Claim settled against Surrey GP who failed to diagnose an Achilles tendon rupture

Posted: 05/10/2015

The Penningtons Manches clinical negligence team has recently settled a claim against a GP in Surrey for the failure to appropriately diagnose an Achilles tendon rupture, and for the failure to refer the claimant for urgent treatment.

Our client reported that, in late September 2012, he stepped over a puddle in the road onto a pavement. He then felt a “snap” at the back of his calf and experienced severe pain to the back of his left calf muscle. Prior to this incident, our client had been referred by his GP for physiotherapy for problems with his long-standing tendonitis. He therefore sought advice from his physiotherapist who examined our client’s left leg to check the continuity of the tendon. Following a brief examination, the physiotherapist advised our client that he had torn his left Achilles tendon and told him to make an appointment to see his GP so that he could be referred to an ankle specialist.

Our client duly attended his GP as recommended and reported the history of his Achilles tendon injury and of the physiotherapist’s diagnosis of an Achilles tendon rupture. But the GP did not perform any examinations on our client’s injured leg and just advised him that a referral would be made to an orthopaedic surgeon.

Unfortunately, it subsequently transpired that the GP stated on the referral letter that advice was required on our client’s long standing tendonitis and failed to accurately state that he was being referred under the suspicion of an Achilles tendon rupture. As a consequence, our client was treated as a routine and non-urgent case which resulted in a three month delay in being seen by a specialist.

As a result of the delay, our client was informed by his treating specialist that the tendon ends had completely separated and “shrivelled up”. Consequently, the only option for treatment was that of extensive surgery which would involve tendon grafting. Our client was informed by the specialist that, if the GP had accurately stated the nature of his injuries three months previously, he would have been seen as an urgent case and would have had the option for non-surgical treatment by way of a plaster cast.

As a result of the above, our client instructed Penningtons Manches to pursue a claim against the GP for the failure to appropriately take a full history of his injury; to examine his injured leg; and to refer him to either A&E or to the orthopedic team urgently under the suspicion of an Achilles tendon rupture. During the course of the claim, medical evidence was obtained from an expert orthopaedic surgeon who was of the view that, as a result of the three month delay, our client’s prospects of achieving a good outcome - even with a surgical repair - was very poor. It was likely that our client will be left with permanent problems with poor function, walking and weight bearing.

A letter of claim was subsequently submitted to the defendant GP’s representatives which set out the allegations of negligence in our client's care. Despite liability in the matter being thoroughly contested, we secured a settlement for our client without the need to issue court proceedings.

Naomi Holland, an associate in the clinical negligence team who ran this case, said: “As this case demonstrates, it is crucial that any medical practitioner obtains a full history and performs an appropriate examination, to ensure the correct diagnosis is reached. It is well documented that a “Simmonds test” (where the lower limb is examined to check the continuity of the Achilles tendon) is a reliable way to detect an Achilles tendon rupture and it is quick to perform. Unfortunately, the delay caused by the GP has had a significant impact on our client’s treatment options and prognosis. It is hoped that by raising awareness of these issues, this will avoid any similar incidents in the future”.

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