AUTUMN 1998 The Standard of Care in Medical Negligence 475 occasion, override expert medical evidence.'" Other fields face a more stringent analysis by judges in an effort to guarantee that expert This includes the ‘but for’ test, arguments relating . The claim was dismissed as causation must be proved to bring a claim in negligence and there was no causation here. Sooriakumaran, P, ‘The changing face of medical negligence law: From Bolam to Bolitho’ [2008] 69 MJHM 6. The original judge also concluded that Dr Horn failing to go and attend to Patrick did not cause his death. However, the court in Bolitho did not specify in what circumstances it would be prepared to hold that the doctor has breached his duty of care by following a practice supported by a body of professional opinion, other than stating that such a case will be "rare". There was a concern that the symptoms were suggestive of pre-term labour. [1], A group of eight medical experts testified in the case at first instance. From Bolam-Bolitho to Modified-Montgomery - A Paradigm Shift in the Legal Standard of Determining Medical Negligence in Singapore. Authorised and regulated by the Solicitors Regulation Authority. He was admitted into St Bartholomew's Hospital and was placed under the care of Dr Horn (the senior registrar) and Dr Rodger. The obstetrician made the decision to prescribe Nifedipine, a tocolytic drug, in order to suppress or postpone pre-term labour. From Bolam to Bolitho: unravelling medical protectionism Christopher Stone January 2011 Introduction In 1990/91 the cost of clinical negligence claims to the NHS was estimated at around £52 million1.Twenty years later, by 2009 © Clyde & Co LLP, Can a doctor really be liable for being ahead of their time when treating patients? Bolam sets out that a doctor is not negligent if they have acted in accordance with a responsible body of opinion. An essential component of an action in negligence against a doctor is proof that the doctor failed to provide the required standard of care under the circumstances. Background The UK Supreme Court judgement in ‘Montgomery v Lanarkshire Health Board’1 has become the landmark case in consolidating the law on standard of care of doctors with regard to duty on disclosure of information to patients on the risks of proposed treatment and possible alternatives.2 Doctors are now obliged to take ‘reasonable care to ensure that the patient is aware of … These were the question facing the court in Jones v Taunton and Somerset NHS Foundation Trust [2019] Med LR 384. Five of them said they would have intubated Patrick after the second episode, let alone the first. However, whether it is viewed as a single Bolam/Bolitho test, a single but two-stage Bolam and then Bolitho test or two totally separate Bolam and Bolitho tests is really rather academic: the key take-home message is that, to be held The Bolam principle. Although he did not consider it necessary to decide the point, Mr Justice Stewart commented that the question remains: if a doctor would not be in breach of duty for prescribing a drug in 2002 because of changes of medical opinion, then should a doctor prescribing the same drug in 1995 be found negligent in a trial taking place after 2002? The core of the case was whether an obstetrician's prescription of Nifedipine was negligent. Here we look at the application of clinical negligence law, the standard to be applied to clinicians, and how to prove what injury has been suffered as a result of alleged negligence. His mother experienced "false alarms" of going into labour during. The professional opinion relied upon cannot be unreasonable or illogical. The Bolitho Test The case of Bolitho v City and Hackney Health Authority dates back to 1997 and concerned the treatment of a sick child in hospital. However, he did not think the testimony of the other three experts was "unreasonable" or "illogical" therefore he could not dismiss them. That would be an unlikely sea change in clinical negligence. Accordingly, it is clear that a threshold of this standard of care must be established in order to objectively assess if medical negligence has occurred. Patrick had two respiratory episodes where he went pale and his breathing became "noisy". Mr Justice McNair put it simply in his judgment: “I myself would prefer to put it this way, that he is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art.” The clinician is judged in accordance with the standards of the reasonably competen… Is your business prepared for climate change? One of our expert writers has created this bespoke sample Law assignment that shows the incredible quality that's guaranteed with every piece of work ordered. "[3] One of the experts stated that Patrick's recovery after each episode did not show a progressive respiratory collapse and that there was only a small risk of total respiratory failure.[3]. Sign up to receive email updates straight to your inbox. It ultimately required surgical drainage and multiple surgical interventions; following which, microbiology evidence confirmed actinomyces. Patrick Bolitho, a two-year-old boy, was suffering from croup. It follows the Bolam test for professional negligence, and addresses the interaction with the concept of causation. These were the question facing the court in Jones v Taunton and Somerset NHS Foundation Trust [2019] Med LR 384. If Dr Horn had come to see Patrick, she would not have intubated him. This states that negligence can only be proven in the case of a missed diagnosis if the chance of survival would have been over 50% had the illness been diagnosed. Between May 2013 and February 2014 the claimant developed a left-sided psoas abscess containing gas and fluid. [1] Dr Horn was notified but did not attend to Patrick. [4], Learn how and when to remove this template message, Bolam v. Friern Hospital Management Committee, British and Irish Legal Information Institute, https://en.wikipedia.org/w/index.php?title=Bolitho_v_City_and_Hackney_HA&oldid=984030901, Articles needing additional references from November 2009, All articles needing additional references, Creative Commons Attribution-ShareAlike License, This page was last edited on 17 October 2020, at 19:04. According to that test, which has been criticised by academic commentators, a doctor would not have acted negligently if his actions conformed to a practice supported by a body of professional opinion. Clinical Negligence – Bolitho Test In the Bolitho case the defending doctor was acquitted both at the original trial, in the Court of Appeal, and finally in the House of Lords. 