'Terem' failed to diagnose appendicitis – and will pay 736 thousand shekels

The Magistrate's Court in Haifa recently ruled that the 'Terem' urgent care clinic network will pay 736 thousand shekels to a 50-year-old woman due to negligence in diagnosing appendicitis.

In October 2019, the woman arrived at the clinic in Nahariya suffering from severe abdominal pain and vomiting. After undergoing a physical examination, she was given a painkiller intravenously. The doctors ruled out the existence of appendicitis, and she was discharged home. However, her pain did not cease, and three days later the woman turned to the emergency room at Rambam, where a rupture of the appendix was discovered. Due to the event, she began to suffer, among other things, from intestinal obstruction and required a series of surgeries, as well as the removal of the appendix and gallbladder.

In the lawsuit she filed, she claimed negligence that led to her dire situation: according to her, the center's doctors should not have settled for a superficial examination, but should have performed a more in-depth assessment to rule out appendicitis, including through a blood count and an abdominal ultrasound. On the other hand, 'Terem' claimed that it acted according to the accepted medical standard, and that the plaintiff's complaints during her visit did not raise an indication of acute appendicitis. "This is an urgent care center in the community, it is not possible to send every patient complaining of abdominal pain for imaging tests," the network claimed, adding that the patient's disability is not related to the event at the heart of the lawsuit, and amounts to only 10%.

But Judge Hadar Masori adopted the position of the court expert that the doctor should have ruled out the plaintiff's appendicitis by taking her blood, and not settle for a physical examination. The expert emphasized that if blood tests had been performed, they would have shown signs of acute inflammation with high probability. In his conclusion, the delay in diagnosis was the decisive factor for the perforation of the appendix, the purulent infection, and the intestinal obstruction. "It seems that the threshold required for performing, at the very least, a blood test was crossed, and not to settle for a physical examination," the judge ruled, relying on the expert opinion.

He rejected the network's attempt to reduce the responsibility placed upon it: "One should not apply a different standard for a doctor in the defendant's clinic than for a doctor in a health maintenance organization (HMO) or a doctor in a hospital. Although the circumstances of each case should be examined not with the wisdom of hindsight, one should not lower the bar of the standard applicable to all doctors, just because of their place of work."

It was determined that the defendant must compensate the patient for her damages, minus 5% contributory negligence imposed on her. In this regard, it was explained in the verdict that given the such significant pain from which she suffered, it was expected of her to turn to receive medical treatment sooner, and not to delay. On the issue of damage, the judge quoted the woman's words that she has been suffering since the incident from chronic diarrhea and severe abdominal pain with high frequency, alongside extreme weakness accompanied by fainting sensations. She said that she was forced to change her diet drastically, and that due to her condition she is required to always be close to a restroom. The judge determined that undoubtedly this condition reflects significantly negatively on her quality of life, and set her functional disability at 20%. After deducting the contributory negligence, she was awarded compensation of about 610 thousand shekels for loss of wages, help from others, and other heads of damage. 'Terem' was also ordered to bear the plaintiff's legal expenses and her lawyers' fees, which, including VAT, were set at about 126 thousand shekels.