Hospital wins appeal in appendicitis case

by | Jan 4, 2017 | Health Blog

The South Metropolitan Health Service was successful in its appeal against the findings of the primary judge in Westcott v Minister for Health [2015] WADC 122.

The claim arose from the alleged negligent care the Plaintiff received as a patient at Fremantle Hospital (the Hospital) in 2009 when it was said that staff delayed in the diagnosis of his appendicitis. It was alleged that the Hospital was negligent by:

  1. failing to diagnose appendicitis on his admission on 31 July 2009;
  2. incorrectly interpreting the CT scans of the Plaintiff’s abdomen on 31 July 2009;
  3. failing to take account of all his symptoms, which would have led to an early diagnosis of appendicitis;
  4. failing to perform a laparoscopy or laparotomy in the period 1 – 3 August 2009, which would have allowed for the Plaintiff’s appendicitis to be diagnosed;
  5. failing to settle any clinical doubts about the diagnosis, including by failing to perform a laparoscopy and/or laparotomy prior to 6 August 2009;
  6. delaying treatment of and failing to drain an appendiceal abscess in the period 31 July 2009 to 6 August 2009; and
  7. delaying surgical treatment until 6 August 2009.

The Plaintiff alleged that the hospital’s omissions resulted in a delay in his treatment for appendicitis and the drainage of his pelvic abscess, as a result of which he suffered physical and psychiatric injury. He succeeded at first instance and was awarded damages of $933,544.87.

Appeal

On Appeal, it was observed that the Plaintiff’s case at trial was run on the basis that the Plaintiff presented with appendicitis in its primary form, and that the Hospital had misdiagnosed his condition as sigmoid diverticulitis. The Hospital submitted that the grounds of appeal must be considered in light of the proper aetiology of the Plaintiff’s condition, and ‘the undisputed finding that he did not have, and the CT scan of 31 July 2009 (properly understood) did not reveal, primary appendicitis’.

The Hospital submitted that the radiologist correctly identified the primary cause of the Plaintiff’s condition and a reasonable report of the CT scan would not have reported primary appendicitis. On this basis the colorectal surgeon’s action in continuing conservative management was appropriate. It was also argued there was no evidence to support the judge’s findings as to the causation of residual abdominal symptoms from the delay in surgery.

The Court of Appeal found that on the primary judge’s findings, the CT scans, properly understood, showed an inflammatory mass caused by sigmoid colitis. The scans excluded a primary inflammation of the appendix. The Court stated that there would need to be some foundation in the expert evidence to conclude that the mere failure to refer (expressly) in the report to the secondary inflammation of the appendix, constituted negligence in the reporting of the CT imaging.

The Court of Appeal also found that the primary judge’s findings of negligence by the surgeon could not be supported. The Court held that there was no evidence that a general surgeon acting reasonably would not, given the findings of the CT scan, have sought the opinion of the colorectal unit, but would instead have treated it as a case of primary or, possibly primary, appendicitis requiring urgent surgery.

The Court also accepted that the trial judge erred in concluding that the abdominal injuries suffered by the Plaintiff were caused by the negligence of the Hospital.

The Appeal was therefore allowed.

To read the full decision in South Metropolitan Health Service v Westcott [2016] WASCA 225, click here.

Gemma McGrath

Gemma McGrath