When do the actions of health visitors constitute negligence?

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The High Court of England recently issued an interesting judgment which examined the duty of care of visiting physicians who come to patients’ homes to provide care and support. It is significant because it is the first clinical negligence case that deals with the role of health visitors, their responsibilities and the standard of care expected of them. In the case of XM Partnership Trust vs. Leicestershire QB / 2017/002909, Justice Stewart considered the plaintiff’s allegations of medical negligence regarding the service of the PA.

Background

The action was brought by the plaintiff’s father on behalf of the plaintiff, born June 27, 2012. The plaintiff received treatment in January 2013 for a rare benign brain tumor. The tumor caused an overproduction of cerebrospinal fluid which accumulated in the ventricles of her brain. This resulted in his head growing unusually fast. At first, the elasticity of the Applicant’s skull compensated for the rapid increase in the size of his head. However, in December 2012, high intracranial pressure started causing symptoms, and his parents took him to an emergency walking center on December 20, 2012. On January 3, 2013, the tumor was successfully removed but, by that time, the Applicant had sustained catastrophic permanent brain damage.

The defendants were the body responsible for the medical examination service which had been provided to the plaintiff and his parents. As part of this service, a number of people went to the applicant’s home to check on his progress. Several had measured the applicant’s weight, but not all had measured his head.

The negligence charge

A number of grounds of negligence were alleged on behalf of the plaintiff.

It was claimed that one of the health visitors, who measured the applicant’s head during a visit on August 8, 2012 (the August visit), should have noticed discrepancies between his weight gain and the increased head circumference and should have either (i) referred it to a general practitioner or pediatrician for evaluation; or (ii) monitored the pattern and rate of growth of the head circumference and arranged for another measurement to be obtained one or two weeks later. It was also said that the medical visitor had (i) failed to inform the parents of the applicant of the contrast between the increase in weight and the head circumference and that this should be monitored, (ii) had not noted it in the claimant’s records and (iii) failed to contact the general practitioner to request that the claimant be followed up on his next visit.

Allegations were made that other medical professionals, who visited after the August visit, failed to (i) identify that the claimant had not seen a general practitioner for a 6 to 8 week check-up, and (ii) rectify this by making an appointment or told his parents to arrange this and (iii) did not tell his parents that he should have seen a GP due the increase in head circumference and the difference in weight gain that had been noted during the August visit.

The written record was amended to indicate that the deviation in the growth of the applicant’s head should have been noted by visual inspection during visits after the August visit where the applicant’s head circumference was not measured .

decision

The defendant had admitted that he could be held liable for the acts and omissions of his health workers if there had been negligence on their part. The court case focused solely on negligence liability and a large body of evidence was presented.

In considering the duty of care owed to a health visitor, Justice Stewart noted that it was clear that the health visitor was required, in the context of this case, to obtain a head circumference measurement. at the first contact and at the 6th week contact. In addition, the visiting physician should plot the head circumference graph, interpret the head circumference size to ensure that their growth was within the expected percentile lines given the potential for future growth and past growth measurements, and, s ‘there was a problem with a rapidly growing head, to consider hydrocephalus and to urgently consult a general practitioner.

The judge found that there had been a breach of an obligation in connection with the August visit. On the basis of the evidence that had been produced, he was satisfied that a standard of due diligence required that, when assessing head circumference growth, the basis of a “red flag” of crossing two lines of percentile was two measurements spaced 6 weeks apart. The judge was convinced that the trajectory of the measurements that were taken of the circumference of the claimant’s head, coupled with the fact that they took place over a period of 4 weeks and not over a minimum period of 6 weeks, required a professional health visitor, including a health visitor, either to re-measure so that there is a minimum period of 6 weeks between measurements or to refer the applicant to a general practitioner. There was no issue of causation with respect to this breach of duty as the respondent accepted that if a referral had been made following the August visit, the result would have been a new head measurement. of the applicant, a successful diagnosis and treatment.

Regarding the failed GP check, a medical visitor had the obligation, in circumstances such as the present case, to remind parents of the GP check and recommend that the baby undergo it, albeit belatedly.

It was also found that there was a breach of duty because a medical visitor did not notice that the plaintiff’s head was disproportionate and did not measure his head circumference and / or referred him for an opinion. medical.

comments

This case is interesting given that it appears to be the first case that focuses on the duty of care of health visitors. It shows that the acts or omissions of the medical representatives can constitute medical negligence. In this case, it was made clear that the standard that a competent health visitor should meet does not require a diagnosis to be made, which a health visitor would likely not be qualified to provide. A referral to a general practitioner would have been sufficient to avoid negligent care. However, the court clarified that the standard to be expected from a health visitor applied regardless of the qualification or position held by the health professional responsible for carrying out the task. This means that it is the responsibility of any healthcare professional performing health checks, regardless of their specific role. While this might not be a surprising finding, it should reassure those who receive services of standards that must be met.


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