Clinical Negligence

Practice Question

1. Whilst on holiday in Spain in August 2018, Tara, aged 23, developed diarrhoea
which continued throughout her three week holiday. On her return to England the
diarrhoea persisted and she went to see her General Practitioner, Dr Clark, at the
Granville Medical Practice. Dr Clark concluded that Tara had contracted a virus in
Spain and told her she would soon recover and she should not worry about it. Three
weeks later Tara was still suffering from diarrhoea and also experiencing stomach
pains and felt generally tired and unwell and so she returned to the Granville Medical
Practice. As Dr Clark was away on paternity leave Tara was seen by Dr Franklin,
who prescribed medication to help relieve the diarrhoea. The medication brought
some relief from the continuing diarrhoea but Tara still felt unwell and realised that
she had lost more than a stone (over 6kg) in weight since the beginning of her
holiday and so she returned to the Granville Medical Practice. She again saw Dr
Franklin who now referred Tara to the Twickenham NHS Trust Hospital for
investigative tests.

At the hospital Tara was seen by Dr Jasper, a Registrar in gastro-enterology, who

after reviewing Tara’s medical records concluded that further tests were
unnecessary as Tara was suffering from irritable bowel syndrome. Dr Jasper gave
Tara dietary advice as how best to manage the condition and referred her back to
her General Practitioner. Tara pointed out her weight loss but Dr Jasper advised that
she should simply follow the recommended dietary changes. Tara found a modest
improvement in her condition as a result of her dietary changes however, she
continued to lose weight and occasionally saw traces of blood in her stools and felt
increasingly lethargic and nauseous. Feeling more and more concerned about her
condition she returned to the Granville Medical Practice four weeks after the hospital
visit and was seen again by Dr Franklin who referred her once more to the
gastroenterology department of the Twickenham NHS Trust Hospital.
Tara was now feeling extremely unwell. She had lost another stone (6kg) in weight
and was passing large amounts of blood in her stools. She was seen at the hospital
by Mr Spring, a consultant in gastroenterology. He performed a rectal biopsy and
further tests. The test results revealed that Tara was suffering from advanced bowel
cancer. Tara was informed that the extent of the disease meant that radical surgery
was necessary.

Tara underwent surgery to remove the cancerous tumours but such was the extent
of the disease she has been left with a permanent colostomy bag. Furthermore, she
was informed that although the surgery was successful her chances of surviving for
the next five years were in the region of 40% as the cancer was at an advanced
stage when it was diagnosed. Tara is very upset as she has further learnt that she
could have opted for intensive chemotherapy instead of surgery which although not
offering such good prospects of a cure would have avoided the need for a colostomy
bag. Mr Spring did not discuss this alternative with her.

Discuss whether Tara has a claim in clinical negligence.

100 marks

GLOSSARY

Colostomy/ colostomy bag: A colostomy is a surgical procedure. During a

colostomy, surgeons divert one end of the large intestine into a visible opening –
known as a stoma – on the patient’s abdomen. A small pouch, or colostomy bag, is
then placed over the stoma to collect waste products that would normally pass
through a person's rectum and anus in the bathroom.
Diarrhoea: a condition in which faeces are discharged from the bowels frequently
and in a liquid form.
Gastroenterologist: A specialist in the treatment of gastrointestinal disease.
Irritable Bowel Syndrome: a condition in which recurrent abdominal pain with
constipation and / or diarrhoea continues for years without any general deterioration
in health.
Rectal Biopsy: the removal of a small piece of living tissue from the rectum, the
terminal part of the large intestine, for microscopic examination.
Stools: faeces; waste matter discharged from the bowels.