Years of dismissed pain: can a delayed endometriosis diagnosis give rise to a medical negligence claim in NSW?
That account — or something close to it — appears in the records of endometriosis patients across Australia with a consistency that is not coincidental. The dismissal is not random. It follows a pattern. And patterns, in law, are evidence of a systemic failure to meet a standard.
This article examines what the clinical standard of care requires when a patient presents with symptoms consistent with endometriosis, where that standard is most commonly breached, and what the law in NSW says about the harm that follows years of diagnostic delay.
What endometriosis is and how it should be managed
Endometriosis is a chronic inflammatory condition in which tissue similar to the lining of the uterus grows outside the uterus — on the ovaries, fallopian tubes, bowel, bladder, and peritoneum. That tissue responds to hormonal cycles just as the uterine lining does: it thickens, breaks down, and bleeds. Unlike menstrual blood, that breakdown has nowhere to go. The result is inflammation, scarring, adhesions, and — in many cases — progressive damage to the reproductive and surrounding organs.1
According to Healthdirect Australia, endometriosis affects approximately one in nine Australian women and people assigned female at birth — around 830,000 Australians.2 It is one of the most common gynaecological conditions in the country. It is also one of the most consistently under-diagnosed.
The hallmark symptoms are well-documented in the clinical literature: dysmenorrhoea (painful periods), dyspareunia (pain during or after intercourse), chronic pelvic pain, dysuria (painful urination), dyschezia (painful bowel movements), and subfertility or infertility. These symptoms are not subtle. They are not rare. A clinician who encounters a patient reporting severe cyclical pelvic pain, pain with intercourse, and bowel symptoms around menstruation is looking at a textbook presentation of endometriosis until proven otherwise.
Standard clinical management proceeds in stages. At the primary care level, a GP who encounters these symptoms should take a thorough gynaecological history, consider endometriosis as a differential diagnosis, and refer the patient to a gynaecologist with expertise in the condition. Transvaginal ultrasound can identify ovarian endometriomas (cysts) and deep infiltrating endometriosis in experienced hands, but a normal ultrasound does not exclude the diagnosis. Definitive diagnosis requires laparoscopy — a surgical procedure in which a camera is inserted into the abdomen to directly visualise and biopsy the lesions. Hormonal management (the oral contraceptive pill, progestins, or GnRH agonists) can suppress symptoms but does not treat the underlying disease and should not substitute for diagnostic investigation in a patient with progressive or severe symptoms.
What it requires: RANZCOG’s guidance states that endometriosis should be considered in any patient presenting with dysmenorrhoea, chronic pelvic pain, dyspareunia, or subfertility. It recommends that clinicians take a detailed history, perform a clinical examination, and arrange appropriate imaging, with referral to a specialist where symptoms are persistent or severe. It explicitly notes that a normal pelvic ultrasound does not exclude endometriosis.
Why this matters: A GP or gynaecologist who dismisses ongoing pelvic pain without considering endometriosis as a differential, or who relies on a normal ultrasound to rule it out, has departed from the standard this guideline establishes.
The standard of care — what clinicians are required to do
The “standard of care” is a legal concept — it means the standard of conduct expected of a reasonably competent clinician practising in the same specialty, in the same circumstances, at the time the care was provided. It is an objective test. The question is not what this particular clinician intended, believed, or was trained to do. The question is what a competent clinician in that role would have done.
For endometriosis, the standard of care at the GP level requires the following at each decision point:
- On first presentation with dysmenorrhoea or pelvic pain: Take a full gynaecological history. Ask about the character, timing, and severity of pain. Ask about pain with intercourse and bowel symptoms. Consider endometriosis as a differential diagnosis. Document the assessment.
- On repeated presentations with the same symptoms: Escalate the investigation. A patient who returns multiple times with the same unresolved pain is not a patient whose symptoms have been explained — she is a patient whose symptoms have not yet been explained. The standard requires action, not repetition of the same inadequate response.
- When symptoms are severe or progressive: Refer to a gynaecologist. Not a general gynaecologist if deep infiltrating endometriosis is suspected — RANZCOG guidance supports referral to a specialist endometriosis centre or an experienced excision surgeon where complex disease is possible.
- When imaging is normal: Advise the patient that a normal ultrasound does not exclude endometriosis. Do not use a normal ultrasound as a reason to close the investigation.
