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Re C (A Minor) (Medical Treatment)
[1998] Lloyd's Rep Med 01
Medical treatment — Minor — Consent — Parent/doctor disagreement — Application to court — Child aged 16 months suffering from spinal muscular atrophy — Intermittent positive pressure ventilation — Doctors considering that it was not in minor's best interests that she should be further ventilated, and if, when ventilation was withdrawn, it should not be reinstituted in event of further respiratory arrest — Parents believing that minor should be taken off ventilation to see whether child might survive for a time but should she suffer further respiratory relapse or arrest she should be replaced on to ventilation — Order to be granted
Williamson v East London & City HA
[1998] Lloyd's Rep Med 06
Professional liability — Plastic surgery — Breast implant — Bilateral closed breast capsulotomies performed by surgeon K — Resulting leakage of silicone gel from implant into right breast — Whether surgeon K failed to investigate patient's complaint — Subsequent consent by patient to operation of replacement breast prosthesis and right open capsulotomy proposed by surgeon N — Consent form altered to cover bilateral replacement breast prosthesis and right subcutaneous mastectomy — Whether patient informed of change in operation — Evidence by operating team that, at operation, there was no way of avoiding mastectomy due to extensive silicone granulosis — Inadequate operation note — Post-operative pathology report diagnosing silicone granuloma — Whether patient had established that plastic surgeons K and N were negligent
Knight v West Kent HA
[1998] Lloyd's Rep Med 18
Professional liability — Obstetrics — Forceps delivery — Long difficult pull by skilled and experienced surgeon — Post-natal medical problems suffered by plaintiff mother — Finding of liability by trial judge on grounds that (1) on the evidence, plaintiff was allowed to remain in labour for too long; (2) to continue with long difficult pull was an error of clinical judgment -Appeal by defendant health authority allowed
Bolitho v City & Hackney HA
[1998] Lloyd's Rep Med 26
Negligence — Evidence — Causation — Negligent omission — Medical practitioner — Correct approach to causation — Correct approach to expert evidence — Professional liability — Paediatric registrar — Causation — Failure to attend child with respiratory difficulties — Child suffering cardiac arrest and resulting brain damage — Registrar admittedly negligent in failing to attend — Whether registrar would have intubated if she had attended — Accepted medical practice — Whether judge bound to rely on evidence of experts available to him — Duty on plaintiffs to prove that doctor would probably have taken specific action, and that if she did not do so her failure was contrary to accepted medical practice
Farthing v NE Essex Health Authority
[1998] Lloyd's Rep Med 37
Limitation — Discretion — Factors to be considered by court — Whether Court of Appeal should set aside judge's decision — Limitation Act 1980 sect 33 — Prejudice — Impairment of evidence — Whether judge had placed insufficient weight upon absence of statement from surgeon who conducted operation negligently — Effect of post-operative letters written by surgeons
R v Croydon Health Authority
[1998] Lloyd's Rep Med 44
Damages — Birth — Remoteness — Plaintiff undergoing pre-employment chest x-ray — Radiographer negligent in failing to report significant abnormality — Plaintiff subsequently becoming pregnant and successfully giving birth to “wanted” child — But for negligence plaintiff would have been referred to cardiologist who would have diagnosed primary pulmonary hypertension (PPH) — Liability admitted for exacerbation of plaintiff's pre-existing condition — Whether defendant liable for expenses of pregnancy, cost of upbringing of child, loss of earnings or accommodation or general damages for reactive depression — Professional liability — Radiology — Duty of care — Pre-employment chest x-ray — Radiologist knowing nothing of plaintiff's medical history, did not meet plaintiff and was not asked to review plaintiff's chest x-ray for diagnostic or therapeutic purposes — Admitted negligence in failing to report significant abnormality — Plaintiff subsequently becoming pregnant — But for negligence plaintiff would have been referred to cardiologist who would have diagnosed primary pulmonary hypertension (PPH) — Whether reasonable to expect radiologist to identify risk to plaintiff and to take steps to communicate that risk to her
Hooper v Young
[1998] Lloyd's Rep Med 61
Professional liability — Gynaecology — Hysterectomy — Damage to left ureter — Three mechanisms by which ureter could have been damaged — Decision by trial judge that none of three possibilities would have occurred but for negligence on part of defendant — Issue whether, in straightforward case, to insert suture in vicinity of ureter so as to kink it inadvertently without negligence
