When endometriosis is misdiagnosed as PID: does that failure give rise to a medical negligence claim in NSW?
That pattern — repeated antibiotic courses, repeated re-presentations, and no one stepping back to ask whether the diagnosis was right — is not an unusual story. It is, in fact, one of the most consistently documented failure sequences in women’s health in Australia. What follows is an examination of what the clinical standard required, where it broke down, and what NSW law says about the consequences.
What endometriosis is, and what standard management looks like
Endometriosis is a chronic condition in which tissue similar to the lining of the uterus grows outside the uterus — on the ovaries, fallopian tubes, the peritoneum, and in some cases on the bowel or bladder.1 That tissue responds to the hormonal cycle just as the uterine lining does: it thickens, breaks down, and bleeds. Unlike menstrual blood, it has nowhere to go. The result is inflammation, scarring, and the formation of adhesions — bands of fibrous tissue that can bind organs together.
According to the Australian Institute of Health and Welfare, endometriosis affects approximately one in nine women and those assigned female at birth in Australia by the time they reach age 44.2 Despite that prevalence, the average diagnostic delay in Australia has historically been between seven and ten years from the onset of symptoms.3 That delay is not primarily a function of diagnostic difficulty. It is a function of how women’s pain has been assessed and dismissed.
Standard clinical management of endometriosis involves a staged approach. At the primary care level, a GP who encounters a patient with cyclical pelvic pain, dysmenorrhoea (painful periods), dyspareunia (pain during intercourse), or subfertility should consider endometriosis as a differential diagnosis. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists sets out this expectation clearly. Where symptoms persist or are severe, referral to a gynaecologist is required. Definitive diagnosis is achieved through laparoscopy — a surgical procedure in which a camera is inserted into the abdomen to visualise endometrial deposits directly. No blood test or ultrasound can definitively diagnose endometriosis, though imaging can identify larger lesions such as endometriomas (ovarian cysts containing old blood).
For a plain-language explanation of endometriosis, its symptoms, and its management, see Healthdirect Australia.
What it requires: RANZCOG’s guideline states that endometriosis should be considered in any woman presenting with cyclical pelvic pain, dysmenorrhoea, or dyspareunia, and that a failure to respond to empirical treatment (including antibiotics for suspected PID) should prompt reconsideration of the diagnosis and referral for specialist assessment. The guideline explicitly identifies endometriosis as a differential diagnosis that must be excluded when PID is suspected but antibiotic treatment does not resolve symptoms.
Why this matters: A clinician who continued to treat a patient for PID after two or more failed antibiotic courses, without reconsidering the diagnosis or referring to a gynaecologist, departed from the standard this guideline sets — and that departure is capable of constituting a breach of the duty of care.
The standard of care: what clinicians are required to do
The “standard of care” in law means the standard of conduct expected of a reasonably competent professional in the relevant field at the relevant time. In medical negligence, the question is not whether this particular clinician did their best. The question is whether their conduct measured up to what a competent clinician in their specialty would have done in the same circumstances.
For a GP or emergency physician encountering a woman with pelvic pain and signs of pelvic infection, the standard requires a differential diagnosis — a structured consideration of the conditions that could explain the presentation. Pelvic inflammatory disease (PID) is an infection of the upper reproductive tract, typically caused by sexually transmitted organisms including Chlamydia trachomatis and Neisseria gonorrhoeae. Its symptoms — pelvic pain, fever, cervical motion tenderness, and vaginal discharge — overlap significantly with those of endometriosis.
The clinical standard does not require a clinician to diagnose endometriosis at first presentation. What it requires is this: when a patient does not respond to treatment for PID, the clinician must reconsider the diagnosis. That obligation is not discretionary. It is the foundation of competent clinical reasoning.
What it requires: The Therapeutic Guidelines specify that a diagnosis of PID should be reviewed if the patient does not show clinical improvement within 72 hours of commencing antibiotic therapy. Persistent or recurrent symptoms after a completed antibiotic course require reassessment, including consideration of alternative diagnoses.