At the specialist level, a gynaecologist who sees a patient with a history of years of pelvic pain, failed hormonal management, and ongoing symptoms has a clinical obligation to consider diagnostic laparoscopy. Continuing to prescribe hormonal suppression without investigating the underlying pathology — particularly where the patient has expressed concern about fertility — does not meet the standard.
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1First symptoms — typically age 15–25
Severe dysmenorrhoea, pelvic pain, bowel symptoms around menstruation. Standard required: gynaecological history, endometriosis considered as differential. What commonly happened: symptoms attributed to “normal periods” or primary dysmenorrhoea. Oral contraceptive pill prescribed without investigation. -
2Repeated GP presentations — months to years later
Patient returns with same or worsening symptoms. Standard required: escalation of investigation, specialist referral. What commonly happened: same prescription renewed, symptoms normalised, no referral made. Patient told pain is “just how it is.” -
3Ultrasound ordered — result normal
Standard required: patient advised that normal ultrasound does not exclude endometriosis; investigation to continue. What commonly happened: normal result used to close the investigation. Patient told “nothing is wrong.” -
4Specialist referral — if made at all
Standard required: gynaecologist to take full history, consider laparoscopy, advise on fertility implications. What commonly happened: further hormonal management prescribed; laparoscopy deferred or not offered; fertility concerns not addressed. -
5Confirmed diagnosis — average 6.4 years after first symptoms3
Laparoscopy finally performed, often after fertility crisis or acute presentation. Disease frequently advanced. Adhesions, endometriomas, or tubal damage present. Harm that accumulated during the delay: progressive organ damage, reduced fertility, years of unmanaged pain, psychological harm.
Sources: Endometriosis Australia; RANZCOG College Statement C-GYN 26. Timeline reflects documented population-level patterns, not any individual case.
Where care breaks down — specific failure patterns
The delay in diagnosing endometriosis is not a mystery. It follows identifiable, recurring patterns — each one a specific point at which a clinician made a decision that fell below the standard the profession sets for itself. Understanding these patterns is essential to understanding whether what happened in any individual case was a clinical misfortune or a clinical failure.
Normalising pain as a feature of menstruation
The most pervasive failure in endometriosis care is the normalisation of pain. A patient presents with dysmenorrhoea severe enough to cause her to miss school, work, or social activities. The clinician responds by telling her that painful periods are normal, prescribing the oral contraceptive pill, and closing the consultation.
That response is not clinically defensible when the pain is severe, progressive, or disabling. RANZCOG’s guidance is explicit: dysmenorrhoea that interferes with daily functioning warrants investigation, not reassurance. The clinician who tells a 19-year-old that her pain is “just part of being a woman” has not performed a clinical assessment. She has performed a dismissal.
She went home with a prescription and no answers. The next month, the pain came back. So did the month after that. Nobody looked further for seven years.
The mechanism behind this failure is well-documented in the medical education literature: clinicians are undertrained in endometriosis, and cultural assumptions about menstrual pain as normal and tolerable create a cognitive shortcut that bypasses proper differential diagnosis.4 That shortcut has a name — anchoring bias — and it is not a defence to a negligence claim.
Failure to refer to a specialist
A GP who manages a patient’s pelvic pain with repeated prescriptions of the oral contraceptive pill, without ever referring her to a gynaecologist, has failed to escalate care in the way the standard requires. The oral contraceptive pill can suppress endometriosis symptoms. It does not treat the underlying disease. A patient whose symptoms persist or worsen on hormonal management is a patient whose underlying pathology has not been addressed.
The standard of care requires referral when: symptoms are severe or disabling; symptoms persist despite first-line hormonal management; the patient expresses concern about fertility; or the clinical picture is consistent with endometriosis and has not been investigated. A GP who ticks none of these referral triggers over multiple years of consultations has not met the standard.
The referral that was never made is often the single most consequential failure in these cases. By the time a specialist finally saw her, the disease had progressed to Stage III. The adhesions were already there.
Misattribution to irritable bowel syndrome or primary dysmenorrhoea
Endometriosis frequently presents with bowel symptoms — bloating, diarrhoea, constipation, and rectal pain that worsen around menstruation. Clinicians who do not take a careful menstrual history often attribute these symptoms to irritable bowel syndrome (IBS) and refer the patient to a gastroenterologist rather than a gynaecologist. The gastroenterologist finds no bowel pathology. The patient is told her symptoms are functional. Years pass.
