The Plaintiff experienced a sudden onset of excruciating pain to her chest radiating to her left arm and was taken to the Hospital’s Accident and Emergency Department for assessment.
While the Hospital’s assessment of the Plaintiff involved a number of aspects, it did not include the administration of a series of blood tests designed to measure the level of a particular protein complex called ‘troponin’ in the blood. Troponin is released into the bloodstream if there is damage to the heart. The Hospital completed its assessment and the Plaintiff was discharged home some 4 hours later. Three days later, she suffered a serious heart attack, described as an ST elevation myocardial infarction (STEMI).
The Plaintiff argued that, given her presentation, the Hospital should have applied its acute coronary syndrome (ACS) pathway, which included administering troponin blood tests.
The Defendant denied that the decision not to administer the troponin blood tests was negligent and/or breached a duty of care, stating that to administer the tests on every patient presenting as the Plaintiff did on that day would be unjustifiably intrusive and burdensome. The Defendant argued that this decision was in accordance with a practice that was, at the time, widely accepted by emergency physicians as competent professional practice pursuant to s5PB(1) of the Civil Liability Act 2002.
The Court considered three fundamental issues:
- Whether, given the Plaintiff’s presentation, it was unreasonable not to administer troponin blood tests;
- Whether the troponin blood tests would have yielded abnormal results had they been administered; and
- Whether, had the troponin blood tests been administered and the results were abnormal, the Plaintiff would have avoided the STEMI.
The Court found that, given the Plaintiff’s presentation, the ACS pathway should have been applied and the failure to administer the troponin blood tests was not a practice then widely accepted by the peers of emergency physicians, as competent professional practice.
On the issue of liability, the Court concluded that the risk of harm to the Plaintiff was foreseeable and the potential seriousness of that harm was very significant. The treatment that would have avoided the harm suffered by the Plaintiff was known to the Hospital staff, it was available, and it was simple to implement. The burden in taking precautions to avoid such a risk was almost non-existent.
On the issue of causation, the Court was satisfied that, had the omission to order troponin blood tests not occurred, and the results were abnormal, the probable course of events is that the Plaintiff would have been admitted to the Hospital’s coronary care unit where she would have received conservative management treatment and more likely than not would have avoided her STEMI.
The Court found that there was no sensible reason for leaving the Plaintiff to bear the harm that she suffered and awarded judgment for the Plaintiff in the sum of $450,000.
To read the decision in Lazarevski v North Metropolitan Health Service [2019] WADC 84, click here.