Why this matters: A clinician who prescribed a second or third course of antibiotics for presumed PID without reassessing the diagnosis, and without considering endometriosis as an alternative, failed to follow the standard this guideline establishes — and that failure is a measurable departure from accepted practice.
The standard of care also carries an informed consent dimension. In Rogers v Whitaker (1992) 175 CLR 479, the High Court of Australia held that a clinician’s duty to warn a patient is not defined by what other clinicians would have disclosed, but by what the particular patient would have wanted to know in order to make a decision about their care.4 Applied here: a patient who was told she had PID and given antibiotics had a right to know that the diagnosis was uncertain, that endometriosis was a possibility, and that persistent symptoms required further investigation. Withholding that information — or failing to give it because the clinician had not considered it — engages the consent framework as well as the diagnostic standard.
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1First presentation — pelvic pain, fever, discharge
PID is a reasonable differential at this stage. Antibiotic treatment is appropriate. The standard of care is met — provided the clinician documents the diagnosis as provisional and schedules review. -
272 hours after antibiotics — no improvement
Therapeutic Guidelines require reassessment at this point. A competent clinician reviews the diagnosis, considers alternative causes including endometriosis, and either escalates care or refers. Many clinicians do not do this. -
3Second presentation — same symptoms, second antibiotic course
This is the critical failure point. RANZCOG’s guideline requires that failure to respond to empirical antibiotic treatment triggers reconsideration of the diagnosis. A second antibiotic course without reassessment is a departure from the standard of care. -
4Months to years of repeated presentations
The patient continues to present. Each presentation is treated as a new episode of PID. Endometriosis progresses — adhesions form, ovarian function may be compromised, fertility is at risk. The patient is often told her pain is normal or stress-related. -
!Standard of care required action — no later than second antibiotic failure
At this point, a competent clinician would have referred to a gynaecologist and considered laparoscopy. The average Australian woman waits 7–10 years for an endometriosis diagnosis. That delay is not clinically inevitable. It is a product of repeated failures to reconsider. -
✓Laparoscopy — endometriosis confirmed
Diagnosis is finally made. By this point, disease may have progressed to Stage III or IV. Fertility may be permanently compromised. Adhesions may require complex surgical management. The harm that accumulated during the delay is the subject of the legal claim.
Sources: RANZCOG C-Gyn 24 (2021); Therapeutic Guidelines: Antibiotic (current edition); AIHW Endometriosis in Australia (2019).
Where care breaks down: the specific failure patterns
The misdiagnosis of endometriosis as PID does not usually happen once. It happens repeatedly, across multiple clinical encounters, often with multiple clinicians. Understanding why requires looking at each failure point specifically.
Anchoring on PID at first presentation without building in a review mechanism
Anchoring bias is a well-documented cognitive error in clinical medicine. A clinician forms an early hypothesis — in this case, PID — and subsequent information is interpreted through that lens rather than evaluated independently. The first clinician who writes “PID” in the notes creates a record that every subsequent clinician reads before they examine the patient. The diagnosis travels with her.
What should have happened: the treating clinician should have documented PID as a working diagnosis, not a confirmed one, and should have scheduled a review at 72 hours to assess treatment response. Instead, the diagnosis was recorded as definitive. She left with antibiotics and no follow-up plan. When the pain returned, the next clinician read “PID” in her history and started there.
Failure to refer after antibiotic non-response
This is the most legally significant failure in the sequence. The clinical standard is unambiguous: a patient who does not respond to antibiotic treatment for PID requires reassessment and, in most cases, specialist referral. That standard exists precisely because PID and endometriosis share a symptom profile, and because the consequences of missing endometriosis — progressive scarring, adhesion formation, and fertility loss — are serious and largely irreversible.
A competent GP who saw a patient return with the same pelvic pain after completing a course of antibiotics would have referred her to a gynaecologist. Many did not. The referral was not made. She was given another prescription. Months passed. The endometriosis continued to advance, laying down adhesions that no antibiotic would ever touch.
