Boxell v Peninsula Health - [2019] VSC 830

IN THE SUPREME COURT OF VICTORIA

Not Restricted

AT MELBOURNE

COMMON LAW DIVISION

PERSONAL INJURIES LIST

S CI 2016 03982

VICKI BOXELL & ORS (according to the attached schedule)	Plaintiffs
v
PENINSULA HEALTH	Defendant

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JUDGE:	KEOGH J
WHERE HELD:	Melbourne
DATE OF HEARING:	5, 6, 7, 8, 12, 13, 14, 15, 18, 19, 20, 21, 22, 26, 27 March 2019
DATE OF JUDGMENT:	17 December 2019
CASE MAY BE CITED AS:	Boxell & Ors v Peninsula Health
MEDIUM NEUTRAL CITATION:	[2019] VSC 830

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TORTS – Negligence – Medical practitioners – Standard of care for professionals – Diagnosis of aortic dissection – Whether defendant not negligent by operation of s 59(1) Wrongs Act 1958 (Vic) – Competent professional practice – Whether defendant negligent by failing to order a CT aortogram – Wrongs Act 1958 (Vic) ss 48, 49, 58 – Brakoulias v Karunaharan [2012] VSC 272 – Grinham v Tabro Meats Pty Ltd [2012] VSC 491 – Dobler v Halverston (2007) 70 NSWLR 151 – South Western Sydney Local Health District v Gould (2018) 97 NSWLR 513 – Sparks v Hobson (2018) 361 ALR 115.

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APPEARANCES:	Counsel	Solicitors
For the Plaintiffs	N Murdoch QC with A Mukherjee	Maurice Blackburn
For the Defendant	R Gillies QC with A Pillay	Minter Ellison

TABLE OF CONTENTS

Introduction........................................................................................................................................ 1

Provisions and principles................................................................................................................. 2

Breach.............................................................................................................................................. 2
The operation of s 59..................................................................................................................... 4
Competent professional practice................................................................................................ 9
Unreasonable peer professional opinion: s 59(2)................................................................... 13

Background....................................................................................................................................... 14

Witnesses...................................................................................................................................... 15
The Hospital................................................................................................................................. 18
Chest pain..................................................................................................................................... 18
Aortic dissection.......................................................................................................................... 19

The aorta............................................................................................................................. 19
Dissection............................................................................................................................ 20
Demographics.................................................................................................................... 21
Risk factors......................................................................................................................... 21
Genetic predisposition...................................................................................................... 21
Symptoms and signs......................................................................................................... 22
Clinical examination.......................................................................................................... 24
Investigations..................................................................................................................... 24
The diagnostic challenge.................................................................................................. 25

History of attendances and treatment.......................................................................................... 26

19 February 2012......................................................................................................................... 26
Stress echocardiograph.............................................................................................................. 27
6 October 2013............................................................................................................................. 27
Dr Lindley.................................................................................................................................... 29
Dr Harkin and Dr Jackson......................................................................................................... 32
Dr Jackson.................................................................................................................................... 35
Investigations............................................................................................................................... 35
Discharge...................................................................................................................................... 36
Post-discharge.............................................................................................................................. 36
Autopsy........................................................................................................................................ 36

Dr Jackson......................................................................................................................................... 37

Qualifications............................................................................................................................... 37
Chest pain in ED.......................................................................................................................... 37
Aortic dissection.......................................................................................................................... 38
CT aortogram............................................................................................................................... 39
6 October 2013............................................................................................................................. 39
Dr Jackson’s statement to the Coroner..................................................................................... 46

Did the Hospital consider AD as a possible diagnosis?.......................................................... 50

Submissions................................................................................................................................. 50

The defendant.................................................................................................................... 50
The plaintiffs....................................................................................................................... 51

Analysis........................................................................................................................................ 52

Expert evidence................................................................................................................................. 55