The critical clinical question — do these bowel symptoms correlate with your menstrual cycle? — is not a complex question. It takes thirty seconds to ask. A clinician who fails to ask it, and who attributes cyclical bowel symptoms to IBS without considering endometriosis, has missed a diagnostic pathway that the standard of care required them to follow.
Similarly, the label “primary dysmenorrhoea” — painful periods with no identifiable underlying cause — is only appropriate after endometriosis and other pelvic pathology have been excluded. Using it as a first-line diagnosis, without investigation, is not a diagnosis. It is a placeholder that forecloses further inquiry.
Inadequate gynaecological history-taking
A proper gynaecological history for a patient presenting with pelvic pain includes: the character, severity, and timing of pain; whether pain occurs with intercourse; whether pain occurs with bowel movements or urination; the impact of pain on daily functioning; any previous investigations; and any fertility concerns. Many of the cases that reach legal examination reveal histories in which none of these questions were asked, or in which the answers were not recorded.
A medical record that contains only “dysmenorrhoea — OCP prescribed” for a patient who presented with debilitating pain is not a record of a clinical assessment. It is a record of a transaction. The law treats the absence of a proper history as evidence that a proper history was not taken — and a clinician who did not take a proper history cannot demonstrate that they met the standard of care.
| Failure pattern | What the standard required | What went wrong | Harm that resulted |
|---|---|---|---|
| Pain normalisation | Investigate severe or disabling dysmenorrhoea; consider endometriosis as differential | Clinician told patient painful periods are normal; no investigation initiated | Years of unmanaged pain; progressive disease; delayed diagnosis |
| Failure to refer | Refer to gynaecologist when symptoms persist on hormonal management or fertility is a concern | GP continued prescribing OCP without referral over multiple years | Disease progression; organ damage; reduced fertility window |
| Misattribution (IBS / primary dysmenorrhoea) | Ask whether bowel symptoms correlate with menstrual cycle; consider endometriosis before labelling IBS | Cyclical bowel symptoms attributed to IBS; no gynaecological referral | Delayed diagnosis; unnecessary gastroenterological investigation; ongoing harm |
| Inadequate history-taking | Take full gynaecological history including pain with intercourse, bowel symptoms, fertility concerns | Consultation recorded only chief complaint; no structured gynaecological history documented | Diagnostic pathway not initiated; no basis for referral or escalation |
Sources: RANZCOG College Statement C-GYN 26; Australian Commission on Safety and Quality in Health Care — Endometriosis Clinical Care Standard (2022).
The Australian Commission on Safety and Quality in Health Care published its Endometriosis Clinical Care Standard in 2022 — the first national standard of its kind in Australia. That standard sets out eight quality statements covering timely diagnosis, patient-centred care, and access to specialist services. Its publication is itself an acknowledgement that the existing standard of care was not being met consistently across the health system.
What happened: The plaintiff alleged that her treating clinicians failed to investigate and diagnose a gynaecological condition over a period of years, resulting in progressive harm that earlier intervention would have prevented or reduced. The case turned on whether the delay in diagnosis constituted a breach of the standard of care and whether that breach caused the harm suffered.
What the court found: The Court of Appeal examined the standard of care applicable to the treating clinicians and the question of whether earlier investigation would have altered the outcome, applying the causation principles in the Civil Liability Act 2002 (NSW).
Why this matters: The case illustrates that NSW courts will examine the specific clinical decisions made at each point in a patient’s care — not just the final outcome — and will assess whether each decision met the standard a competent clinician would have applied.
The legal framework in NSW
Medical negligence claims in NSW are governed primarily by the Civil Liability Act 2002 (NSW). That Act codifies the common law negligence framework and introduces specific provisions that affect how medical claims are assessed. Understanding those provisions is essential to understanding what a delayed endometriosis diagnosis claim must establish.
Duty of care
Every clinician who undertakes to treat a patient owes that patient a duty of care. For endometriosis, the duty arises at the first consultation at which symptoms consistent with the condition are presented. It applies to the GP who first hears the complaint, the gynaecologist to whom the patient is referred, the specialist who performs the laparoscopy, and the hospital or clinic in which care is provided. The duty is not in dispute in these cases. What is in dispute is whether it was breached.