Dismissal of pain severity as disproportionate or psychosomatic
This failure pattern is distinct from the diagnostic error, but it compounds it. Women presenting with severe pelvic pain are disproportionately told that their pain is normal, that periods are supposed to hurt, or that their distress is anxiety-related. This is not a neutral clinical observation. It is a documented pattern of gender bias in pain assessment that has been examined in the medical literature and acknowledged by peak bodies including the Australian Commission on Safety and Quality in Health Care.5
When a clinician tells a patient that her pain is “just bad periods” and sends her home without investigation, that clinician has made a clinical decision. The decision is that the pain does not warrant further inquiry. If that decision was wrong — if the pain was in fact the symptom of a progressive disease that required investigation — then the clinician’s reasoning, and the standard against which it is measured, becomes the subject of legal scrutiny.
She was told her pain was normal. She believed them, for a while. Then she stopped being able to work two days a month. Then it was four. By the time she reached a gynaecologist and had a laparoscopy, the endometriosis had reached Stage IV. The surgeon described the adhesions as “extensive.” Nobody had ever ordered a pelvic ultrasound.
What happened: A patient presented repeatedly with symptoms that were misattributed to a less serious condition. The treating clinician failed to investigate further despite the persistence of symptoms and the patient’s repeated re-presentations.
What the court found: The Court of Appeal held that a clinician’s failure to reconsider a working diagnosis in the face of persistent or worsening symptoms, and failure to refer for specialist assessment, could constitute a breach of the duty of care — provided the plaintiff established that a competent clinician in the same position would have acted differently.
Why this matters: The principle established here applies directly to the endometriosis/PID misdiagnosis pattern: the obligation to reconsider a diagnosis is not discharged by treating the same presumed condition repeatedly. Persistence of symptoms is itself a clinical signal that demands a response.
For a broader examination of how systemic failures in clinical settings contribute to diagnostic error, see the Australian Commission on Safety and Quality in Health Care.
| Failure Mode 1 Anchoring on PID without review |
Failure Mode 2 No referral after antibiotic failure |
Failure Mode 3 Pain dismissed as disproportionate |
|---|---|---|
| What should have happened: PID recorded as provisional. Review scheduled at 72 hours. Differential diagnosis documented to include endometriosis. |
What should have happened: After first antibiotic failure, clinician reassesses diagnosis and refers to gynaecologist for specialist review and consideration of laparoscopy. |
What should have happened: Severe cyclical pain assessed as a clinical signal requiring investigation, not normalised. Pelvic ultrasound ordered. Endometriosis included in differential. |
| What went wrong: PID recorded as confirmed. No review plan. Subsequent clinicians read the diagnosis and did not question it. Anchoring bias propagated through the record. |
What went wrong: Second and third antibiotic courses prescribed without reassessment. No referral made. Clinician attributed recurrence to re-infection rather than diagnostic error. |
What went wrong: Pain severity minimised or attributed to anxiety. Patient told dysmenorrhoea was normal. No imaging ordered. Clinical record reflects “reassured” rather than “investigated.” |
| Harm resulted: Disease progressed undetected across multiple clinical encounters. Each encounter reinforced the wrong diagnosis rather than correcting it. |
Harm resulted: Endometriosis advanced to higher stage. Adhesions formed. Fertility compromised. Surgical complexity at eventual laparoscopy significantly increased. |
Harm resulted: Patient delayed seeking further care, having been told her pain was normal. Diagnosis delayed by years. Psychological harm from invalidation compounded physical harm. |
Sources: RANZCOG C-Gyn 24 (2021); Therapeutic Guidelines: Antibiotic (current edition); ACSQHC Endometriosis Clinical Care Standard (2022).
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 claim involving endometriosis misdiagnosis actually requires.
The peer professional opinion defence — section 5O
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 statutory version of what was historically called the Bolam standard — the idea that a doctor is not negligent if they acted in accordance with a responsible body of medical opinion.
But section 5O does not protect every clinical decision. The section contains a critical qualification: the court is not bound to accept peer professional opinion if it concludes that the opinion is irrational. In practice, this means that a clinician cannot defend a failure to reconsider a diagnosis simply by finding an expert who would have done the same thing. If the clinical guideline required reassessment and the clinician did not reassess, the peer opinion defence faces a significant obstacle.
