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Medical negligence can't be inferred simply by the occurrence of a recognised complication

16 March 2023

In the Queensland District Court matter of Coulon v Adams [2022] QDC 291, the principle of res ipsa loquitur was addressed in determining that a doctor was not liable for a splenic injury suffered by a patient during a colonoscopy. 

Coulon v Adams [2022] QDC 291


On 15 February 2018, Mrs Mary Coulon (Plaintiff) attended upon Dr Felicity Adams (Defendant) with complaints of nausea and rectal bleeding with a long history of constipation issues. It was decided during the consult that an elective colonoscopy should be performed.

Dr Adams performed the procedure on 7 March 2018. The procedure was difficult due to looping with a redundant colon and she was unable to proceed past the distal ascending colon. The Plaintiff was discharged that day.

The following day the Plaintiff was unwell with significant pain and attended hospital where a CT scan showed a large ruptured subscapular splenic haematoma. The Plaintiff was admitted for surgery and her spleen was removed.  As a consequence of the surgery, she was required to take oral antibiotics indefinitely and alleges a number other sequelae.

Liability Issues

The substantive issue before the court was whether the Defendant was negligent for allegedly failing to manipulate the colonoscope correctly, using excessive force and failing to exercise due care and skill.

The Plaintiff also alleged that the Defendant had failed to warn her of the risk of injury to her spleen.


The Defendant gave oral evidence explaining the procedure, the technique adopted and the difficulties encountered. The Court formed the view that Dr Adams was a very careful and methodical person.

Expert evidence indicated that a splenectomy is a rare, though recognised, complication of a colonoscopy.  However, Dr Goodman (for the Plaintiff) contended that a splenic injury is always due to inappropriate manipulation of the colonoscope – when carried out correctly splenic injuries do not occur.  In cross-examination, Dr Goodman was taken to paragraphs from an article referred to in his report that contained a number of paragraphs contrary to his opinion.

Dr Hourigan (for the Defendant) commented that splenic injuries can occur even with colonoscopic technique that would be considered best practice. Dr Hourigan stated Dr Adams' approach to this difficult case would be considered best practice.


The Court determined that the Plaintiff's expert evidence relied upon an inference being drawn that the injury could only have happened as a result of the negligent acts of the Defendant. However, there was no direct evidence that anything done by Dr Adams was in error. The evidence is that a splenectomy is a rare, but recognised, complication of a colonoscopy. There is no justification for inferring that the event was caused by negligence.

The Court referred to the authority decisions of Breen v Larkin (1) and Schellenberg v Tunnel Holdings Pty Ltd (2) holding that the principle of res ipsa loquiter does not apply to these situations.

The Plaintiff's allegation of the failure to warn were also dismissed by the Court, finding that a warning was given by the Defendant and, even if it had not been supplied, considered that it would not have altered the view of the Plaintiff as to the desirability of the colonoscopy.

(1) Breen v Larkin [2003] QCA 549; [2002] QSC 107

(2) Schellengerg v Tunnel Holdings Pty Ltd (1999) 200 CLR 121

If you require further information or have any queries in relation to this legal update, please contact  Luke Gollan (Senior Associate).

We would like to acknowledge the contribution of Kaitlyn Scarcella (Law Clerk) to this article. 

Further Reading