I have no doubt that, in the generality of cases, the proposition of law is correct but equally have no doubt that the judge in the circumstances of the present case was not guilty of any self-misdirection. (Emphasis added.) Bolitho v City and Hackney Health Authority: HL 24 Jul 1997 References: Gazette 10-Dec-1997, Times 27-Nov-1997, [1997] UKHL 46, [1998] AC 232, [1997] 4 All ER 771, [1997] 3 WLR 1151 Links: House of Lords , Bailii He submitted that the judge was wrong in law in adopting that approach and that ultimately it was for the court, not for medical opinion, to decide what was the standard of care required of a professional in the circumstances of each particular case. Case analysis: Bolitho versus City and Hackney Health Authority. A practice as to disclosure approved and adopted, by a profession or section of it may be in many cases the determining consideration as, to what is reasonable. I will have to consider some of their reasons hereafter. It follows the Bolam test for professional negligence, and addresses the interaction with the concept of causation.. Facts LORD HOFFMANN My Lords, I have had the advantage of reading in draft the speech prepared by my noble and learned friend, Lord Browne-Wilkinson. The sister was sufficiently concerned about his condition to bleep Dr. Horn rather than to go through the usual chain of command by first contacting the senior house officer, Dr. Rodger. ... Bolitho v City and Hackney Health Authority. The cases linked on your profile facilitate Casemine's artificial intelligence engine in recommending you to potential clients who might be interested in availing your services for similar matters. Despite my anxiety as to the result in this particular case, it is to me clear that Hutchinson J. asked the right questions and did not misdirect himself in answering them. (RESPONDENTS) ON 13 NOVEMBER 1997 LORD BROWNE-WILKINSON My Lords, This appeal raises two questions relating to liability for medical negligence. (APPELLANT) v. CITY AND HACKNEY HEALTH AUTHORITY (RESPONDENTS) ON 13 NOVEMBER 1997. Bolitho v City and Hackney Health Authority House of Lords Citations : [1998] AC 232; [1997] 3 WLR 1151; [1997] 4 All ER 771; [1998] PIQR P10; [1998] Lloyd’s Rep Med 26; (1998) 39 BMLR 1. change. In this case, again the appellant patients appeal was dismissed. Nurse Newbold tried to take Patrick's pulse and rate of respiration but this proved very difficult as he appeared quite well and was jumping about and playing in his cot. For the reasons which he has given, I, too, would dismiss this appeal. LORD SLYNN OF HADLEY My Lords, I have had the advantage of reading in draft the speech prepared by my noble and learned friend, Lord Browne-Wilkinson. Bolitho v City and Hackney Health Authority1 IN recent years, considerable criticism has been levelled at the test for determining the standard of care in negligence with respect to persons within the medical profession. Chester v Afshar [2004] UKHL 41; [2005] 1 AC 134; [2004] 3 WLR 927; [2004] 4 All ER 587 HL. But if, in a rare case, it can be demonstrated that the professional opinion is not capable of withstanding logical analysis, the judge is entitled to hold that the body of opinion is not reasonable or responsible. Nor can I see any circumstances in which the Bolam test could be relevant to such a question. At around 2 p.m. the second episode occurred. I would dismiss the appeal. Assignment 01 EDAHOD5 Educator as assessor.pdf, 2017 Health Science Rules and Syllabuses web-version.pdf. . The court must be vigilant to see whether the reasons given for putting a patient at risk are valid in the light of any well-known advance in medical knowledge, or whether they stem from a residual adherence to out-of-date ideas." At around 12.40 p.m. on 17 January there occurred the first episode. In particular in cases involving, as they so often do, the weighing of risks against benefits, the judge before accepting a body of opinion as being responsible, reasonable or respectable, will need to be satisfied that, in forming their views, the experts have directed their minds to the question of comparative risks and benefits and have reached a defensible conclusion on the matter. . A defendant cannot escape liability by saying that the damage would have occurred in any event because he would have committed some other breach of duty thereafter. The Dr. Rodger examined him and was also concerned about his condition. Thus, the body of professional opinion, though almost universally held, was not reasonable or responsible. The views of the plaintiff's experts were largely based on the premise that over the last two hours before the catastrophe Patrick was in a state of respiratory distress progressing inexorably to hypoxia and respiratory failure. In my judgment it was for the judge to assess the truth of her evidence on this issue. [1997] UKHL 46 Expert witness In this medical negligence case, the House of Lords considered how expert evidence as to a body of professional opinion in a professional negligence case should be dealt with. Having made his findings of fact, the judge directed himself as to the law by reference to the speech of Lord Scarman in