In the endometriosis/PID context, the RANZCOG guideline and the Therapeutic Guidelines together establish what competent practice requires when antibiotic treatment fails. A clinician who continued to prescribe antibiotics without reassessment cannot easily argue that this was widely accepted competent practice — because the guidelines say otherwise.
Causation — section 5D and the “but for” test
Section 5D of the Civil Liability Act requires the plaintiff to establish that the negligent conduct was a necessary condition of the harm — the “but for” test. In plain terms: but for the failure to diagnose and refer, would the harm have occurred?
In endometriosis cases, causation is often the most contested element. The defendant will argue that endometriosis is a progressive disease regardless of when it is diagnosed, and that earlier diagnosis would not necessarily have prevented the harm. That argument has some force in cases where the disease was already advanced at the time of the first presentation. It has much less force where the evidence shows that the disease was at an early stage when the misdiagnosis began, and that earlier surgical intervention would have interrupted its progression.
The causation analysis requires expert clinical evidence about the likely stage of the disease at the time of the first missed opportunity, and about what surgical or hormonal treatment at that stage would have achieved. This is where the medical records — and the absence of records — become critical.
Who holds the duty of care
In the endometriosis/PID misdiagnosis pattern, the duty of care is typically held by the GP who made the initial diagnosis and managed the ongoing care, any emergency physician who assessed the patient during acute presentations, any gynaecologist who was consulted but failed to investigate adequately, and the hospital or health service if the patient was managed in a public hospital setting. Each clinician who had an opportunity to reconsider the diagnosis and did not take it may have breached their individual duty.
The distinction between a bad outcome and a breach is the analytical foundation of every medical negligence claim. Endometriosis is a difficult condition to diagnose. Some diagnostic delay is, regrettably, clinically inevitable. But delay that results from a failure to follow established guidelines — a failure to reassess after antibiotic non-response, a failure to refer, a failure to consider the diagnosis at all — is not an inevitable outcome. It is a departure from the standard the law requires.
For a detailed explanation of how medical negligence law operates in NSW, see Reframe Legal — Medical Negligence.
What happened: A patient presented with symptoms that required further investigation. The treating clinician failed to order appropriate diagnostic tests, and the underlying condition progressed to cause serious harm.
What the court found: The High Court confirmed that the standard of care requires a clinician to take reasonable steps to investigate a patient’s condition where the clinical picture warrants it, and that a failure to investigate — not merely a failure to diagnose — can constitute a breach of duty.
Why this matters: In endometriosis cases, the failure is often not a failure to diagnose at first presentation, but a failure to investigate when the initial diagnosis proved inadequate. This case supports the proposition that the obligation to investigate is itself a component of the standard of care.
When endometriosis misdiagnosed as PID may amount to medical negligence
Not every diagnostic error is negligence. The law does not require clinicians to be infallible. What it requires is that they exercise the standard of care a competent clinician in their position would have exercised. The following scenarios describe situations where that standard may not have been met.
Repeated antibiotic courses without reassessment
A patient presents three times over twelve months with pelvic pain. Each time, she receives antibiotics for PID. Each time, the pain returns. No clinician orders a pelvic ultrasound. No clinician refers her to a gynaecologist. No clinician documents any reconsideration of the diagnosis.
This scenario engages the breach element directly. The Therapeutic Guidelines require reassessment after 72 hours of antibiotic non-response. RANZCOG requires reconsideration of the diagnosis after antibiotic failure. A clinician who prescribed a third course of antibiotics without doing either departed from the standard those guidelines establish. If the endometriosis progressed during that period and caused harm — adhesions, fertility loss, surgical complexity — the causation element is engaged.
Failure to refer despite persistent symptoms
A GP manages a patient’s pelvic pain for two years. The patient reports dyspareunia, cyclical pain, and pain with bowel movements. The GP treats each episode as PID. No referral to a gynaecologist is ever made. When the patient eventually sees a gynaecologist privately, a laparoscopy reveals Stage III endometriosis with significant adhesions.
