Cultural diversity and the failure of doctors to follow up with patients

19 November 2013

By Libby Brookes, Associate, Medical Law Department, Sydney

What duties does a doctor have to follow up a patient who does not return or carry out instructions regarding further medical testing? What responsibility lies with the patient and how do cultural issues impact on these issues? The case of Young v Central Australian Aboriginal Congress Inc and Ors [2008] NTSC 47 is a case on point. Here, the Plaintiff Mr Impu was an Indigenous man attending a health clinic operated by the Central Australian Aboriginal Congress (CAACI). On 2 March 2000, Mr Impu complained to Dr Boffa, general practitioner, at a clinic run by CAACI that he had discomfort in the left side of his chest. Dr Boffa made an appointment for him to have a fasting cholesterol test on 6 March 2000 to investigate the possibility of ischaemic heart disease and made an appointment with a specialist on 21 March 2000. Unfortunately, Mr Impu failed to attend either of these appointments. He returned to the clinic on several occasions before his death with complaints unrelated to his heart. The clinic did not raise with Mr Impu whether he had undergone the tests or visited the specialist. Mr Impu died from a coronary thrombosis on 26 January 2001.

The court was required to look at several issues. Firstly, what systems the medical centre had in place to follow up patients who did not attend appointments and whether they were reasonable. The court found that the CAACI did not have in place proper administrative procedures to ensure Mr Impu attended the appointments as part of a treatment plan for such a serious condition. Their usual procedure of taking it up with the patient on their next visit did not work on for Mr Impu as on his return, the doctor had the file of a patient with a similar name to the plaintiff! Accordingly, the system was hardly effective and the court found that CAACI had breached their duty of care to Mr Impu.

A second issue the court was required to look at was whether the standard of care for follow up was altered by the cultural background of the patient, in this case, the Mr Impu being an Indigenous Australian. Evidence from one of the doctors in the clinic was that around 30-50 per cent of patients failed to attend due to social problems. The court found the fact the CAACI was aware of this and therefore it made it even more important to have an effective follow up system. The court held that the standard of care for a general practitioner providing care to Aboriginal people in Central Australia required the doctor to take into account the particular needs of Indigenous people in a more remote setting. The court found that Dr Boffa did indeed take these things into account, but here the system let him down. There was no responsibility for Dr Boffa to personally follow up with Mr Impu, rather, there was a responsibility on CAACI to have an effective system in place. Such system would, on balance, have caused him to follow through with the tests and the specialist consultation.

A third issue the court was required to look at was whether Mr Impu bore some responsibility for his health and that by failing to do so, whether he contributed to his death. The court found that he had indeed contributed to his death by failing to attend for the tests and the specialist consultation. They assessed the contribution his inactions made to his death at 50 per cent, a significant finding which caused the amount of his compensation to be halved.

This case highlights that cultural issues will indeed be taken into account by a court in formulating the appropriate content of a doctor's duty of care to a patient. Medical centres are required to have effective systems to assist patients to take care of their health by following through with doctor's recommendations and referrals but patients themselves must bear some responsibility for follow through. A significant reduction on the amount of compensation a court will award the plaintiff is a real possibility and reduces the culpability of the medical professional.