Background

C who was aged 46 - 48 at the time of the alleged negligence, had a history of hypertension for which he had been prescribed Bendroflumethiazide and Atenolol in November 2004.  

The Defendants in this case were all GP's at the surgery that C attended.

On 10/01/2006 C saw D1 and informed him that he had stopped taking his medication as he thought it was causing erectile dysfunction. He was then prescribed Olmesartan. C had blood tests in January 2006 revealing normal renal function.

Routine blood tests in February 2007 showed a raised creatinine level of 157 and a reduced eGFR of 43.  Normal levels should be up to 110 and in excess of 100.  C should have been referred for renal investigation but no action was taken by the GP surgery.  

Following an attendance at hospital for pain in his leg in September 2007 C was found to have a raised creatinine level of 179 and an eGFR of 37.  A letter was sent by the hospital to the GP surgery advising of C's renal problems and advising that investigations be carried out. 

C saw D2 on 21/09/2007 and was referred to Renal Physicians through the NHS Choose and Book system.  C was unaware of this referral and failed to book an appointment, he did however continue to visit the surgery.

On 01/11/2007 C saw D2 complaining of back pain and was referred to a back clinic. D2 noted that C was not able to take non-steroidal anti-inflammatory drugs, due to poor renal function but did not enquire about the renal referral and whether C had attended or made an appointment.

Following attendance at the back clinic the consultant wrote to the GP surgery on 21/01/2008 advising that there should be investigation of C's deteriorating renal function. The consultant also referred C to a rheumatologist as he was having difficulty walking due to swelling in his legs.

C missed the appointment with the rheumatologist who then wrote to the GP surgery in April 2008 advising that he had noticed from C's notes that he had a raised creatinine level of 186 and advising that he required urgent referral to a renal physician.  The GP surgery took no action on receipt of the letter.

C saw all of the Defendants on a number of occasions at the surgery during the course of 2008 but no blood tests were carried out and no enquiries were made regarding his renal function.  Routine blood tests were not taken until April 2009. These showed a very high creatinine level of 371 and eGFR of 11.   Again no action was taken by the D's once the results were received.

On 22/04/2009, C felt that his health was seriously deteriorating and that the GP's at the surgery were not listening to him, so he registered at a new GP surgery.  Blood tests were immediately carried out revealing creatinine levels of 353 and an eGFR of 16.  

On 05/05/2009 the new GP referred C as an emergency to a renal physician.  Advanced renal disease and renal scarring was confirmed following a biopsy. C went onto renal dialysis in May 2010 and underwent a kidney transplant in May 2011.

Medical Evidence

The opinion of a GP expert was sought to comment on liability and it was noted that despite C's medical history renal function tests were not performed often enough and that C was not appropriately referred to a renal physician.

Following this the opinion of a Consultant Nephrologist was sought and it was confirmed that there were several opportunities for renal referral. It was noted that there were missed opportunities for renal referral in February 2007, September 2007 and April 2008.

Had C been referred earlier this would have led to a kidney biopsy and confirmation of his kidney disease.  However it was noted that even if C had been referred earlier this would not have prevented his progression to end stage renal failure but would have delayed it by up to 2 years.

As a result of the failure to refer C, his symptoms were not appropriately managed.  C had 2 years of unnecessary pain and suffering, water retention and general lethargy and malaise.  C was unable to work due to his symptoms.

Legal Proceedings

C sought damages for personal injuries and losses suffered as a result of D's negligence.  A Letter of Claim was sent to all Defendants.

Prior to a response on liability being received the D's made an offer to settle the claim which was accepted.

The matter was settled at £30,000.

Settlement

The claim was settled on a global basis however, a breakdown of the settlement figure is as follows:

General damages: £10,000 for 2 years additional pain and suffering

Special damages: £20,000   - mainly for 2 years past loss of earnings.

D also agreed to pay C's costs of the case.

Solicitors for the Claimant: Sarah Towler, Russell-Cooke

Solicitors for the Defendant:   D1: DAC Beachcroft LLP

                                                D2: MDDUS

                                                D3 & D4: Berrymans Lace Mawer