A recent decision of the Queensland Court of Appeal confirms
that sometimes a pathology service needs to do more than just
provide accurate test results.
Mrs Papa had been the recipient of an artificial mitral valve.
She required lifelong anti-coagulant therapy (warfarin medication)
as a result. Sullivan Nicolaides' Warfarin Care Service had
been monitoring the levels of warfarin in Mrs Papa's blood.
Warfarin levels were translated into a measure of clotting time
(INR) which was advised to Mrs Papa and her general practitioner
together with recommendations regarding her warfarin dose. Both
high and low INR levels carry significant risks. Mrs Papa's INR
levels had been both too high and too low during early 2002, and on
27 February 2002 a pathologist from Sullivan Nicolaides advised Mrs
Papa and her general practitioner that Sullivan Nicolaides would no
longer monitor Mrs Papa's INR levels. This was apparently
because it apprehended that she had not been compliant with its
Mrs Papa saw her general practitioner on 28 February. He
adjusted her warfarin dose and referred her to another warfarin
monitoring service. On 29 February Mrs Papa suffered a stroke that
resulted in severe injuries.
The trial judge found that Sullivan Nicolaides should have
contacted Mrs Papa and her GP to alert them to the sub-therapeutic
INR readings and recommend that additional steps be taken to remedy
that issue including investigating alternative forms of
anti-coagulation. The judge found that if Sullivan Nicolaides had
done this, Mrs Papa would have been referred to her cardiologist
and that treatment recommended by him would most likely have
prevented her suffering a stroke.
Sullivan Nicolaides appealed. It argued that the claim was one
for the loss of a chance of a better outcome and therefore not one
in which Mrs Papa could recover damages (as a plaintiff must show
it is at least 51% likely they have suffered an injury to recover
damages). It argued that the evidence did not support either the
liability or causation findings and that the findings were reached
relying too much on the benefit of hindsight.
The Court of Appeal rejected these arguments. The majority found
there was sufficient evidence to support the findings on both
liability and causation. The dissenting judge would have allowed
the appeal on the basis it was no more than speculative that Mrs
Papa would have undergone the treatment suggested by her
cardiologist (which itself carried significant risks).
The case illustrates the issues that may arise where a number of
different medical practitioners or services are treating a patient.
Sullivan Nicolaides provided monitoring of Mrs Papa's INR and
warfarin dosage recommendations. It probably saw this as its
primary role. The court however accepted that although the expert
evidence was mixed, something more was required. A 'business as
usual' approach was in this case, not enough.
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guide to the subject matter. Specialist advice should be sought
about your specific circumstances.
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What happens if a patient, particularly a mental health patient,.
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