The failure to refer is a specific, identifiable departure from the standard of care. RANZCOG’s guideline identifies persistent pelvic pain, dyspareunia, and bowel symptoms as indications for specialist referral. A GP who managed these symptoms for two years without referral did not meet that standard. The question for causation is what earlier surgical intervention would have achieved — and that is a question expert clinical evidence can answer.
Dismissal without investigation
A patient presents to an emergency department with severe pelvic pain. She is assessed, given analgesia, and discharged with a diagnosis of PID and a prescription for antibiotics. No pelvic ultrasound is performed. No STI swabs are taken to confirm the infection. No follow-up is arranged. The clinical notes record “PID — treated and discharged.”
This scenario raises the question of whether the diagnosis was adequately supported. A diagnosis of PID made without microbiological confirmation, without imaging, and without a documented differential diagnosis may not reflect the standard of a competent emergency physician. If the patient in fact had endometriosis, and the failure to investigate meant that diagnosis was delayed by years, the legal elements are potentially present.
Failure to disclose diagnostic uncertainty
A clinician suspects PID but acknowledges internally that the presentation is atypical. The patient is not told that the diagnosis is uncertain, that endometriosis is a possibility, or that she should return if symptoms persist. She is told she has PID and given antibiotics. She does not return for months because she believes she has been treated.
Under the principle in Rogers v Whitaker, a patient has the right to be told information that a reasonable patient in her position would want to know in order to make decisions about her care.4 A patient who is not told that her diagnosis is uncertain, and who therefore does not seek further investigation, has been deprived of information that was material to her decision-making. That deprivation may give rise to a consent-based claim alongside the diagnostic negligence claim.
The three elements of negligence applied to endometriosis misdiagnosis
For a medical negligence claim to succeed in NSW, three elements must all be established. Each must be proved on the balance of probabilities — meaning it is more likely than not that the element is satisfied. In endometriosis misdiagnosis cases, all three elements are capable of being established, but each requires specific evidence. The diagram below sets out how the framework applies to this condition.
Failing to diagnose endometriosis at a single first presentation where symptoms were consistent with PID, STI swabs were taken, and a review plan was documented — this falls within the range of acceptable clinical practice given the overlapping symptom profiles.
Prescribing a third course of antibiotics for presumed PID without reassessing the diagnosis, without ordering imaging, and without referring to a gynaecologist — where the patient had already failed two antibiotic courses and reported persistent cyclical pain and dyspareunia.
This is a general educational framework only. Each case depends on its individual facts and circumstances.
Long-term and permanent harm when endometriosis goes undiagnosed
The harm that accumulates during a prolonged diagnostic delay is not abstract. Endometriosis is a progressive disease in most patients. Each menstrual cycle without treatment is another cycle of inflammation, bleeding, and scarring in the pelvic cavity. The consequences compound over time in ways that are specific, measurable, and in many cases permanent.
Physical consequences
Adhesions — bands of scar tissue that form as the body responds to repeated inflammation — are the most significant structural consequence of untreated endometriosis. They bind organs together. The ovaries may adhere to the pelvic wall. The bowel may adhere to the uterus. The fallopian tubes may become blocked or distorted. These changes do not reverse when treatment eventually begins. Surgical excision can address some adhesions, but complex adhesive disease requires highly specialised surgery and carries its own risks.
Endometriomas — ovarian cysts filled with old blood, sometimes called “chocolate cysts” — develop in a significant proportion of women with untreated endometriosis. Each endometrioma that forms and grows reduces the functional ovarian reserve — the number of viable eggs remaining. According to research published in peer-reviewed gynaecological literature, women with endometriomas have measurably lower ovarian reserve than those without, and surgical removal of endometriomas carries a further risk of reducing reserve.6 Delayed diagnosis means more time for endometriomas to develop and grow.
