Knott v Leading
| Jurisdiction | England & Wales |
| Judge | Mrs Justice Nicola Davies |
| Judgment Date | 22 July 2010 |
| Neutral Citation | [2010] EWHC 1827 (QB) |
| Docket Number | Case No: 8LS90181 |
| Date | 22 July 2010 |
| Court | Queen's Bench Division |
[2010] EWHC 1827 (QB)
IN THE HIGH COURT OF JUSTICE
QUEEN'S BENCH DIVISION
LEEDS DISTRICT REGISTRY
Before: The Hon. Mrs Justice Nicola Davies Dbe
Case No: 8LS90181
Mr Robin Oppenheim QC (instructed by Irwin Mitchell) for the Claimant
Mr George Hugh-Jones QC (instructed by Medical Protection Society) for the Defendant
Hearing dates: 20 th, 21 st, 24 th, 25 th, 26 th May & 29 th June 2010
Mrs Justice Nicola Davies:
This claim is brought by Rachael Knott, now aged 20, arising from the allegedly negligent medical care provided to her by Dr Alan Leading, her general practitioner, on 19 April 2000. It is alleged that on that day Dr Leading visited the claimant at her home and failed to act upon the presence of three petechial spots on her neck. On 20 April 2000 the claimant was admitted to Pinderfields Hospital where investigations revealed that she was suffering from meningococcal disease. As a result of the disease the claimant developed profound deafness in her right ear, severe hearing loss in her left ear together with tinnitus and vestibular dysfunction. The claimant's case is that on 19 April Dr Leading failed to note, detect or recognise that she had three non-blanching petechiae on her neck, failed to recognise and act upon the fact that meningococcal disease could not be excluded and failed to urgently refer her to hospital. As a result of the defendant's failure the claimant has suffered injury with consequent loss and damage.
The defence case is that on 19 April 2000 only one spot was present on the claimant's neck, it was non-petechial, urgent referral was not required. It is agreed that if the three spots were petechial and the claimant had fever or some other systemic sign on 19 April 2000, the differential diagnosis should have included meningococcal disease and the claimant should have been referred to hospital. There is a conflict of evidence as between the claimant's parents and the defendant and one of his colleagues, Dr Taylor, as to the number and nature of spots which it is alleged were present on the claimant's neck on 19 and 20 April. The resolution of this issue is central to the allegation of breach of duty.
Factual Evidence —Mrs Karen Knott
Mrs Knott is the mother of the claimant who was born on 26 August 1989. Mrs Knott and her family were patients of the Crofton Health Centre, Crofton Village, Wakefield. On 12 April 2000 Mrs Knott took Rachael to Crofton Surgery for what was diagnosed as an infection in her right ear. A five day course of antibiotics was prescribed. By the time of completion of the antibiotics Rachael's pain had disappeared, she felt fine. On 18 April 2000 Rachael went to school. On 19 April Rachael woke up between 7.30am and 8.00am and complained of feeling ill. Mrs Knott said she had a high temperature and was vomiting. Mrs Knott described Rachael as being “red hot” over her body, she moved Rachael to her own bed to provide more space and to better care for her. It was the opinion of her mother that Rachael was too unwell to be taken to the surgery, she could hardly stand up. Mrs Knott told her husband that she was going to telephone for a doctor's visit. Mr Knott left for work. Using the home landline telephone or a mobile telephone, Mrs Knott spoke to a receptionist at the surgery between 8.30am and 9.30am. She told the receptionist that Rachael had a temperature and had been vomiting. The receptionist asked Mrs Knott if she could take Rachael around to the surgery as it was only a few minutes from the house, Mrs Knott said that Rachael was not well enough.
The note made by the receptionist records: “high temperature – sick half an hour ago. On neck + down chest – rash…” In her witness statement dated 30 November 2009 Mrs Knott stated: “It is possible that I told her that Rachael's chest was pink or flushed. But I don't remember that clearly”. In the same statement it is recorded: “Rachael was very hot but the only thing approaching a rash that I was aware of were those spots on her neck. Her chest might have been a bit pink but I wouldn't describe that as a rash. If she had had a proper rash, it would have been obvious to me, as she wasn't wearing her top, due to her high temperature and the bedding was folded back”. In her evidence to the court, Mrs Knott said of Rachael's chest “It's not what I would call a rash…it was not a rash in my mind”.
Having telephoned the surgery, Mrs Knott rang her husband. Her witness statement records: “After calling the doctor's surgery, I spoke to Malcolm to update him. Again, I cannot recall if I would have telephoned him with my landline or mobile phone or if he phoned me.”