Maynard v. West Midlands Regional Health Authority [1984] 1 W.L.R. (APPELLANT) v. CITY AND HACKNEY HEALTH AUTHORITY (RESPONDENTS) ON 13 NOVEMBER 1997 LORD BROWNE-WILKINSON My Lords, This appeal raises two questions relating to liability for medical negligence. I read him as saying that, without expert evidence he would have thought that the risk involved would have called for intubation, but that he could not dismiss Dr. Dinwiddie's views to the contrary as being illogical. The court has an obligation, to scrutinize professional practices to ensure that they accord with the standard of, reasonableness imposed by the law. This preview shows page 5 - 7 out of 7 pages. Nurse Newbold left a colleague with Patrick and reported to Sister Sallabank who told her to bleep the doctors again. 2004. “Mental Capacity, Legal Competence and Consent.” Journal of the Royal Society of Medicine, 920: 415-420. When Sister Sallabank returned to Patrick she was extremely surprised to see him walking about again with a decidedly pink colour. Bolitho v City of Hackney Health Authority [1997] 4 All ER 771 is a Tort Law case focusing on breach of duty, causation and the Bolam Test. I emphasise that in my view it will very seldom be right for a judge to reach the conclusion that views genuinely held by a competent medical expert are unreasonable. The defendants' experts, on the other hand, considered the facts as recounted by Sister Sallabank indicated that Patrick was quite well apart from the two quite sudden acute episodes at 12.40 p.m. and 2 p.m. Of these five, the judge was most impressed by Dr. Heaf, a consultant paediatrician in respiratory medicine at the Royal Liverpool Children's Hospital, which is the largest children's hospital in the United Kingdom. Bolitho v. City and Hackney Health Authority [1996] 4 All ER 771 is an important English tort law case, on the standard of care required by medical specialists. Please log in or sign up for a free trial to access this feature. contains alphabet), Bolitho v. City and Hackney Health Authority. It follows the Bolam test for professional negligence, and addresses the interaction with the concept of causation. 2002 Jun;8(3):222-3. L.R. The doctor who negligently failed to attend to, the boy said that she would not have intubated had she attended. In particular, where there are questions of assessment of the relative risks and benefits of adopting a particular medical practice, a reasonable view necessarily presupposes that the relative risks and benefits have been weighed by the experts in forming their opinions. This argument, which was raised for the first time by amendment to the notice of appeal in the Court of Appeal, commended itself to Simon Brown L.J. Five of them were called on behalf of Patrick and were all of the view that, at least after the second episode, any competent doctor would have intubated. The case came on for trial before Hutchinson J. Dr. Rodger did not attend Patrick after the second episode. The Bolam test--should the judge have accepted Dr. Dinwiddie's evidence? It was this test which Lord Scarman was repeating, in different words, in Maynard's case in the passage by reference to which the judge directed himself. As a result he suffered a cardiac arrest. He refused to "substitute his own views for those of the medical experts." TORT – NEGLIGENCE – STANDARD OF CARE FOR MEDICAL PROFESSIONALS – CAUSATION. In case of any confusion, feel free to reach out to us.Leave your message here. There was a change in Patrick's condition. According to the accounts of Sister Sallabank and Nurse Newbold, although Patrick had had two severe respiratory crises, he had recovered quickly from both and for the rest presented as a child who was active and running about. She took this course because she felt something was acutely wrong. By clicking on this tab, you are expressly stating that you were one of the attorneys appearing in this matter. Pearce v United Bristol Healthcare NHS Trust [1999] 48 BMLR 118. Before your Lordships, Mr. Brennan, for the appellant, submitted, first, that the Bolam test has no application in deciding questions of causation and, secondly, that the judge misdirected himself by treating it as being so relevant. "Bolitho v. City and Hackney Health Authority" [1997] 4 All ER 771 is an important English tort law case, on the standard of care required by medical specialists. Bolitho v City and Hackney Health Authority [1997] UKHL 46. Nurse Newbold immediately returned to Patrick. Common to both sides is the recognition that I must decide whether Dr. Horn would have intubated (or made preparations for intubation), and, even if she would not, whether such a failure on her part would have been contrary to accepted practice in the profession." The nurse who was observing Patrick summoned Sister Sallabank, a skilled and experienced nurse. Legal versus medical causation. In relation to decision-making on behalf … The passages from his judgment which I have quoted (and in particular those that I have underlined) demonstrate this. City and Hackney Health Authority continued (back to preceding text) Where, as in the present case, a breach of a duty of care is proved or admitted, the burden still lies on the plaintiff to prove that such breach caused the injury suffered: Bonnington Castings Ltd. v. Wardlaw [1956] A.C. 613; Wilsher v. My Lords, This appeal raises two questions relating to liability for medical negligence. The assessment of medical risks and benefits is a matter of clinical judgment which a judge would not normally be able to make without expert evidence. discover english bolitho pdf J.bolithounsw.edu.au. Sister Sallabank also heard the buzzer and sent out a call for the cardiac arrest team. To the extent that the Lord Justice noticed the first question--would Dr. Horn have intubated?