Breach — and the peer professional opinion defence
Section 5O of the Civil Liability Act provides that a clinician does not breach their duty of care if they acted in a manner that was widely accepted by peer professional opinion as competent professional practice. This is the “peer professional opinion” defence — and it is frequently misunderstood as a shield that protects any clinician who can find an expert to support their conduct.
That reading is wrong. Section 5O(2) provides that peer professional opinion does not apply if the court considers that the opinion is irrational. More importantly, the defence requires that the practice be “widely accepted” — not merely that one expert can be found to defend it. A practice of dismissing severe pelvic pain without investigation, or of relying on a normal ultrasound to exclude endometriosis, is not widely accepted by competent gynaecological practice. RANZCOG’s own guidelines say the opposite.
Causation — the “but for” test
Section 5D of the Civil Liability Act sets out the causation test. The plaintiff must establish that the breach was a necessary condition of the harm — that is, but for the breach, the harm would not have occurred. In delayed diagnosis cases, this requires expert evidence that earlier diagnosis and treatment would have prevented or reduced the harm suffered.
For endometriosis, causation evidence typically addresses: whether earlier laparoscopy would have identified the disease at a less advanced stage; whether earlier surgical or hormonal treatment would have preserved fertility or prevented organ damage; and whether the years of unmanaged pain constituted a separate and compensable harm in themselves. Each of these is a question for expert gynaecological evidence — not a question the patient must answer alone.
What happened: The plaintiff alleged that her treating doctor failed to diagnose a condition over a period of time, and that earlier diagnosis would have resulted in a better outcome. The case examined the standard of care applicable to a GP and the causation question of whether earlier action would have made a difference.
What the court found: The Court of Appeal confirmed that the standard of care is assessed objectively — by reference to what a competent clinician in the same position would have done — and that the causation question requires the court to assess what would have happened had the breach not occurred, on the balance of probabilities.
Why this matters: This case establishes the analytical framework NSW courts apply to delayed diagnosis claims: the standard is objective, and causation is assessed on the balance of probabilities — not certainty.
The critical distinction in these cases is between a bad outcome and a breach. Endometriosis is a condition that can progress even with optimal management. Not every case of advanced disease at diagnosis is evidence of negligence. The question is whether the disease progressed because of a failure to investigate — a failure that a competent clinician would not have made. That distinction is what separates a compensable claim from a clinical misfortune.
For a comprehensive overview of how these claims are structured and pursued in NSW, see Reframe Legal — Medical Negligence.
When a delayed endometriosis diagnosis may amount to medical negligence
The following scenarios map specific factual situations to the legal elements of negligence. Each is drawn from the documented failure patterns in endometriosis care and from the legal framework that applies in NSW.
Scenario 1: Repeated GP presentations with no referral over multiple years
A patient presents to the same GP on four or more occasions over three years with severe dysmenorrhoea, pelvic pain, and pain with intercourse. Each time, the GP prescribes or renews the oral contraceptive pill. No referral to a gynaecologist is made. No investigation beyond a pelvic ultrasound is ordered. The ultrasound is normal. The GP tells the patient her results are fine.
This scenario engages breach directly. The standard of care required the GP to escalate investigation after repeated presentations with unresolved symptoms. The normal ultrasound did not close the diagnostic question — RANZCOG’s guidance is explicit on this point. The failure to refer, over multiple years, in the face of persistent and disabling symptoms, is a departure from the standard a competent GP would have applied.
Causation requires expert evidence that earlier referral and laparoscopy would have identified the disease at an earlier stage and that earlier treatment would have reduced the harm — whether that harm is measured in disease progression, fertility loss, or years of unmanaged pain.
Scenario 2: Bowel symptoms attributed to IBS without gynaecological investigation
A patient presents with cyclical bowel symptoms — bloating, diarrhoea, and rectal pain that worsen in the week before and during menstruation. The GP refers her to a gastroenterologist. Colonoscopy and other bowel investigations are normal. The gastroenterologist diagnoses IBS. No one asks whether the symptoms correlate with her menstrual cycle. No gynaecological referral is made. Three years later, laparoscopy reveals deep infiltrating endometriosis involving the bowel.
