Change of Heart

Published: 08 Apr 2021

A 52-year-old female underwent a heart transplant for a dilated cardiomyopathy.

It transpired that 30 years before she had complained of some palpitations and was taken into a major hospital. In the cardiac unit she underwent various tests. Her palpitations settled without any particular management, but she was told she had a “weak heart”. No follow-up was arranged at the time, but she was advised to speak to her General Practitioner.

One week later she phoned a locum at the General Practice who left a written message in the notes for the Principle indicating that the lady had phoned saying she had been discharged with a “weak heart”. The Principle did not contact her in relation to this.

Over the next few years she was seen on a number of occasions, including throughout two pregnancies, and there was no further mention of her difficulties. There had been no communication from the hospital to the General Practitioner.

Dilated cardiomyopathy can require cardiac transplantation in around 25% of cases at the time of diagnosis, which is usually in the second or third decade. Thereafter, the incidence rises approximately 1% per year if it is untreated. The likelihood of requiring any heart surgery is very low in patients who have been treated from the time of diagnosis with drugs called ACE inhibiters, and on the balance of probabilities, this lady would not have required cardiac transplantation had she been so treated.

The first hurdle was the statute of limitations, and it was argued that she initially had a “weak heart” and had been told to contact her GP. She undertook this on one occasion and did not mention it again, even though she saw her GP on many occasions, and she did not mention it during her pregnancies.

The GP failed in his duty by not discussing the matter with her at the time he was informed by his locum, nor did he seek any information from the hospital. The hospital records did not contain any discharge letter to the General Practitioner. The duty of care was therefore breached by both the General Practice and the Cardiac Unit.

It was held that she had a 20% element of contributory negligence. She acknowledged that she had been told to phone her GP and did so but did not follow-up. The statute was overcome because she was not aware her condition could deteriorate so significantly and that she might require cardiac transplantation if she did not receive drug therapy. The statute was therefore deemed to have commenced when she was admitted to hospital in heart failure a short time before her transplantation, which was her time of knowledge, and the GPs with the hospital were each found to be 40% liable.

MDU figures for 2020 show that less than one in six actions in medical negligence actually succeed. with the vast majority failing on the grounds of causation. It must be remembered that subsequence is not the same as consequence.

Initial screening is therefore essential to manage client expectations at an early stage. This avoids unnecessary effort and costs for all concerned. Too many cases are taken to Court with no chance of success. This is stressful for both the client and their legal advisor, and indeed for the medical personnel involved.

For fast and effective screening of all potential medical negligence cases, contact Peyton Medico Legal Services now on +44 (0)28 87724177, or email

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J.W. Rodney Peyton OBE

Firm: Peyton Medico Legal
Country: United Kingdom - UK Wide - UK Wide

Practice Area: Medical Negligence Expert Witness

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