Family awarded damages from ‘negligent’ doctor after fatal heart attack

Lord Armstrong
Lord Armstrong
The family of a man who died from a heart attack after his GP failed to diagnose his health problems and refer him to hospital have been awarded damages for the doctor’s “negligence”.
A judge in the Court of Session ruled that the GP was “professionally negligent” and that her failures were “materially causative” of the patient’s death.
Cardiac event
Relatives of William Brown sued Dr Alison Smith and her fellow GPs at the Craig Nevis Surgery in Fort William after he died aged 67 on 6 January 2011.
Lord Armstrong heard that the pursuers sought damages from the defenders on the basis that the deceased’s death was caused by negligence on the part of Dr Smith in the course of the deceased’s attendances with her on 31 December 2010 and 5 January 2011. 
The deceased’s wife Euphemia Brown, 70, of Caol, Lochaber, his children and his brother and sister claimed that Dr Smith failed to diagnose that Mr Brown was suffering from “unstable angina” when he attended at her practice on 31 December 2010.
The family also claimed that Dr Smith failed to refer Mr Brown to hospital on that date and failed to prescribe “appropriate medication”, namely low dose aspirin and beta blockers, which would have helped his condition. 
Mr Brown’s relatives further claimed that it was cold on the day Mr Brown suffered his heart attack and that this weather could have triggered the cardiac arrest.
In advance of the proof, it was accepted that Dr Smith was negligent in that on 31 December 2010 she ought to have provided the deceased with “worsening advice” to the effect that if his chest pain occurred more frequently with little or no exertion or lasted longer than 15 minutes, then he should call a 999 ambulance.
It was also excepted that the GP was negligent, on 5 January 2011, in failing immediately to admit the deceased to hospital for “further investigation”.
But the issue of causation remained live and the pursuers’ case was that admission to hospital on or before 2 January 2011 would have resulted in treatment that would have “avoided the fatal cardiac event”, and that admission to hospital would have “avoided exposure to the cold”, a factor which could have contributed to the onset of the fatal cardiac event, on 6 January 2011.  
The court was told how the deceased had previously enjoyed good health who enjoyed playing golf and cycling.
On 29 December 2010, Mr Brown, who had not previously suffered from chest pain, became unwell after walking up and down stairs.
He visited Dr Smith that day and she arranged for him to have an ECG test after checking his blood pressure and pulse.
The following day, Mr Brown once again suffered pain after going out for a walk, when he only got as far as his garden gate.
On 31 December 2010, Mr Brown once again suffered chest pain and his wife arranged an emergency appointment with Dr Smith.
The deceased then attended Dr Smith again on 5 January 2011 and once again complained of chest pain, but the GP failed to refer him to hospital.
‘Professionally negligent’
Having heard evidence from medical experts and considered the case law, the judge concluded that Dr Smith breached her duty of care towards Mr Brown. 
In a written opinion, Lord Armstrong said: “On the basis of the relevant case law to which I was referred…and my findings in relation to the agreed issues, I find that Dr Smith was professionally negligent and breached the duties of care which she owed to the deceased, in that on Friday 31 December 2010, she (i) failed to diagnose unstable angina, (ii) failed to refer him immediately to hospital, (iii) failed to provide appropriate worsening advice, and (iv) failed to prescribe the medication appropriate for a diagnosis of stable angina. 
“Having considered the further authorities to which I was referred…and applying the principles to be derived from them to the facts of this case, I am satisfied, given my findings in relation to the agreed issues, that it is proved that these failures were materially causative of death, in that their consequences were that the deceased was denied the appropriate treatment which, on the balance of probabilities, would have reduced his level of cardiac ischaemia to the extent that ventricular arrhythmia would have been prevented.  
“I find, in addition, that in any event, if the fatal cardiac event on Thursday 6 January 2011 was caused by exposure to cold, as a provocational trigger, her failures were responsible for him being denied the protection from such exposure which admission to hospital would have provided.”

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