Both the GP and the gastroenterologist may have breached the standard of care. The GP failed to take a menstrual history that would have identified the cyclical pattern. The gastroenterologist, on finding no bowel pathology, failed to consider and document whether a gynaecological cause had been excluded. The failure to ask one question — do these symptoms correlate with your period? — is the specific clinical decision point at which the standard was not met.
Scenario 3: Fertility harm following delayed diagnosis
A patient in her late twenties presents to a gynaecologist with a history of pelvic pain and subfertility. The gynaecologist prescribes hormonal management and advises the patient to “try naturally” for another twelve months before considering investigation. Twelve months later, laparoscopy reveals bilateral endometriomas and tubal adhesions. The patient’s fertility specialist advises that IVF is now the only realistic pathway to pregnancy.
The question here is whether the gynaecologist’s decision to defer laparoscopy for twelve months met the standard of care for a patient with a history of pelvic pain and documented subfertility. RANZCOG’s guidance supports earlier surgical investigation in patients with subfertility where endometriosis is suspected. A twelve-month deferral, without documented clinical reasoning, is difficult to defend against expert evidence that earlier laparoscopy would have identified and treated the disease before tubal damage occurred.
Scenario 4: Failure to advise on the limitations of ultrasound
A patient is told, after a pelvic ultrasound, that “everything looks normal” and that there is no evidence of endometriosis. She is not told that ultrasound cannot detect peritoneal endometriosis or superficial lesions, and that a normal ultrasound does not exclude the diagnosis. She accepts the reassurance and does not seek further investigation for two years. When laparoscopy is eventually performed, peritoneal endometriosis is found.
This scenario engages both breach and informed consent. The clinician who told the patient her ultrasound was normal without explaining its diagnostic limitations provided information that was, in context, misleading. Under the principles established in Rogers v Whitaker (1992) 175 CLR 479, a clinician has a duty to disclose information that a reasonable patient in the plaintiff’s position would want to know — and a patient who is told her results are normal would want to know if that result does not actually exclude the condition she is worried about.5
The three elements of negligence applied to endometriosis
For a delayed endometriosis diagnosis to give rise to a successful negligence claim in NSW, three elements must all be established. The absence of any one of them is fatal to the claim. The presence of all three — supported by expert clinical evidence and the medical records — is what transforms a clinical failure into a compensable legal wrong.
Endometriosis progressing despite timely diagnosis and appropriate surgical and hormonal management — the disease can be aggressive even with optimal care, and progression alone does not establish breach.
A GP who, over four years of repeated presentations with severe dysmenorrhoea and pain with intercourse, never referred the patient to a gynaecologist and never documented a differential diagnosis — resulting in Stage III disease and tubal damage at first laparoscopy.
This is a general educational framework only. Each case depends on its individual facts and circumstances.
Long-term and permanent harm from delayed endometriosis diagnosis
The harm from a delayed endometriosis diagnosis is not confined to the period of the delay. It compounds. Each month that the disease progresses without treatment is a month in which adhesions form, organs are damaged, and the window for effective intervention narrows.
Physical consequences
Advanced endometriosis causes structural damage that cannot always be reversed. Ovarian endometriomas — cysts filled with old blood — can destroy ovarian tissue and reduce ovarian reserve. Adhesions between the ovaries, fallopian tubes, bowel, and bladder can distort pelvic anatomy and obstruct the fallopian tubes. Deep infiltrating endometriosis involving the bowel or bladder may require complex surgical resection with significant risks. Tubal damage caused by adhesions is a leading cause of infertility in women with endometriosis — and it is damage that accumulates silently during the years of diagnostic delay.
According to Endometriosis Australia, approximately 30–40% of people with endometriosis experience subfertility or infertility.6 For those whose diagnosis was delayed, the question of whether that fertility loss was avoidable — or whether earlier intervention would have preserved reproductive function — is precisely the causation question that expert evidence must address.
Psychological consequences
Years of being told that pain is normal, that nothing is wrong, and that the problem is not real produce psychological harm that is independent of the physical disease. Research published in the Australian and New Zealand Journal of Obstetrics and Gynaecology has documented elevated rates of depression, anxiety, and post-traumatic stress in people with endometriosis, with the diagnostic delay itself identified as a contributing factor — not merely the disease.7 The experience of medical dismissal is not a neutral event. It erodes trust, delays help-seeking, and causes harm that persists after the physical diagnosis is finally made.