Clough v Tameside & Glossop HA
[1998] Lloyd's Rep Med 69
Evidence — Disclosure — Medical negligence action — Communication from senior house officer involved with treatment of plaintiff disclosed by defendants to expert witness — Expert's report disclosed to plaintiffs with intention of relying upon it — Plaintiff's application for disclosure of SHO's communication allowed by district judge under RSC Order 24, r 10(1)
Smith v Leicester Health Authority
[1998] Lloyd's Rep Med 77
Limitation — Knowledge — Discretion — Diagnosis of spina bifida in 1952 — Operations in 1953, 1954 unsuccessful — X-rays in 1954 and 1955 showing enlargement of spinal canal — Negligent failure by radiologist to report enlargement — Laminectomy in May 1957 showing cyst in spinal column — Cyst contents aspirated but plaintiff rendered tetraplegic — Plaintiff hearing of possible error in her case in 1983 but advised by Spinal Injuries Association in 1984 that any claim was time barred — In November 1990 plaintiff received her expert's first report — Writ issued on May 22, 1992 — X-rays from 1954 to 1956 were not tracked down by plaintiff's solicitor until 1995 — Whether judge erred in holding that plaintiff had constructive knowledge prior to 1983 that tetraplegia was attributable to omission of defendant — Whether, in considering whether to exercise his discretion in plaintiff's favour under Limitation Act 1980, sect 33 judge misdirected himself on several circumstances that he had to take into account
Bates v Leicester Health Authority
[1998] LS Law Med 93
Limitation — Knowledge — Discretion — Knowledge by plaintiff born in 1968 that his cerebral palsy was caused by duration of his mother's labour — Writ issued on February 10, 1995 — Whether plaintiff fixed with knowledge of omission which constituted alleged negligence — Constructive knowledge of plaintiff with great difficulties of communication where potential source of knowledge was parent — Whether equitable to allow action to proceed if writ was issued more than three years after date of knowledge of attributability
Tahir v Haringey Health Authority
[1998] Lloyd's Rep Med 104
Damages — Loss of amenity — Delay — Medical negligence resulting in two or three hours” delay in neurological operation — Plaintiff contending that delay caused general increment in injury — Whether plaintiff had to prove that damage was actually caused by delay
Butters v Grimsby and Scunthorpe HA
[1998] Lloyd's Rep Med 111
Damages — Pain and suffering — Gynaecology — Medical negligence in evacuation of uterus — Uterus punctured and cervix damaged — Complications culminating in hysterectomy — Award of £50,000 by judge — No consideration given to post-trial pain and suffering — Consideration of Judicial Studies Board Guidelines
Powell v Boladz
[1998] Lloyd's Rep Med 116
Doctor — Duty of care — Relatives of deceased child patient — Alleged substitution of forged for genuine documents in medical records following death — Claims by parents of deceased child based on breach of duty of care and conspiracy — Whether duty of care owed to relatives — Whether psychiatric injury to relatives reasonably foreseeable — Claim by mother as secondary victim witnessing trauma of child's suffering and death — Whether intention to injure could be imputed to defendants — Whether conspiracy pleaded or made out on facts — Whether expenses of appeal to Secretary of State resulted from unlawful acts
Oksuzoglu v Kay, Oldershaw
[1998] Lloyd's Rep Med 129
Procedure — Pleadings — Medical negligence action — Failure to submit up to date medical report with statement of claim — Need to obtain consent of defendant or order of court — Particulars of claim — Causation — Necessity to provide particulars of claim where plaintiff had case in negligence but major part of loss not caused by that negligence — Consent order for trial of preliminary issues — Comments by court — Costs — Discetion — Winning party — Plaintiff's potential claim of £300,000 reduced to £3,000 following late amendment — Plaintiff awarded full costs of action — Who was essentially winning party — defendants' appeal — Damages — Pain and suffering — Cancer in child -
Hammond v West Lancashire HA
[1998] Lloyd's Rep Med 146
Limitation — Discretion — Prejudice — Destruction of x-rays — Judge exercised discretion to exclude time limit where health authority had destroyed x-ray records — Appeal by defendant health authority
Finnegan v Parkside Health Authority
[1998] Lloyd's Rep Med 149
Procedure — Delay — Dismissal for want of prosecution — Appeal against dismissal not lodged in time — Application for leave to appeal dismissed — Decision by recorder that, in absence of explanation of delay during crucial period, there was no material on which court could exercise discretion in plaintiff's favour, so that any question of prejudice, even if minimal or non-existent, was immaterial
