In Taylor v Woodgate, the District Court of New South Wales dismissed a claim of medical negligence against an orthopaedic surgeon following a hip replacement and subsequent revision surgery. The plaintiff alleged failures in providing information about risks, surgical technique, and post-operative care. However, the court preferred the defendant’s contemporaneous clinical notes and the joint orthopaedic expert evidence, finding no breach of duty across five key issues.
In issue
- In this case, the District Court of New South Wales considered whether the defendant, Dr Woodgate (orthopaedic surgeon), breached his duty of care in relation to a hip replacement procedure, and a subsequent revision procedure. The plaintiff claimed that Dr Woodgate was negligent in failing to warn him of the risk of complications, failing to perform the revision procedure to the expected standard, and failing to provide him with adequate post-operative management. The case was heard by His Honour Weber DCJ.
The background
The plaintiff, Mr Taylor, had a history of hip issues, having suffered a slipped upper femoral epiphysis when he was 14 years old. He underwent a procedure to insert three pins into his femur in 1984, two of which were removed two months after the procedure. The plaintiff attended Dr Woodgate in late 2010, complaining of left hip pain. Dr Woodgate performed a procedure to remove the remaining pin from his femur. The plaintiff continued to complain of hip pain, so Dr Woodgate recommended hip replacement. He performed the plaintiff’s hip replacement on 10 May 2011, using prosthetic components including an acetabular cup, neck, and head made from CoCrMo (cobalt–chromium–molybdenum) alloy, and an MSA Size 2 femoral stem made from titanium alloy. The plaintiff underwent a revision of the hip replacement by Dr Woodgate on 30 August 2011. He continued to consult with Dr Woodgate on a number of occasions following the revision procedure. There were significant factual disputes as to the information conveyed between the plaintiff and Dr Woodgate at these consultations.
The plaintiff claimed that, had Dr Woodgate provided adequate information about the risks associated with the 'novel and untested, metal-on-metal, short-stem prosthesis' he recommended, he would have not elected to undergo the procedure on 10 May 2011, and would have had hip replacement surgery at a later date using a different implant with a longer femoral stem. He further alleged that Dr Woodgate failed to adequately check for loosening of the femoral stem during the revision procedure on 30 August 2011. Finally, the plaintiff claimed that Dr Woodgate failed to provide adequate post-operative care, including a failure to investigate his complaints of pain and restricted movement, and failing to identify radiological evidence of loosening of the femoral stem.
Orthopaedic expert witnesses were qualified by each of the parties – Dr Doig for the plaintiff, and Dr O’Sullivan for the defendant. The experts provided separate reports and subsequently attended a conclave after which they produced a joint report. They gave evidence concurrently at the hearing. Weber DCJ noted that the joint report demonstrated that Dr Doig and Dr O’Sullivan agreed on a significant proportion of the issues they were asked about.
The decision at trial
The parties agreed that the issues for determination in this case could be condensed down to five distinct issues. The trial judge considered each of the five issues individually.
The first issue was Dr Woodgate’s alleged failure to advise and/or warn the plaintiff prior to the surgery on 10 May 2011 with respect to the risk of complications and the nature of the prosthesis he recommended. Weber DCJ noted that the orthopaedic experts agreed that it was not unreasonable for Dr Woodgate to have recommended a short stem implant. His Honour also found that Dr Woodgate had advised the plaintiff of the risks and benefits of the proposed surgery, as indicated by his recording 'R&B' (i.e. risks and benefits) in his clinical notes. Breach was therefore not established as to the first issue. Furthermore, in the event that breach had been established, His Honour indicated that he would not have found that the plaintiff had established causation.
The second issue was the steps taken during the revision surgery to identify and eliminate loosening. Weber DCJ accepted Dr Woodgate’s evidence as to the steps he undertook during the revision surgery, commenting that he 'presented as a very organised, methodical man'. The plaintiff’s case on the second issue was therefore not established.
The third issue was Dr Woodgate’s alleged negligence in post-operative management. Weber DCJ accepted Dr Woodgate’s clinical notes in preference to the plaintiff’s recollection, such that where there was a factual dispute between the two, he accepted the version supported by Dr Woodgate’s clinical records. His Honour further accepted the submission made on behalf of Dr Woodgate that the plaintiff gave evidence which exaggerated the extent of his pain after the revision surgery, finding that the plaintiff had significant credit issues. His Honour found that Dr Woodgate took a history of the plaintiff’s level of function and activity at each consultation after the revision surgery, which was accurately recorded in his notes. Breach was not established in relation to the third issue.
The fourth issue was Dr Woodgate’s consideration of radiographic imaging. Weber DCJ did not accept the plaintiff’s expert evidence from Dr Thomson (radiologist) and preferred the joint report of the orthopaedic experts. The orthopaedic experts both said that there was no radiological evidence of movement in the stem from August 2011 to 2017. Accordingly, the plaintiff did not establish breach in relation to the fourth issue.
The fifth and final issue was whether the plaintiff would have had pain free and functional use of his leg if a conventional stem had been used. Weber DCJ found that, on balance, the plaintiff would have had the same result had a conventional stem been used in August 2010 as he did from the short stem prosthesis. His Honour noted that the plaintiff had a revision procedure to insert a more conventional stem by a different surgeon in 2019, and he continues to have similar problems with his hip. Therefore, breach was not established in relation to the fifth issue.
Weber DCJ considered that it was not practicable to provide an alternate conclusion on damages in this case. His Honour noted that there were many factual issues involved in the conclusions on liability which, if altered on appeal, would flow on to a different conclusion on damages.
There was judgment and verdict for the defendant against the plaintiff, and the plaintiff was ordered to pay the defendant's costs.
Implications for you
This case underscores the importance of maintaining accurate and detailed clinical notes. The trial judge placed significant weight on Dr Woodgate’s records of the plaintiff’s condition and level of functioning, rejecting the plaintiff’s contradictory claims. This highlights the need for comprehensive documentation of patient history, level of function, and the discussions surrounding treatment and outcomes. Clear and precise documentation can be a critical defence in medical negligence cases, particularly where patient-reported outcomes conflict with the practitioner’s recorded observations.