Financial and social consequences
Endometriosis imposes a substantial economic burden. A 2019 study published in PLOS ONE, drawing on Australian data, estimated the annual economic burden of endometriosis in Australia at approximately $9.7 billion — including healthcare costs, lost productivity, and unpaid care.8 At the individual level, that burden includes: time off work during symptomatic periods; reduced capacity for full-time employment; costs of repeated medical consultations, investigations, and surgeries; costs of assisted reproduction where fertility has been compromised; and the unpaid burden on partners and family members who provide care.
Each of these categories is a head of compensable loss in a NSW negligence claim. The financial harm is not speculative — it is documented, quantifiable, and directly attributable to the delay.
What compensation covers in NSW
A successful medical negligence claim in NSW can recover compensation across two broad categories: general damages (for pain, suffering, and loss of enjoyment of life) and special damages (for economic loss and out-of-pocket expenses).
General damages for non-economic loss are subject to a threshold under section 16 of the Civil Liability Act 2002 (NSW). The threshold requires that the harm constitute at least 15% of a “most extreme case” before non-economic loss is recoverable. In practice, this threshold is met in cases involving significant permanent impairment — including infertility, chronic pain requiring ongoing management, or permanent organ damage. Below the threshold, non-economic loss is not recoverable, but economic loss and out-of-pocket expenses remain compensable.
The limitation period for medical negligence claims in NSW is three years under the Limitation Act 1969 (NSW). Critically, for delayed diagnosis cases, the limitation period runs from the date the plaintiff knew, or ought reasonably to have known, that they had a claim — not necessarily from the date the negligent act occurred. A person who was not diagnosed until years after the negligent failure may have more time than they realise.
| Severity of harm | Indicative range (NSW) | Key factors |
|---|---|---|
| Moderate injury with recovery | $50,000–$150,000 | Duration of pain, treatment required, time off work |
| Serious injury with lasting effects | $150,000–$500,000 | Permanent impairment, ongoing treatment, care needs |
| Severe or life-changing injury | $500,000–$2,000,000+ | Catastrophic loss of function, lifetime care, lost earnings |
These figures are general reference ranges only. Each case turns on its own evidence — medical records, expert clinical opinion, and economic reports that quantify the actual loss. Fertility loss, in particular, can attract significant damages where it is established that earlier diagnosis would have preserved reproductive function and where the cost of assisted reproduction is documented.
How to think about your own situation
The questions below are not a legal test. They are prompts to help you think clearly about whether your experience may warrant further examination.
These questions are not a legal test. But the pattern they reveal — when several of them point in the same direction — is often the starting point for a proper examination of whether the standard of care was met. The medical records, read alongside the clinical guidelines that applied at the time, will tell a clearer story than memory alone. For a detailed explanation of how that examination works in NSW, see Reframe Legal — How Medical Negligence Claims Work in NSW.
Uncertainty is normal — and it is not evidence that nothing went wrong
Most people who have lived through years of dismissed endometriosis pain do not arrive at a legal question feeling certain. They arrive feeling confused, exhausted, and often still doubting themselves — because the system that failed them spent years telling them their experience was not real.
That self-doubt is a rational response to a confusing experience. It is not evidence that nothing went wrong. The law does not require a patient to be certain that negligence occurred before seeking an examination of the facts. What the law requires is that the claim be supported by objective evidence — medical records, expert clinical opinion, and the clinical guidelines that applied at the time. The patient’s certainty is not part of that test.
The standard of care is an objective benchmark. It asks what a competent clinician in the same specialty, in the same circumstances, would have done. That question is answered by expert evidence — not by the patient’s recollection of how confident her doctor seemed, or by the fact that the doctor was kind, or by the fact that she was told everything was fine. A clinician can be kind, confident, and genuinely well-intentioned, and still have fallen below the standard the profession sets for itself.
In my view, the most important thing to understand about this area of law is that the analysis is evidence-based and objective. The records almost always tell a clearer story than anyone’s recollection of events. A consultation note that records only “dysmenorrhoea — OCP renewed” for a patient who presented with disabling pain is not a record of a clinical assessment that met the standard. It is a record of a gap — and gaps, in medical negligence law, carry legal weight.