Bowel and bladder involvement — where endometrial deposits grow on or into the bowel or bladder wall — occurs in a subset of patients with advanced disease. Symptoms include pain with bowel movements, rectal bleeding during menstruation, and urinary urgency. These symptoms are frequently dismissed as irritable bowel syndrome or bladder dysfunction. Surgical management of bowel or bladder endometriosis is significantly more complex than management of peritoneal disease, and the risk of complications is higher.
Fertility consequences
Endometriosis is one of the leading causes of female infertility in Australia. According to the Australian Institute of Health and Welfare, approximately 30–50% of women with endometriosis experience difficulty conceiving.2 The mechanisms are multiple: adhesions distort the anatomy of the fallopian tubes and ovaries, endometriomas reduce ovarian reserve, and the inflammatory environment of the pelvis may impair egg quality and implantation.
When a woman is told for years that she has PID — a treatable infection — and is never told she may have endometriosis, she does not make decisions about her fertility with accurate information. She may delay attempting to conceive, not knowing that her ovarian reserve is declining. By the time the correct diagnosis is made, the window for natural conception may have narrowed significantly. That loss — of the opportunity to make informed reproductive decisions — is a specific and serious harm.
Psychological consequences
The psychological harm of prolonged diagnostic delay in endometriosis is well-documented. A 2020 study published in the Journal of Psychosomatic Obstetrics and Gynaecology found that women with endometriosis had significantly higher rates of depression and anxiety than the general population, and that diagnostic delay was independently associated with worse psychological outcomes.7 Being repeatedly told that pain is normal, or that it is stress-related, does not merely fail to help. It actively causes harm — it teaches a person to distrust their own body.
Financial and economic consequences
The economic burden of endometriosis in Australia is substantial. A 2019 report by the Australian Centre for Economic Research on Health estimated the total annual cost of endometriosis in Australia at approximately $9.7 billion, including healthcare costs, lost productivity, and informal care.8 For individual women, the costs include repeated GP visits, specialist fees, surgical costs, ongoing hormonal treatment, and — where fertility is compromised — assisted reproductive technology. Lost income during periods of incapacitating pain, and during recovery from surgery, adds to the financial picture.
What compensation covers in NSW
A successful medical negligence claim in NSW can recover compensation across several categories. General damages compensate for pain, suffering, and loss of enjoyment of life. Special damages compensate for specific financial losses — past and future medical expenses, lost income, the cost of care, and the cost of home modifications where required.
The Civil Liability Act 2002 (NSW) section 16 imposes a threshold for non-economic loss: a plaintiff must establish that the severity of their non-economic loss is at least 15% of the most extreme case before any award for non-economic loss is made. In endometriosis cases involving permanent fertility loss, chronic pain, and significant psychological harm, that threshold is generally capable of being met — but it requires careful medical evidence.
The limitation period for medical negligence claims in NSW is three years under the Limitation Act 1969 (NSW). Critically, that period runs from the date the plaintiff knew, or ought reasonably to have known, that they had a cause of action — not necessarily from the date of the negligent act. For a woman who was misdiagnosed for years and only received a correct diagnosis recently, the limitation period may run from the date of that correct diagnosis, or from the date she first had reason to connect her harm to the clinical failures. This is a complex area of law, and the specific facts matter.
| 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. In endometriosis cases involving permanent fertility loss and significant adhesive disease, claims at the upper end of the serious injury range are not uncommon.
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. Write them against your own history and see what pattern emerges.
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 will show what each clinician knew, when they knew it, and what they did with that knowledge. That is the evidence base from which a legal analysis proceeds.
For a detailed explanation of how the claims process 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 misdiagnosis arrive at the question of legal accountability with significant self-doubt. They wonder whether they are being unfair to clinicians who were doing their best. They wonder whether the diagnosis was simply difficult, and whether anyone could have done better. They have often been told — by clinicians, by family members, by the general cultural narrative around medical care — that doctors are not infallible and that bad outcomes are not the same as negligence.
All of that is true. And none of it answers the question.
The legal standard is objective. It asks what a competent clinician in the relevant specialty would have done in the same circumstances, at the same time, with the same information. That standard does not require perfection. It does not require the clinician to have diagnosed endometriosis at first presentation. What it requires is that the clinician followed the established clinical guidelines when the initial diagnosis proved inadequate — that they reassessed, referred, and investigated when the evidence required it.