M v Calderdale & Kirklees HA
[1998] Lloyd's Rep Med 157
National Health Service — Health authority — Statutory duty — Termination of pregnancy contracted to private hospital — No opportunity for patient to divert from route of treatment arranged on her behalf — Whether patient entitled to remain in same position as patient who remained in NHS care — Operation negligently conducted — Resulting failure of abortion — Whether National Health Service owed non-delegable duty in particular circumstances — Whether health authority had taken reasonable care in its dealings with private hospital
Ratcliffe v Plymouth & Torbay HA
[1998] Lloyd's Rep Med 162
Res ipsa loquitur — Medical negligence — Applicability — Unexplained neurological defect following general and spinal anaesthetic — Dispute on site of injection of spinal anaesthetic — Expert evidence at trial of possible cause of defect — Whether judge erred in finding that injection was inserted in correct space at chosen level of spine — Whether judge's approach to applicability of res ipsa loquitur doctrine could be faulted
Berry v Calderdale Health Authority
[1998] Lloyd's Rep Med 179
Limitation — Knowledge — Discretion — Whether patient had knowledge that injury to left wrist was sufficiently serious to justify instituting proceedings — Whether county court judge erred in disapplying primary limitation period under Limitation Act 1980 sect 33 — Steps to be taken by plaintiff's solicitors where emergency legal aid not obtainable in time
Thompson v Blake-James
[1998] Lloyd's Rep Med 187
Professional liability — General practitioner — Vaccination — Contra-indications — Advice to parents of small child — Foreseeability — Doctor advising against vaccinations because of reasonable belief that child had suffered seizure — Alternative immunisation advised against whooping cough (where vaccination was imminent) — Failure to advise on vaccination against measles using immunoglobulin (where vaccination was due 12 months later) — Doctor and parents aware that another doctor would be involved — Whether judge erred in not considering (a) whether there was valid distinction between nature of advice when no question of immunisation was in prospect and advice given when definitive decision had to be taken, or (b) whether general practitioner could have foreseen that his omission would cause parent to decide against vaccination — Expert evidence that duty of doctor might vary in relation to advice on immunisation of small child according to reluctance or otherwise of parent to have that child immunised
Hallatt v North West Anglia HA
[1998] Lloyd's Rep Med 197
Professional liability — Obstetrics — Screening for gestational diabetes — Risk assessment — Glucose tolerance test — Whether random urine sample result converted case from one in which no GTT was required into one where it was — Single and isolated observation of mild gycosuria at 29 or 30 weeks
O'Driscoll v Dudley Health Authority
[1998] LS Law Med 210
Limitation — Knowledge — Attributable — Cerebral palsy — Action alleging negligent mismanagement of birth commenced over 23 years after plaintiff's birth — Plaintiff profoundly physically handicapped from birth and dependant on assistance and advice of parents — Parents alerted by television programme but deciding to leave claim until plaintiff aged 21 (mistakenly believed to be age of majority) — Whether delay unreasonable — Degree of knowledge required of act or omission constituting negligence in medical case of some complexity — Whether defendants had established that plaintiff had actual knowledge at any time before seeing her expert's report — Whether knowledge that injury could be attributed to hypoxia was knowledge that injury was “attributable” to act or omission alleged to constitute negligence — Whether constructive knowledge on plaintiff's part had been established — Whether discretion under sect 33 could be exercised in plaintiff's favour by Court of Appeal
Wisniewski v Central Manchester HA
[1998] Lloyd's Rep Med 223
Professional liability — Obstetrics — Delivery — Midwife's decision not to call doctor — Doctor's failure to attend mother — Whether doctor negligent in (a) failing to attend patient to examine her and consider CTG trace before deciding what to do; (b) relying upon midwife - Doctor's failure to attend at trial — Whether leading to inference that if he had attended patient he would, after examination of patient and CTG trace, have concluded that it was necessary and safe to rupture membrane and proceed to a caesarean section — Whether, had caesarean section been performed, plaintiff would not have suffered from cerebral palsy
Rhodes v West Surrey & NE Hampshire HA
[1998] Lloyd's Rep Med 246
Professional liability — Gynaecology — Termination procedure — Perforation of uterus — Whether plaintiff had established negligence by consultant gynaecologist during termination of pregnancy or laparotomy
