Failure to diagnose tuberculosis (TB)

The claimant presented at the A&E Department of the Defendant Trust with pleuritic chest pain. Whilst respiratory examination was noted to be normal, a chest x ray was thought to reveal the watermark sign. The claimant underwent a CT pulmonary angiogram which revealed tree in bud inflammatory changes in the left upper zone with nodular consolidation. The claimant was given a course of amoxicillin for a lower respiratory tract infection and a diagnosis of costochondritis was also made.

The abnormality seen on the CT scan was not investigated further; there was no referral to a Respiratory Physician. The NHS accepted that this amounted to a missed opportunity which led to a failure to make a diagnosis of TB and start appropriate treatment.

The Claimant continued to have symptoms of cough, chest pain and fatigue and consulted the NHS 111 service, the GP out of hours service and their own GP.

2 years later the Claimant reported increasing symptoms and was admitted to the Hospital and was found to have severe consolidation throughout the left lung with cavitation in the upper lobe. The Claimant was started on standard quadruple anti-tuberculous chemotherapy for two months and dual therapy for a further four months. The Claimants condition and chest x ray improved but remained breathless and x rays revealed residual left upper lobe scarring and volume loss with further residual scarring by the left heart border.

The NHS maintained there was no evidence of significant lung damage caused by the delay. The Claimant maintained there was, which affected her ability to work and self-care. The claimant's arguments were supported by expert evidence but the effects were limited by the claimants pre-existing health conditions.

The Claimants case was valued by counsel as follows:

• Pain suffering and loss of amenity £26,000

• Loss of earnings £4,500

• Care £30,452.38 and miscellaneous loss

• Total £60,952.38.

Given the risks of litigation and the dispute in relation to causation the Claimant accepted £55,000