the significant changes seen on the ECG, and if he did not feel confident in interpreting the changes, expert advice should have been sought.
The cardiology expert was able to determine the age of the myocardial infarction, and found that it had occurred some months before. Therefore, the infarction itself could not have been treated, but the claimant had suffered four months of ongoing angina due to his severely narrowed arteries, and should have been treated much earlier. He was lucky not to have sustained more serious injury as a result of the negligence, and fortunately the GP’s defence union took a pragmatic approach to the claim, settling it promptly.
Philippa Luscombe, a partner in Penningtons Manches’ clinical negligence team, commented: “We cannot expect GPs to be experts in every field, but this case does highlight the importance of knowing what areas lie within a professional’s competence. If GPs are unsure whether they are competent to perform a procedure or interpret a test, the onus is on them to acknowledge this and seek assistance from a colleague or specialist discipline.”