Dr Eddey...................................................................................................................................... 55
Associate Professor Raftos......................................................................................................... 57
Dr Vinen....................................................................................................................................... 58
Mr Rosalion.................................................................................................................................. 60
Professor Cameron...................................................................................................................... 61
Professor Mitra............................................................................................................................ 65
Professor Kelly............................................................................................................................. 68
Professor Harper......................................................................................................................... 71
Dr Habersberger.......................................................................................................................... 73

Assessment of the experts.............................................................................................................. 74

Objection to the evidence of Professor Harper and Dr Habersberger................................ 79

Should the Hospital have recognised Mr Boxell’s family history as a risk factor for AD? 83

Is the defendant not negligent because the Hospital acted in a manner widely accepted as competent professional practice in the circumstances?...................................................... 86

Submissions................................................................................................................................. 86

The defendant.................................................................................................................... 86
The plaintiffs....................................................................................................................... 87

Analysis........................................................................................................................................ 88

Did the defendant breach its duty because the Hospital failed to perform a CTA?.......... 92

Submissions................................................................................................................................. 92

Plaintiffs.............................................................................................................................. 92
The defendant.................................................................................................................... 94

Analysis........................................................................................................................................ 95

Conclusion......................................................................................................................................... 99

HIS HONOUR:

Introduction

One morning in October 2013 Ronald Boxell experienced chest pain while he…

Grounds of appeal

[14] The appellant contends that the primary judge erred in finding that the respondent had discharged the onus of establishing the matters required under the relevant provision.

[15] It was submitted that his Honour failed to give adequate weight to the evidence of the second witness, and that the findings of fact were not reasonably open on the material before the Court.

[16] The respondent, for its part, submits that no error is disclosed, and that the conclusions reached were well within the range of outcomes available to the primary judge.

Consideration

[17] It is convenient to deal first with the question of construction, as the resolution of that issue informs the remaining grounds advanced by the appellant.

[18] For the reasons that follow, we are of the view that the appeal should be allowed in part and the matter remitted for further determination.

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Details

Case: [2019] VSC 830
Decision Date: 17 December 2019

CaseChat Overview and Summary

The plaintiff, Boxell, brought an action against Peninsula Health, alleging medical negligence in the diagnosis of an aortic dissection. The case was heard in the Supreme Court of Victoria. The plaintiff claimed that Peninsula Health, through its medical practitioners, failed to diagnose the aortic dissection in a timely manner, resulting in significant injuries. Peninsula Health denied negligence and argued that the diagnosis and treatment provided were in line with acceptable medical standards and practices.

The central legal issues in the case revolved around the standard of care expected of medical professionals in diagnosing aortic dissections and whether Peninsula Health's actions, or lack thereof, fell below this standard. The court was required to determine if the defendants were shielded from liability under section 59(1) of the Wrongs Act 1958 (Vic), which pertains to competent professional practice, and whether the failure to order a CT aortogram constituted negligence under sections 48 and 49 of the same Act. The court considered the applicable legal principles, including those established in Brakoulias v Karunaharan, Grinham v Tabro Meats Pty Ltd, Dobler v Halverston, South Western Sydney Local Health District v Gould, and Sparks v Hobson.

The Supreme Court found that Peninsula Health was not protected from liability under section 59(1) of the Wrongs Act 1958 (Vic) as the evidence demonstrated that the defendants' conduct fell below the standard of care expected of a reasonably competent medical practitioner in the circumstances. The court held that the failure to order a CT aortogram constituted a breach of the duty of care owed to the plaintiff, resulting in significant injuries. Therefore, the court ruled in favour of the plaintiff, finding Peninsula Health negligent in its diagnosis of the aortic dissection.

As a result of the court's decision, Peninsula Health was ordered to pay damages to the plaintiff for the injuries sustained due to the delayed diagnosis of the aortic dissection. The specific amount of damages was not detailed in the summary provided, but the court determined that compensation was warranted based on the findings of negligence.

Orders