Varipatis v Almario

In *Varipatis v Almario*, the appeal concerned a medical negligence claim brought by the respondent patient against the appellant doctor. The dispute centred on the appellant's treatment of the respondent, who was morbidly obese and had elevated liver function tests, during the period between 1998 and 2001. The patient alleged that the doctor breached his duty of care by failing to adequately manage his weight and associated health risks, leading to the deterioration of his health and the development of liver cancer.

The Court of Appeal was required to determine whether the appellant doctor breached his duty of care to the respondent patient. Specifically, the court considered whether the doctor was negligent in failing to re-refer the patient to an obesity clinic, given the patient had previously ignored a referral, and whether such a referral would have been an exercise in futility. The court also examined whether the doctor breached his duty by failing to refer the patient to a bariatric surgeon, assessing this against the prevailing practice of general practitioners at the relevant time. Furthermore, the court had to determine issues of causation, including whether the doctor's alleged failure to advise the patient of the true cause of his health problems, and his support for the patient's erroneous belief about chemical exposure, caused further deterioration. Finally, the court considered whether the failure to refer the patient to an obesity clinic was causative of his liver cancer, particularly in light of the patient's unwillingness to utilise available weight loss services.

The Court of Appeal allowed the appeal, setting aside the judgment and orders of the trial judge. The court reasoned that the doctor's duty of care did not extend to compelling a patient to undergo treatment or to persist in offering referrals that the patient had previously ignored and was unlikely to accept. The court found that the doctor had provided appropriate advice regarding weight loss and had acted within the scope of reasonable medical practice at the time. The court concluded that the alleged failures did not breach the requisite standard of care and, in any event, were not causative of the patient's liver cancer, given the patient's own lack of engagement with available treatment options. Consequently, the respondent was ordered to pay the costs of the appellant on appeal and at trial, and was granted a certificate under the Suitors' Fund Act 1951 (NSW) in respect of the costs of the appeal.