Family of fatal heart attack victim fail in negligence claim over GP’s failure to call ambulance

The family of a woman who died from a heart attack an hour after a doctor visited her at home and failed to call an ambulance have had a “negligence” claim against the GP dismissed.

 

Jerry Taylor, the husband of the late Linda Taylor, and their three children raised an action for damages against the Daily Health Centre in Ayrshire following Mrs Taylor’s in 2009 death at the age of just 32, but a judge in the Court of Session ruled that the doctor who misdiagnosed her did not breach his duty of care.

 

Lord Tyre heard that the pursuers sought reparation from the general practice and the partners of the surgery where Mrs Taylor had been a patient for about nine years and who were responsible for her care at the time of her death.

 

 

The court was told that in the morning of 26 March 2009 Mrs Taylor, a smoker who was clinically obese - weighing approximately 104kg - felt unwell. 

 

Her friend Shona Barr telephoned the defenders’ surgery on Mrs Taylor’s behalf, and reported that she was suffering from pain in her chest and left arm.

 

Dr Thomas Malloch, a partner in the defenders, immediately made a home visit to Mrs Taylor. 

 

After questioning and examining her, Dr Malloch concluded that Mrs Taylor was suffering from “musculo-skeletal pain” and “gastro-intestinal upset”, and he prescribed analgesics. 

 

However, approximately one hour later Mrs Taylor died and cause of death was coronary artery atherosclerosis. 

 

The pursuers claimed that Dr Malloch was negligent in failing to summon an ambulance to take Mrs Taylor to hospital to investigate whether she was suffering a heart attack, or an “acute coronary syndrome” (ACS), as was in fact the case. 

 

 

On behalf of the pursuers it was submitted that Dr Malloch had a duty to exclude ACS and that if there remained any possibility of it he had to refer Mrs Taylor to hospital. 

 

He had failed adequately to address the risk factors, including in particular her mother’s history of angina. 

 

His diagnosis of musculo-skeletal pain was “illogical”. 

 

It was a matter of agreement between the expert witnesses that there were features of Mrs Taylor’s presentation that were either typical of or at least consistent with ACS, namely chest pain and pain down the left arm, vomiting, and pain in the mid-thorax posteriorly.

 

In these circumstances there remained a possibility of ACS such that a referral to hospital by ambulance was mandated and no ordinarily competent GP would have failed to do so.

 

It was also submitted that Dr Malloch failed to obtain Mrs Taylor’s “informed consent” to the course of action which he decided to take, as he did not inform her that her symptoms and risk factors could mean the presence of ACS, which was a breach of the 2008 General Medical Council Guidelines, and a breach of the duty incumbent upon him as set out by the UK Supreme Court in Montgomery v Lanarkshire Health Board [2015] AC 1430.

 

It was likely that if she had been advised of the risks of ACS and pulmonary embolism, she would have agreed to hospital admission by ambulance and would have survived.

 

 

It was accepted by the defenders that if Dr Malloch had diagnosed ACS and summoned an ambulance, Mrs Taylor would not have died. 

 

But the defenders’ position was that Dr Malloch did not depart from “usual practice” and that his actions were consistent with those of a general practitioner exercising the “ordinary skill and care” reasonably to be expected of him.

 

It was submitted that, based on the history supplied to Dr Malloch by Mrs Taylor, which did not include chest pain, together with her presentation and his examination of her, the decision that she did not require to be admitted to hospital in connection with ACS or pulmonary embolism was “logical”.

 

Mrs Taylor’s complaint of pain when moving her neck from side to side was not consistent with ACS but was instead suggestive of a musculo-skeletal problem, and the fact that Dr Malloch’s diagnosis of musculo-skeletal pain had not been resolved when he left was not indicative of negligence.

 

Although family history was relevant, it was less relevant than Mrs Taylor’s relatively young age and taking into account her social/lifestyle factors. 

 

It was argued that on the information available to Dr Malloch he was “entitled” to proceed as he had done.

 

Finally, it was submitted that the pursuers’ case based upon failure to obtain informed consent, based on the case of Montgomery, was “irrelevant” - a distinction fell to be drawn between (i) the doctor’s role when considering possible investigatory or treatment options, and (ii) the doctor’s role in discussing with the patient any recommended treatment and possible alternatives; the first remained an exercise of professional judgment, and no duty existed to discuss that judgment with the patient or seek consent to treat the patient in accordance with it.

 

 

Following a proof on the question of liability, during which the court heard evidence from expert witnesses, the judge found in favour of the defenders.

 

In a written opinion, Lord Tyre said: “I hold that in deciding not to admit Mrs Taylor to hospital as a matter of urgency, Dr Malloch did not depart from usual and normal practice, and did not fall below the standard reasonably to be expected of an ordinarily competent general practitioner exercising reasonable skill and care. 

 

“In short, Dr Malloch’s diagnosis was wrong, but it was not negligent. The pursuers’ case accordingly fails.”

 

The judge also rejected the pursuers’ contention that Dr Malloch was in breach of any duty incumbent upon him by virtue of the decision of the Supreme Court in Montgomery v Lanarkshire Health Board. 

 

He added: “Had Dr Malloch – or the hypothetical ordinarily competent doctor exercising reasonable skill and care – decided that Mrs Taylor’s history, presentation and examination required her to be admitted urgently to hospital, there would have been nothing to discuss, and the same applies to the decision which Dr Malloch made that urgent admission was not necessary. 

 

“It was a decision falling within the exercise of professional skill and judgment, and not a decision as to which of two or more alternative forms of treatment, carrying differing risks, ought to be undertaken. To attempt to apply the ratio of Montgomery to the circumstances of the present case would, in my view, be to extend it significantly beyond what the Supreme Court regarded as the scope of the duty of care that it had held to exist.”