During the course of the morning Rachael continued vomiting. Her mother described her as being very lethargic, exhausted, she could not be bothered, she was not Rachael. Mrs Knott said that she tried to talk to her daughter but Rachael was not responsive. She did not want to take any paracetamol or water. Rachael was very pale, odd looking, when sick her face would flush up but for the remainder of the time her face was a waxy colour. Rachael spent the morning dozing between bouts of vomiting. Mrs Knott recalls that when Rachael said she needed to go to the toilet, Mrs Knott almost had to carry her there. Rachael complained that she ached all over her body and her mother noted that in spite of her having a high temperature she had very cold hands and feet.
Mrs Knott had seen items about meningitis on television. She specifically recalled Dr Hilary Jones on GMTV, he had given advice as to what to do if meningitis was suspected. Mrs Knott was concerned that Rachael could be suffering from meningitis as Rachael was waiting for her meningitis vaccine. Mrs Knott was aware that a high temperature, vomiting, stiff neck, spots or a rash, dislike of bright lights are all signs of meningitis. She knew the test was to press the spots to see if they faded under pressure. As a result, Mrs Knott said she was constantly looking all over Rachael's skin.
During the course of the morning Mrs Knott found three tiny red or purple spots between Rachael's ear and collar bone. The spots were on the left side of her neck. In her evidence she said they were like pin pricks. Mrs Knott said she was constantly touching and pressing on the skin to see if the spots would disappear. In her witness statement Mrs Knott said “I pressed on them with my fingers and a glass but they would not go away. I kept pressing on them, really hoping they would go white, disappear or fade, but they just stayed the same red/purple colour”. When cross-examined Mrs Knott said that she used her thumbs to press the spots, she used opposing thumbs one after the other. Mrs Knott demonstrated the actions to the court, it was clear she was using opposing thumbs in sequence. In re-examination Mrs Knott said she tested using fingers and thumbs, the spots did not fade, they stayed the same size, they did not change or go white.
Dr Leading's visit
In her witness statement Mrs Knott recalled “Dr Leading called at the house at about lunchtime. I can't say for certain what time he attended but my understanding was that morning surgery had finished at about 12.30pm and that he came straight after that”. In her oral evidence Mrs Knott said that Dr Leading opened the front door, shouted up to her and came up to the bedroom. Rachael was lying down and when Mrs Knott heard the doctor come in she went over, sat Rachael up and supported her with her arms. Rachael was wearing just her pants as she was too hot. She was not perky. Mrs Knott told Dr Leading that Rachael had been vomiting, she had had a high temperature since waking, she had had a course of antibiotics the previous week.
Dr Leading examined Rachael's ears and throat. Mrs Knott pointed out the three spots on Rachael's neck and said “She has got three spots on her neck and I'm worried about them”. Mrs Knott said that she pushed the spots on Rachael's neck. Dr Leading then took hold of Rachael's neck, he pushed her head back and then tried to pull it down, Rachael winced. Dr Leading said to Mrs Knott “It's not what you're thinking”. Mrs Knott said she was glad, “I thought it was not meningitis and so I was relieved, I did not press him about it”. She said that Dr Leading did not examine the spots; he did not look all over Rachael's body for spots. Dr Leading thought it was a viral infection and told Mrs Knott to give Rachael plenty of fluids and a cool bath to try and keep her temperature down. Mrs Knott could not remember if Dr Leading had examined Rachael's chest but accepted that he might have done so. She said that once she had been told “It's not what you're thinking” she could not really focus. At the time of Dr Leading's visit, the bedroom curtains were open and the room was fairly bright.
In her witness statement Mrs Knott states: “I remember that after Dr Leading left, I spoke to Malcolm. My recollection is that he was on his lunch break, which was from 12.30pm to 1.00pm. I told him that the doctor had been and what he had said”. In her oral evidence Mrs Knott said that she spoke to her husband after Dr Leading's visit and told him what had occurred. Mrs Knott gave Rachael a cool bath, she had to carry her to the bath. Even after the bath Rachael's temperature did not come down, she was “red hot”. Mrs Knott continued to try to give Rachael fluids, she also tried to give her a piece of toast but Rachael was unable to keep anything down. During the day of 19 April Mrs Knott noticed that Rachael had a horrible smell on her breath; it was a sweet sickly smell.
Mr Knott arrived home from work between 5.00pm and 5.15pm. He went straight to the bedroom. Mrs Knott showed him the spots on Rachael which...
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