Wood v West Dorset General Hosp
[1998] Lloyd's Rep Med 258
Procedure — Striking out — Cause of action — Medical negligence — Proof of injury — Alleged failure to advise of risk in treatment of pre-existing spinal complaint by manipulation under anaesthetic (MUA) — Claim struck out — New material — Whether judge was wrong to take view that further time would not lead to production of medical report which would substantiate plaintiff's case
Brown v Lewisham & North Southwark HA, ex p Blackpool, Wyre and Fylde HA
[1998] Lloyd's Rep Med 265
Professional liability — Cardiothoracic surgery — Haematology — Causation — Post-operative complications — Successful coronary artery bypass graft operation at Guy's Hospital — Harvesting of long saphenous vein from patient's left leg — Use of heparin in course of surgery — Development of antibodies — Further administration of heparin at Royal Victoria Hospital — Adverse reaction in form of heparin-induced thrombocytopenia and thrombosis (HITT) — Surgeon aware in rare cases heparin could cause low platelet counts but not aware of more serious reaction in which thrombocytopenia was associated with thrombosis — Surgeon considering patient's condition to be critical, calling for urgent anticoagulation treatment — Failure by haemotologist to examine medical records — Failures in communication — Amputation of patient's left leg
Nawoor v Barking Havering and Brentwood HA
[1998] Lloyd's Rep Med 313
Professional liability — Paediatric medicine — Premature baby — Friable skin — Leakage of IV fluid — Lasting injury — Standards of 1991 — Observations in baby care room — Whether negligent failure promptly to observe leak and injury caused by leak — Whether post-incident management negligent in adopting conservative treatment — Comments by court
Skelton v Lewisham & North Southwark HA
[1998] Lloyd's Rep Med 324
Professional liability — Anaesthetics — Hypotensive episode — Brain damage — Anaesthetic notes below standard acceptable in 1983 — Whether indicative of unexplained carelessness, whether in breach of a duty of care or not — Cause of brain damage — Whether hypotensive episode caused or contributed to by negligence of anaesthetists — Whether anaethetists negligently failed to observe and respond to episode earlier.
Hutton v East Dyfed Health Authority
[1998] Lloyd's Rep Med 335
Hospital — Accident and emergency — Diagnosis — Failure to diagnose pulmonary embolism — Patient admitted with severe chest pain — ECGs showed abnormalities — Indication of possible respiratory problem or haemodynamic disturbance in pulmonary circuit — Whether hospital doctor negligent
Chissell v Poole Hospital NHS Trust
[1998] Lloyd's Rep Med 357
Professional liability — Obstetrics and gynaecology — Failed vacuum termination of pregnancy — Probable removal of one of pair of twins — Survivor hidden behind first in uterus or in another horn or section of uterus, where it was protected from catheter — No indication that pregnancy might be a twin pregnancy — Evidence that instances of one twin surviving termination of pregnancy were rare events, whereas missed abortion a common gynaecological problem — Whether decision not to call for scan, or other specific follow-up of operation, was negligent — Whether surgeon fell below standard of reasonably competent careful and skilful consultant gynaecologist in failing to make such arrangements
Scott v Nucrete Buildings Ltd
[1998] Lloyd's Rep Med 375
Personal injury claim — Medical evidence — Alleged gross restriction of back movement — Employee's claim against employers — No pathological cause — No psychiatric evidence to show that there was large psychogenic component in plaintiff's complaints — Aetiology of disc prolapse
Taylor v Shropshire Health Authority
[1998] Lloyd's Rep Med 395
Professional liability — Gynaecology — Sterilisation — Whether warning of risk of failure given to patient — Whether patient would have agreed to sterilisation if warning had been given — Whether evidence established operator error by very experienced surgeon — Specialised consent form: Comments by court
Gates v McKenna
[1998] Lloyd's Rep Med 405
Causation — Schizophrenia — Hypnosis Acute schizophrenic episode following hypnosis on stage — Different theories of causation
Drake v Pontefract Health Authority
[1998] Lloyd's Rep Med 425
Professional liability — Psychiatry — Depressive — Failure to diagnose agitated depression and properly assess suicide risk — Views of defendants' psychiatric team founded on mistaken diagnosis — Whether views were illogical and could not be supported
Palmer v Tees Health Authority
[1998] Lloyd's Rep Med 447
Negligence — Duty of care — Abduction, sexual abuse, murder and mutiliation of girl aged 4 — Perpetrator diagnosed as very disturbed — Nervous shock suffered by mother — Whether health carers owed duty of care to mother and daughter — Test to be applied — Whether mother could recover for nervous shock