A patient sued her Moranbah based GP (Dr Swenson) alleging that she suffered an allergic reaction to the antibiotic Norfloxacin, which then led to extreme photosensitivity, cerebral vasculitis and stroke. She alleged the prescription of the antibiotic was inappropriate. The claim was unsuccessful. This article is a brief summary of the Supreme Court’s comprehensive reasons.
Background
In February 2014 the patient presented at her GP with abdominal pain in the kidney area. Her pathology showed blood in the urine and elevated levels of leukocytes (fighter blood cells). She also had mild fever and higher than normal blood pressure.
Although the test results were not yet conclusive (as some tests were outstanding) Dr Swenson was concerned that the patient had complicated urinary tract infection and was at risk of quickly developing serious illness. The GP wanted to prescribe antibiotics. The patient alleged that she told the GP that she was fearful of antibiotics as she had been treated with antibiotics in the past in South Africa and she was allergic to penicillin, sulphur and another unknown substance.
Importantly, the judge found that the patient only advised Dr Swenson of her allergy to penicillin and sulphur but not about an allergy to an unknown substance.
Having been advised of penicillin and sulphur allergy, Dr Swenson told the patient that there are different classes of antibiotics. Just because you are allergic to one doesn’t mean you are allergic to all. Dr Swenson did some research, and prescribed Norfloxacin, an antibiotic from a class not related to penicillin or sulphur.
Test results which became available in the following few days showed that the patient did not have urinary tract infection. By then, however, the patient had taken the Norfloxacin tablets. As it happens, she was allergic to Norfloxacin also. She went on to allege that in the ensuing years her health deteriorated and 3 years later she suffered a stroke – all because of taking these tablets.
Was it inappropriate to prescribe Norfloxacin?
As a medical professional, a GP owes a patient a duty of care.
In Queensland, doctors have a very powerful statutory defence to negligence claims. With one exception (discussed below) a doctor escapes liability if they can show that their treatment was accepted by a significant number of respected doctors as competent professional practice.
What does this mean? In simple terms, if an experienced doctor gives expert evidence in court that Dr Swenson did what many other GPs would have done, then that’s enough for the doctor to win.
Which is precisely what happened. The court heard expert evidence from a very experienced GP. He said that when a GP is presented with pathology results indicating the strong probability of a serious infection, it’s best not to wait but to start antibiotics straight away. And if the patient is allergic to a particular type of antibiotics, it’s reasonable to prescribe one from a different class.
What is the exception?
A doctor can’t escape liability if they fail to give advice about the risks of a particular treatment (even if the treatment is reasonable). Say a patient is blind in eye and needs surgery on the good eye. The doctor fails to advise that there is a 20% risk of losing vision in the good eye because of the surgery. Even if the doctor doesn’t make any mistakes during surgery, if the patient loses their vision, they can say that if they had known of the risk, they would never have agreed to surgery as they only had one good eye to begin with and didn’t want to lose their remaining vision. In such a case, even if the treatment was entirely appropriate, the doctor can’t escape liability because they failed to advise about the risks involved.
Even if it was appropriate for Dr Swenson to prescribe antibiotics, should she have advised about the risks? The Court said no, as the patient was already acutely aware of the risk and was very afraid of developing a further allergic reaction to the prescription of any antibiotic. (This aspect of the judgment is somewhat unclear. For example, assuming antibiotics can cause stroke, shouldn’t the doctor advise about this? After all, a stroke is not the same as an allergic reaction.)
Should the GP have checked what happened earlier in South Africa?
The patient alleged Dr Swenson should have checked the South African medical records first before prescribing Norfloxacin. However, because the patient was specific about the two substances she was allergic to, there was no need to check the South African patient records. In addition, the court found Dr Swenson asked about the South African hospital, but the patient couldn’t name it, and in any event, it would have taken approximately 17 days to obtain records.
Did the antibiotic actually cause extreme photosensitivity, cerebral vasculitis and stroke?
Based on very complex expert evidence, the court found that the patient did have a minor allergic reaction but otherwise her health problems (including her stroke) were not caused by ingesting Norfloxacin. This type of antibiotic has a short half life (i.e. most of it leaves your system very quickly). The patient took a very low dose for a short time. She went back to work and her serious health problems presented years later.
What are the lessons of this case?
It’s always important to remember that sometimes there are bad outcomes even if the doctor does everything by the book. Assume that the antibiotic had in fact caused the patient’s health issues. Even so, this case shows that a claim won’t succeed if the doctor acted in accordance with widely accepted professional practice. It was enough to show that a GP can prescribe antibiotics based on a provisional diagnosis of probable infection.