--he said that the judge was wrong to accept Dr. Horn's evidence that she would not have intubated. The Privy Council held that even though completion in Hong Kong style was almost universally adopted in Hong Kong and was therefore in accordance with a body of professional opinion there, the defendant's solicitors were liable for negligence because there was an obvious risk which could have been guarded against. He has subsequently died and these proceedings have been continued by his mother as administratrix of his estate. Completion in Hong Kong style provides for money to be paid over against an undertaking by the solicitors for the borrowers subsequently to hand over the executed documents. He had not slept well and had been restless; further he seemed to be having increasing difficulty in breathing and was wheezier. The appeal of the argument was to the judge "as a layman" not a conclusion he had reached on all the medical evidence. The judge accepted this evidence. James Watt. However, the judge also expressed these doubts: "Mr. Brennan also advanced a powerful argument--which I have to say, as a layman, appealed to me--to the effect that the views of the defendant's experts simply were not logical or sensible. These decisions demonstrate that in cases of diagnosis and treatment there are cases where, despite a body of professional opinion sanctioning the defendant's conduct, the defendant can properly be held liable for negligence (I am not here considering questions of disclosure of risk). Patrick suffered catastrophic brain damage as a result of cardiac arrest induced by respiratory failure. The judge identified the questions he had to answer as follows: "[Mr. Owen, for the defendants] submitted therefore that (if once it was held that Dr. Horn was negligent in failing to attend at either 12.40 p.m. or 2 p.m) the sole issue was whether Patrick would on one or other of these occasions have been intubated. . He was entitled on all the evidence to accept that of Dr. Dinwiddie. Bolitho v City and Hackney Health Authority [1998] AC 232. This practice opened the gateway through which a dishonest solicitor for the borrower absconded with the loan money without providing the security documents for such loan. Again, in the passage which I have cited from Maynard's case, Lord Scarman refers to a "respectable" body of professional opinion. Once you create your profile, you will be able to: Claim the judgments where you have appeared by linking them directly to your profile and maintain a record of your body of work. where the Court sets the law not the profession. . in Joyce v. Merton, Sutton and Wandsworth Health Authority [1996] 7 Med. Although the judge does not in turn say so, it was implicit in his judgment that he accepted that Dr. Dinwiddie's view was a reasonable view for a doctor to hold. is not determinative of the issue of causation. The first, which I believe to be more apparent than real, relates to the proof of causation when the negligent act is one of omission. By this, I mean the second hurdle which a Plaintiff may have to cross in getting home an allegation of medical negligence where the first hurdle consists of … and (2) If she would not have intubated, would that have been negligent? (1980) 2 NSWLR 542 where a patient in Royal Prince, Alfred Hospital who had been born with a spinal problem had her spinal cord totally, severed leaving her a paraplegic. Dr. Horn seemed alarmed that Patrick was in such distress when he had appeared perfectly well a short time before during the consultant's round. Accordingly he held that it had not been proved that the admitted breach of duty by the defendants had caused the catastrophe which occurred to Patrick. There was evidence, that he would not have intubated whereas five other experts, be a logical basis for the opinion not to intubate. Bolitho test: A legal test that modified the 1957 Bolam test, which the English courts had been using to determine medical negligence by a doctor or nurse. 583. I adopt the analysis of Hobhouse L.J. As to the first of those issues, Dr. Horn's evidence was that, had she come to see Patrick at 2 p.m., she would not have arranged for him to be intubated. Get 2 points on providing a valid reason for the above As it seems to me, if Dr. Horn would have intubated, then the plaintiff succeeds, whether or not that is a course which all reasonably competent practitioners would have followed. But there is some difficulty in analysing why it was correct. 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