Afolabi v Southdoc Services Ltd and Anor (Approved)

Factual and Procedural Background

This judgment, delivered by Judge Reynolds on 11 February 2026, concerns a clinical negligence claim brought by the Plaintiff arising from an out-of-hours general practice consultation on 13.12.17 at Company A. The Plaintiff (then eleven) was seen by the Defendant (a GP) after presenting with vomiting, abdominal pain and later diarrhoea. The Defendant recorded a working diagnosis of likely gastroenteritis, provided a handwritten advice note, verbal "red flag" safety-netting and a hospital referral letter (which included a handwritten “Cave appendicitis” notation). The Plaintiff alleged that the Defendant negligently failed to identify appendicitis and to refer to hospital on 13.12.17, causing a three-day diagnostic delay and a perforated appendix with significant complications. Proceedings were commenced by the Plaintiff's mother in 2021 while the Plaintiff was a minor; the Plaintiff had reached majority by trial. The trial heard lay and expert evidence for both sides. The court dismissed the claim and awarded costs to the Defendants pursuant to S169 of the Legal Services Regulation Act 2015.

Legal Issues Presented

1. Was the primary diagnosis of gastroenteritis on 13.12.17 reasonable?
2. Was the Defendant's management and safety-netting advice to the Plaintiff and her mother reasonable and in accordance with the standard expected of a GP acting with ordinary care?
3. If there was a breach of duty, what would have occurred had the Plaintiff been referred to hospital on 13.12.17 (causation and likely clinical outcome)?

Arguments of the Parties

Plaintiff's Arguments

• The Defendant failed to identify that the Plaintiff met diagnostic criteria for acute appendicitis and failed to refer to hospital on 13.12.17, causing a three-day delay culminating in perforation.
• The handwritten note provided was inadequate and allegedly confusing, which compounded delay and prevented timely presentation to the Emergency Department.
• The Plaintiff suffered serious complications (perforation, laparotomy, wound infection, permanent scarring and psychological effects) as a result of the delay.

Defendants' Arguments

• The diagnosis of likely gastroenteritis was reasonable on the clinical presentation (vomiting settling, diarrhoea onset, soft abdomen, mild generalised tenderness, no rebound or guarding, mild fever) and was consistent with GP standards of care.
• The Defendant provided appropriate management: clinical examination, verbal red flag/safety-netting advice, a handwritten explanatory note and a hospital referral letter to be used if deterioration occurred.
• To the extent deterioration occurred, it was the Plaintiff's mother's failure to follow the red flag advice or to use the referral letter that caused delay; had the Plaintiff been referred on 13.12.17 she likely would have been discharged from an ED with similar advice.
• Expert evidence for the Defendants supported a watchful-waiting approach and concluded there was no indication for immediate surgery on 13.12.17.

Table of Precedents Cited

Court's Reasoning and Analysis

The court undertook a fact-led analysis, giving significant weight to contemporaneous clinical records. Key elements of the reasoning were:

• The contemporaneous notes recorded the history, examination findings (temp 37.7, abdo soft, mild generalised tenderness, no rebound or guarding, urine ketones, pulse 72), a working diagnosis of "Likely GE", management including conservative measures, red flag advice, and a referral letter annotated "Cave appendicitis". The court treated these records as reliable.
• The court preferred the Defendant's evidence about the plaintiff's presentation (including ability to get onto the examination couch unaided) over the conflicting accounts of the Plaintiff and her mother, on the basis of contemporaneous documentation and the Defendant's prior review of triage notes.
• On breach: the court held that the diagnosis of gastroenteritis was reasonable in the circumstances. It accepted that appendicitis remained a differential diagnosis but found the Defendant's decision to manage conservatively with safety-netting rather than immediate referral conformed to the standard expected of a GP acting with ordinary care. The court preferred the evidence of the Defendant's GP expert (Expert Boland) over the Plaintiff's GP expert (Expert Murphy) on this issue.
• The court found the Defendant provided red flag advice and a hospital referral letter; concerns about the handwritten note causing confusion were introduced late in updated particulars and were not established to the court's satisfaction.
• On causation: even assuming a breach, the court accepted evidence from Defendant experts that had the Plaintiff presented to an ED on 13.12.17 she would likely have been triaged, blood tests would likely have been normal, and she would in all probability have been discharged with similar safety-netting—thus the same adverse outcome would have been likely. Several experts opined that perforation most likely occurred on 14–15.12.17 and that presentation on 14/15 would have avoided the need for laparotomy.
• Accordingly, the court concluded there was no clinical negligence by the Defendant or Company A that caused the Plaintiff's injuries.

Holding and Implications

CLAIM DISMISSED

Holding: The court dismissed the Plaintiff's claim, finding (1) the primary diagnosis of gastroenteritis on 13.12.17 was reasonable and (2) the Defendant's management and advice met the standard expected of a GP acting with ordinary care.

Implications: The direct consequence is that the Defendants are not liable for the Plaintiff's injuries; the Defendants were awarded their costs under S169 of the Legal Services Regulation Act 2015. The opinion does not purport to establish a new legal precedent beyond applying established authorities (Dunne and Morrisey) to the facts.