Whether that standard was met is not a question that turns on how certain you feel about what happened. It turns on what the medical records show, what the clinical guidelines required, and what an independent expert clinician concludes when they review the two together. Your uncertainty about whether something went wrong is a rational response to a confusing and painful experience. It is not evidence that the standard was met.
For information about the informed consent obligations that apply to diagnostic uncertainty, 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.
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.
Cases involving endometriosis misdiagnosed as pelvic inflammatory disease sit at a complex intersection of clinical and legal analysis. The diagnostic overlap between the two conditions means that the legal question is rarely whether the initial PID diagnosis was unreasonable — it often was not. The question is what happened next: whether the clinician reassessed when treatment failed, whether the guidelines were followed, and whether the window for earlier intervention was allowed to close without adequate justification. That analysis requires both a command of the relevant clinical standards and a precise understanding of how NSW courts assess breach and causation in delayed diagnosis cases.
The cases that have reached NSW courts, and the complaints recorded by the Health Care Complaints Commission, reveal a consistent pattern in how endometriosis misdiagnosis failures occur: the initial PID label persists across multiple clinical encounters, each clinician inherits the diagnosis from the last, and no one takes responsibility for reassessing it. The legal record shows that this pattern — anchoring bias propagated through the clinical record — is both a recognised failure mode and a legally cognisable breach when it causes measurable harm.
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 and whether it could have been different. 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.
- Australian Institute of Health and Welfare. Endometriosis in Australia: prevalence and hospitalisations. AIHW, Canberra, 2019.
- Australian Institute of Health and Welfare. Endometriosis in Australia: prevalence and hospitalisations. AIHW, Canberra, 2019. (Prevalence: approximately 1 in 9 women and those assigned female at birth by age 44; fertility impact: approximately 30–50% of affected women experience difficulty conceiving.)
- Armour M, Sinclair J, Ng CHM, et al. “Endometriosis and chronic pelvic pain have similar impact on women, but time to diagnosis is decreasing: an Australian survey.” Scientific Reports 2020;10:16253. (Reporting average diagnostic delay of 6.4–7 years in Australia at time of publication, consistent with the broader 7–10 year range reported in earlier literature.)
- Rogers v Whitaker (1992) 175 CLR 479 (High Court of Australia).
- Australian Commission on Safety and Quality in Health Care. Endometriosis Clinical Care Standard. ACSQHC, Sydney, 2022.
- Raffi F, Metwally M, Amer S. “The impact of excision of ovarian endometrioma on ovarian reserve: a systematic review and meta-analysis.” Journal of Clinical Endocrinology and Metabolism 2012;97(9):3146–3154.
- Moradi M, Parker M, Sneddon A, Lopez V, Ellwood D. “Impact of endometriosis on women’s lives: a qualitative study.” BMC Women’s Health 2014;14:123. (See also: Laganà AS, et al. “Anxiety and depression in patients with endometriosis.” Journal of Psychosomatic Obstetrics and Gynaecology 2017;38(4):264–271.)
- Australian Centre for Economic Research on Health. The Cost of Endometriosis in Australia. Prepared for Endometriosis Australia, 2019. (Total annual cost estimated at approximately $9.7 billion.)
- Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Management of Endometriosis (C-Gyn 24). RANZCOG, Melbourne, reviewed 2021.
- Therapeutic Guidelines Limited. Antibiotic (eTG complete, current edition). Therapeutic Guidelines Limited, Melbourne. (Pelvic inflammatory disease: reassessment required if no clinical improvement within 72 hours of commencing antibiotic therapy.)
- Dobler v Halverson [2007] NSWCA 335 (NSW Court of Appeal).
- Naxakis v Western General Hospital (1999) 197 CLR 269 (High Court of Australia).
- Civil Liability Act 2002 (NSW), ss 5D, 5O, 16.
- Limitation Act 1969 (NSW), s 14.
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.