Missed Pelvic Infection Diagnosis – Lessons from a Clinical Negligence Ruling

The Case in Focus: An Escalating Clinical Picture Ignored

A recent clinical negligence ruling, Philipa Hodgson v Dr Daniel Hammond & Anor, handed down in the High Court offers a profound examination of how missed clinical signs can escalate into life-altering consequences. At the heart of the case was a missed pelvic infection diagnosis—an omission that led to unnecessary suffering, avoidable surgery, and long-term fertility concerns for the patient.

This judgment is particularly relevant to those of us working within the expert witness and medico-legal sector. The case, while anonymised here for confidentiality and professionalism, involved a young woman who presented with a combination of abdominal pain, vaginal discharge, and persistently raised inflammatory markers. Despite these red flags, and multiple contacts with general practitioners over a two-week period, a definitive diagnosis of pelvic inflammatory disease (PID) was not made until much later—by which time complications had already taken hold.

The Missed Opportunity: When Diagnosis is Delayed

What made the case striking was the interplay between evolving symptoms and clinical decision-making. The patient was reviewed both in-person and via telephone across several consultations. Laboratory results continued to point toward systemic infection, and symptoms remained unresolved despite antibiotic treatment. Yet, the pivotal diagnostic step—a pelvic examination—was not performed when arguably it should have been. The judgment concluded that this oversight constituted a breach of duty.

Crucially, the court found that had an appropriate examination been conducted at an earlier stage, signs of PID would have been detectable. Antibiotic therapy could have commenced within 48 hours, preventing the development of a tubo-ovarian abscess, the removal of a fallopian tube, and the cascade of chronic pain and fertility complications that followed. In other words, the missed pelvic infection diagnosis had tangible, avoidable outcomes that were both physical and psychological in nature.

Clinical Standards and the Missed Pelvic Infection Diagnosis

From a medico-legal perspective, this case reinforces core principles that underpin clinical negligence evaluation. The court relied on the well-established Bolam and Bolitho tests to assess whether the standard of care met that of a responsible body of medical opinion—and if that opinion was logically defensible. The failure to perform or arrange a timely pelvic examination did not withstand that analysis. The defendant’s own expert conceded this point during trial, ultimately removing factual causation from contention.

Documentation Matters: A Lesson for All Clinicians

But the case speaks to more than clinical decision-making. It also highlights the forensic weight given to clinical documentation. Notes made by one GP were praised for their clarity, which allowed the court to accurately infer the thought process behind the decision not to escalate the patient’s care. Conversely, vague or reconstructive testimony from another clinician was ultimately found to lack credibility, especially when it strayed beyond the content of contemporaneous records.

Implications for Expert Witnesses and Legal Teams

For expert witnesses—especially those engaged by legal teams in primary care, women’s health, or nursing negligence claims—the implications are far-reaching. Firstly, it underlines the importance of not treating telephone consultations as mere administrative follow-ups. If symptoms are ongoing or unclear, physical assessment remains critical. Secondly, it reaffirms the importance of thorough record keeping, not just for continuity of care, but for its evidential value in any subsequent legal challenge.

Beyond the Individual: Systemic Learning

Moreover, the case draws attention to the role of system-level contributors to diagnostic delay. Multiple clinicians had input across the timeline, with no single moment of overt neglect. Yet the absence of a coordinated, escalation-based approach allowed a serious condition to advance unchecked. In expert witness work, this kind of cumulative oversight is increasingly forming the basis of liability arguments—especially where handover, triage, or inter-practitioner communication is at issue.

A Human Impact: The Patient’s Voice

Finally, the emotional and reproductive impact of a missed pelvic infection diagnosis cannot be understated. The patient’s symptoms persisted for years, leading to repeated surgery, fears over her reproductive future, and at one point, a miscarriage. Expert witnesses must be prepared to assess not just breach and causation, but also the enduring quality-of-life implications that follow a failure of this kind.

Conclusion: Lessons for Clinical and Legal Professionals

As the medico-legal industry continues to evolve, this ruling serves as both a cautionary tale and a professional benchmark. It reminds us that diligence in history-taking, commitment to comprehensive physical assessment, and attention to clinical red flags are not just good medicine—they are defensible practice. And in the expert witness arena, these are the foundations upon which sound, ethical, and credible opinion is built.

For Apex Experts, whose panel includes specialist nurses and GPs providing expert witness reports across the UK, this case is a sharp and timely example of the complexities and responsibilities our experts navigate. It also reinforces our core values: clear, impartial, well-reasoned reporting grounded in clinical realism and legal rigour.