The scene

A patient in his early 50s saw an MDU member who worked as an independent GP for a DVLA assessment. This GP wasn't the patient's regular doctor, and performed an examination as a precondition to the return of the patient's driving licence.

The patient had been banned from driving for 24 months, having failed a breath test and being found significantly over the legal alcohol limit. His blood pressure was recorded on the DVLA form as 182/105.

Some five years later the patient was seen by his own GP, whose note recorded 'See pn [practice nurse] for BP review.' Despite this recommendation the patient didn't have his blood pressure checked and went on to suffer a minor stroke a few years later.

The patient was advised to stop drinking and smoking but suffered a further stroke the same year, which proved fatal.

The claim

A claim was pursued by the patient's wife on behalf of the estate, alleging that during the DVLA examination, the MDU member failed to advise the patient have his blood pressure checked by his own GP and diagnosed the patient with 'white coat hypertension'. It was also alleged that the patient told his wife about this diagnosis afterwards and that his high blood pressure may have been because of his anxiety about the appointment.

The GP had no memory of the consultation and relied on his habitual practice in defence of his actions. He confirmed that the DVLA provided a printed form for completion by the examiner, which doesn't have to be included in the patient's GP records. The form didn't invite any comments and allowed no room for individual observations or notes by the examiner.

The GP described his typical examination, which would have included a cognitive assessment and taking the average of up to three blood pressure readings. Having established the readings weren't normal, the GP would have asked the patient about his history of blood pressure and family hypertension.

He explained in his defence that a diagnosis couldn't be made from blood pressure readings taken on a single occasion, and also confirmed that while he may have used the expression, he did not make a diagnosis of 'white coat hypertension'. In accordance with his typical practice he would have advised the patient to consult his GP, explaining that if he did have hypertension it would need treatment.

The outcome

The MDU obtained expert reports from a GP and neurologist. While the neurology experts on both sides of the case couldn't agree to what extent the risk of stroke was increased by hypertension, they acknowledged that there would nevertheless have been an increase.

None of the experts were able to say that had the patient been seen by his GP following the DVLA assessment, on the balance of probabilities his blood pressure reading would have been raised.

The claimant argued that because the patient's untreated hypertension carried an increased risk of stroke, it materially contributed to the subsequent strokes. The case eventually went to trial for the judge to determine the facts.

The court found in favour of the GP on the facts, and that he advised the patient to have his blood pressure checked by his own doctor. It also accepted that the GP did not make a diagnosis of white coat hypertension. On factual causation, the court held that the patient was given advice to attend his GP to have his blood pressure checked and didn't do so. It also found that the claimant had failed to prove that any subsequent blood pressure reading would have been raised.

The court determined that even if the GP had breached his duty of care by failing to advise the patient to have his blood pressure monitored by his own doctor, this would not have altered the outcome. The judge confirmed the 'but for' test applied, which asks, 'but for the existence of x, would y have happened?'

In light of the patient's lifestyle the judge also commented that even if the court had found the GP to be liable, any damages would have been reduced by 25%. This reflected contributory negligence on the part of the patient for failing to have his blood pressure checked when advised to do so by his own GP five years after the DVLA assessment. The claim was dismissed and the MDU recovered their costs of defending the matter to trial.