In a landmark decision, the New South Wales Court of Appeal upheld the appeal of a general practitioner (GP) who was previously found negligent for not referring a morbidly obese patient for bariatric surgery. The case, Varipatis v Almario [2013] NSWCA 76, provides important clarification on the limits of a GP’s duty of care when a patient refuses to follow medical advice.
Background of the Case
The patient, under the GP’s care between 1997 and 2011, was suffering from several health issues exacerbated by his morbid obesity. It was critical that he lose weight to prevent the onset of cirrhosis, which eventually developed in June 2001, followed by liver cancer. The Trial Judge initially found the GP negligent for failing to refer the patient to a bariatric surgeon in 1998, concluding that this omission contributed to the patient’s deteriorating health.
During the trial, it was revealed that the GP had discussed the need for weight loss with the patient in 1997. The GP had also referred the patient to a range of specialists, including a respiratory physician who in turn referred him to an obesity clinic. Although the patient had lost 30 kilograms following the referral, he ultimately refused to continue the weight loss treatment, stating that the weight loss did not improve his condition.
Court of Appeal’s Decision
In overturning the trial decision, the Court of Appeal ruled that the GP had fulfilled his duty of care by advising the patient to lose weight and referring him to appropriate specialists. The Court found that a GP’s responsibility stops short of continually pursuing referrals if a patient refuses treatment.
The Court emphasised that, while a GP is expected to advise patients about the need for weight loss and offer specialist referrals, they are not required to go beyond this if the patient rejects the advice. The Court noted that further referrals in such circumstances would be “an exercise in futility.”
Crucially, the Court pointed out that the evidence from expert general practitioners and endocrinologists did not support the conclusion that a reasonable GP in 1998 would have referred the patient to a bariatric surgeon. The Court held that it would be unreasonable to impose a greater duty on the GP in these circumstances.
Key Takeaways
The Court of Appeal’s decision reinforces the principle that patients bear responsibility for their own healthcare decisions. A GP’s duty does not extend to forcing further medical interventions if a patient, fully understanding the risks, chooses not to follow clear medical advice.
This case serves as an important reminder for healthcare professionals that while it is essential to provide firm and clear advice, the legal duty of care is limited when a patient makes an informed choice to decline treatment.
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