Key issue

The Plaintiff alleged that:

  • a medical officer at the Hospital incorrectly recorded on a discharge summary sheet that an injury to his left acromioclavicular (AC) joint was a subluxation rather than a dislocation; and omitted to refer him to seek orthopaedic review to determine the most appropriate form of treatment for his injury; and
  • the Hospital’s failures gave rise to his residual left shoulder pain and restriction caused by a delay in receiving surgical treatment.

Background

The Plaintiff suffered an injury to his left AC joint in an incident unrelated to the Hospital.

After presentation to the Hospital, the Plaintiff underwent an x-ray of his left shoulder which revealed ‘a dislocation of the left AC joint’. Whilst a medical officer recorded in the hospital notes that the Plaintiff suffered an ‘A/C joint dislocation’, the same medical officer incorrectly recorded ‘AC joint subluxed L shoulder’ in the discharge summary sheet provided to the Plaintiff. Conservative management was implemented, and the Plaintiff was advised to see his general practitioner (GP) in two weeks. The Hospital did not have any further involvement in the Plaintiff’s treatment.

After consultation with a GP on two subsequent occasions, conservative management was maintained. After another presentation to his GP, the Plaintiff was referred to an orthopaedic surgeon.

The orthopaedic surgeon put the Plaintiff on a public waiting list as a semi-urgent case. The Plaintiff underwent reconstruction surgery which produced a good anatomical result as revealed by subsequent x-rays and imaging. The Plaintiff reported ongoing pain in his left shoulder together with restricted movement which he alleged would not have occurred (or been minimised) had he undergone earlier reduction surgery.

Findings

The Court found in favour of the Hospital, on the basis that:

  • It is widely accepted that both conservative and surgical treatments are competent professional practice for AC joint dislocations of the kind suffered by the Plaintiff [44].
  • Nothing turned on the incorrect reference to subluxation rather than dislocation or the failure to advise of the need for orthopaedic review as the Plaintiff’s GP was not misled and brought his own medical judgment to the task and treated the Plaintiff accordingly [60] – [62].
  • The evidence was not persuasive of a finding that it was more probable than not that the Plaintiff’s ongoing left shoulder pain had been caused by a failure to proceed with early reduction surgery [90].
  • There was a lack of evidence pointing to a probable better outcome from reduction surgery in the event of it having happened [103].
  • The requirement of causation is not overcome by redefining the mere possibility that the Plaintiff’s ongoing problems might not have eventuated as a chance and then saying that that chance has been lost, given that now he does have problems with his left shoulder. It was not open to argue that the present position of shoulder pain must be the result of the negligent act or omission of the Hospital [121].
  • There is an absence of cogent evidence that the Plaintiff is worse off by not having early reduction surgery than by proceeding to treat his injury conservatively and when that failed, by later having reconstructive surgery and being where he is today. That early surgery might have made a difference does not prove causation: Adeels Palace at [45] and see also [54] – [56]. [122].
  • It could not be found that the Hospital’s failure to report the need for orthopaedic review caused the Plaintiff to suffer a result which was less than what he may have had in the event of earlier orthopaedic referral and/or reduction surgery. The ‘but for test’ in Adeels Palace [45] has not been met [123].

Read the decision here: Chester v WA Country Health Service [2019] WADC 152

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