For a detailed explanation of the consent obligations that apply when a clinician advises a patient about the limitations of a diagnostic test, see Reframe Legal — Informed Consent and Medical Negligence. For information about the regulatory framework that governs clinician conduct in Australia, see AHPRA — Australian Health Practitioner Regulation Agency.
About the author
Dr Rosemary Listing is a lawyer with a PhD in law, specialising in medical negligence. Her legal practice concentrates on cases where clinical care in NSW failed to meet the standard the law and the profession require. Her doctoral research and legal practice have given her a rigorous command of the clinical standards against which negligent conduct is measured, and of the evidentiary requirements those claims must satisfy in NSW courts.
Delayed endometriosis diagnosis cases sit at a particularly demanding intersection of clinical and legal complexity. The clinical standard — what a competent GP or gynaecologist was required to do at each decision point — must be assessed against the specific guidelines that applied at the time of the consultations in question. The legal threshold — establishing that the breach caused measurable harm, rather than that the disease simply progressed — requires expert evidence that engages directly with the biology of the condition and the documented trajectory of the patient’s care. Neither question is straightforward, and neither can be answered without a thorough examination of the records.
The cases that have reached NSW courts, and the complaints recorded by the Health Care Complaints Commission, reveal a consistent pattern in how endometriosis diagnostic failures occur: the failure is rarely a single dramatic error. It is an accumulation of inadequate responses — each individually defensible in isolation, but collectively representing a sustained departure from the standard of care that the profession’s own guidelines require. That pattern is what legal analysis must identify and articulate.
The people who seek a legal examination of their records in these cases are not looking to blame anyone. They want to understand what happened to them — why it took so long, whether it had to, and whether the harm they carry was avoidable. Many waited years before seeking any examination of the facts, often because they had been told so many times that their pain was normal that they had begun to believe it themselves.
Dr Listing examines medical records alongside expert clinical opinion and applies the legal standard — not to assign blame, but to give people an honest answer about whether what happened to them met the benchmark the profession sets for itself. That answer, whatever it is, is what most people are actually seeking.
- Giudice LC, ‘Endometriosis’ (2010) 364 New England Journal of Medicine 2389.
- Healthdirect Australia, ‘Endometriosis’ <https://www.healthdirect.gov.au/endometriosis>.
- Endometriosis Australia, ‘Endometriosis Facts’ <https://www.endometriosisaustralia.org> (reporting an average diagnostic delay of 6.4 years in Australia).
- Armour M et al, ‘Endometriosis and academic performance: a cross-sectional study’ (2019) 19 BMC Pediatrics 138; see also Moradi M et al, ‘Impact of endometriosis on women’s lives: a qualitative study’ (2014) 14 BMC Women’s Health 123 (discussing normalisation of pain and its role in diagnostic delay).
- Rogers v Whitaker (1992) 175 CLR 479 (High Court of Australia).
- Endometriosis Australia, ‘Endometriosis and Fertility’ <https://www.endometriosisaustralia.org>.
- Facchin F et al, ‘Mental health in women with endometriosis: searching for predictors of psychological distress’ (2017) 32(9) Human Reproduction 1855; see also Australian and New Zealand Journal of Obstetrics and Gynaecology literature on psychological sequelae of diagnostic delay.
- Armour M et al, ‘The cost of illness and economic burden of endometriosis and chronic pelvic pain in Australia: a national online survey’ (2019) 14(10) PLOS ONE e0223316.
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists, College Statement C-GYN 26: Endometriosis (current edition) <https://www.ranzcog.edu.au>.
- Australian Commission on Safety and Quality in Health Care, Endometriosis Clinical Care Standard (2022) <https://www.safetyandquality.gov.au>.
- Civil Liability Act 2002 (NSW), ss 5D, 5O, 16.
- Limitation Act 1969 (NSW), s 14.
- Tabet v Campbell [2019] NSWCA 274.
- Dobler v Halverson [2007] NSWCA 335.
This article contains general legal information only. It does not constitute legal advice, and reading it does not create a lawyer–client relationship. The law discussed applies to New South Wales, Australia. Each person’s circumstances differ. Time limits apply to legal claims in NSW, and these limits may affect your position. You should seek independent legal advice about your specific situation.