High Court dismisses claim of negligence against GP at SouthDoc

Reasonable diagnosis of gastroenteritis was made but girl was later admitted to CUH and subsequently underwent surgery for a perforated appendix

The court heard the child was brought to the SouthDoc clinic in circumstances where she had been feeling unwell since the previous day. File picture: Eddie O'Hare

The High Court has dismissed a woman's claim of negligence against a GP for allegedly failing to identify acute appendicitis which she claimed caused a three-day delay in diagnosis resulting in a perforated appendix.

Ms Justice Leonie Reynolds found that Dr Rachel Finnegan, who has more than 20 years’ experience, including in out‑of‑hours services, made a reasonable diagnosis of gastroenteritis on then 11-year-old Maria Afolabi on December 13, 2017.

Ms Afolabi, now an adult and a full-time student, sued Dr Finnegan and SouthDoc out-of-hours co-op service where the GP worked.

She alleged that Dr Finnegan was negligent in failing to identify that she met several diagnostic criteria for acute appendicitis and in failing to refer her to hospital that evening.

It was common case between the parties that she suffered serious medical complications due to the perforation of her appendix including a prolonged hospital stay and surgical intervention complicated by severe wound infection.

She also had a long midline surgical incision resulting in permanent disfiguring scarring and the risk of further adverse consequences as outlined in medical reports presented to court.

There was a full defence and it was asserted that Dr Finnegan’s diagnosis of gastroenteritis was reasonable in the clinical circumstances and that she managed the patient appropriately in providing general and “red flag” advice together with a hospital referral letter.  

It was claimed that, to the extent her condition deteriorated, her mother, Gladys Afolabi, failed to follow the advice provided by Dr Finnegan and/or to use the referral letter as advised.

The court heard the child was brought to the SouthDoc clinic in circumstances where she had been feeling unwell since the previous day.  When there was no improvement in her condition, her mother got an appointment with SouthDoc in circumstances where their own GP surgery had closed early that day.

At that consultation, Dr Finnegan took a history of symptoms. Ms Afalabi was examined and a diagnosis of likely gastroenteritis was made.

The doctor made a note that the mother was particularly concerned about the possibility of appendicitis and voiced her concerns. Her mother insisted on a referral letter for the hospital for use should her daughter's condition deteriorate. It was provided in a sealed envelope.

By December 16, her pain was worse and Mrs Afolabi, a healthcare support worker, said her daughter was very weak and dehydrated.

She decided she could not wait the full five days for the bug to clear and took her daughter to the emergency department at Cork University Hospital. She was immediately admitted and subsequently underwent surgery for a perforated appendix.

Dismissing the action, Ms Justice Reynolds said she had concluded that the primary diagnosis of gastroenteritis by Dr Finnegan was reasonable.

She was further satisfied that Dr. Finnegan’s management and advice to Ms Afolabi and her mother was in accordance with the standard expected of a GP acting with ordinary care.

"In circumstances where there was no clinical negligence on the part of either Dr Finnegan or SouthDoc, I must dismiss the plaintiff’s claim," she said.

She also awarded costs against Ms Afolabi.