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. Duri… It follows the Bolam test for professional negligence, and addresses the interaction with the concept of causation. However, following each episode Patrick seemed well and was 'jumping' around. In his opinion Lord Browne-Wilkinson accepted the principle that a judge would have to consider whether a body of medical opinion was logical, but decided that the opinion used by the defence in Bolitho was indeed logical. But Dr Horn argued that even if she had come to see Patrick, she would not have intubated him, and such a decision would have been consistent with a respectable body of professional opinion. [3] Especially on a young child as they must be anaesthetised and ventilated. For example, if a case of cancer was not found, but the patient would have only had a 35% chance of survival anyway, negligence would not … On the health authority's side, it was admitted that Dr Horn had breached her duty of care in not coming to see Patrick. Although he was revived, he suffered severe brain damage and later died. Half an hour after the second episode, Patrick suffered both a respiratory arrest and a cardiac arrest. This action was continued by Bolitho’s mother as adminastrix of his estate. The test was formulated in the case of Bolamwhich, despite dating back to 1957, remains good law. Bolitho narrowed the scope of the test, stating that the court must be satisfied that the body of opinion relied upon has a logical basis. Medical advances have to be well-evidenced before being put into practice, and the court is hardly likely to encourage behaviour to the contrary. The paper "The Bolam Test of Negligence" states that more fundamental shift away from negligence would support disclosure of troubles with explicit measures and the StudentShare Our website is a unique platform where students can share their papers in a matter of giving an example of the work to be done. So there was a need to decide if the hypothetical decision not to intubate Patrick would have been a breach of duty. We doubt it. Bolitho brought an action in the tort of negligence against the defendant health authority. cases involving skilled professionals such as doctors. Only in "a rare case" would the courts find that the body of opinion is unreasonable. I. An understanding of this approach and of the shift from the traditional Bolam test is The claimants argued that the doctors failed to take reasonable care by not attending to Bolitho after the call from the nurses. Mr Jones argued that the obstetrician was negligent on the basis of the test in Bolitho v City and Hackney Health Authority [1998] AC 232, refined in Bolam v Friern Hospital Management Committee [1957] 1 WLR 582. Since it was introduced in 1957, the Bolam principle has been routinely applied to medical negligence cases in determining whether the doctor’s acts fell below the required standard of care. Bolitho narrowed the scope of the test, stating that the court must be satisfied that the body of opinion relied upon has a logical basis. Bolam test = old standard of care D in this case argued that he gave the procedure in exactly the same way he was taught and courts held that a doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men. Sample Undergraduate 2:1 Nursing Assignment See for yourself why we're the world's leading academic writing company. [3] "A young child does not tolerate a tube easily and the child unless sedated tends to remove it. The Bolam Test has formed the backdrop to all clinical negligence cases since 1957, providing a cornerstone for the defence of these claims. Although Mr Justice Stewart left the issue for the consideration of a higher court, we have little doubt that a court would not find that Bolam can be inverted in this way. Author information: (1)Department of Palliative Medicine, Tan Tock Seng Hospital In 1997, Lord Browne-Wilkinson, in Bolitho v City and Hackney HA, reaffirmed Patrick's mother, as administratrix of his estate, sued the local health authority for negligence. Start studying Negligence- Breach of duty. INTRODUCTION When is a doctor liable for giving a patient negligent medical advice? The law defines this as a duty to provide care that conforms to the standard reasonably expected of a competent doctor. [2], The House of Lords held that "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". Clyde & Co LLP is a limited liability partnership registered in England and Wales. The main source of discontent was the apparent judicial abdication of the power to determine the standard of care required to avoid negligence liability. Strauss, DC & JM Thomas, ‘What does the Medical Profession mean by “Standard of Care?”’ [2009] 27 JCO 32. Three of them said they would not have. All the experts agreed that intubation is not a routine, risk-free process. [43] In Bolitho (Administratrix of the Estate of Patrick Nigel Bolitho (deceased)) v City and Hackney Health Authority [1997] 4 All ER 771 it was established that a doctor could be liable for negligence in respect of diagnosis and Bolitho v City and Hackney HA Standard of care is that of the reasonable person professing to have or exercising that skill at that level. There was evidence from highly respected medical journals prior to November 1995 which demonstrated that a responsible body of medical practitioners could have selected either Ritodrine or Nifedipine. KEY WORDS: Bolam test, Bolitho, clinical negligence, legal standard of care, medical litigation In medical litigation, the central question that arises is whether or not a doctor has attained the standard of care that is required by But a more realistic question is this: is a doctor negligent by the standards of the day entitled to be lucky? What if they are not following a recognised practice, but time and advancements in treatment prove them right? 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. In the case of Hii Chii Kok v Ooi Peng Jin London Lucien [Hii Chii Kok], 1 the Court of Appeal departed from established case law and created a new test to determine the standard of care a doctor must meet to discharge his duty to the patient he is advising. 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