Proving breach of duty in a clinical negligence claim
For a clinical negligence claim to be successful, a claimant must be able to prove that the medical professional's actions caused or contributed to their injury.
Medical professionals have a legal duty of care for their patients. Doctors are expected to exercise reasonable skill when performing their duties, in order to keep their patients safe. If acceptable care standards are not met, a doctor may be deemed to have breached this duty of care.
A medical professional who breaches their duty of care is not necessarily liable for their patient's injuries. A claimant must also be able to show that their doctor's action (or inaction) caused their injury.
The Bolam test for breach of duty
The test used to determine whether a medical professional has breached their duty of care is known as the 'Bolam test'.
To satisfy the Bolam test, a medical professional must show that he acted in a way that a responsible body of medical professionals in the same field would regard as acceptable.
The Bolam test is essentially a peer review of a doctor's behaviour. If others would have acted in a similar way, then the doctor is unlikely to have breached his duty of care.
It does not matter that other medical professionals might have delivered a different treatment or acted differently. Given the complexities of modern medicine, it is possible, and even likely, that a dissenting doctor might have done things differently. The key point is that a group of similar professionals think that the doctor acted in an acceptable manner.
Did your doctor's negligence cause your injuries?
For a clinical negligence claim to succeed, your solicitor will also need to prove that your doctor's actions caused your injury (causation). This is sometimes known as the ‘but for' test, i.e. but for the medical professional's actions, the injury would not have occurred.
The ‘but for' test can be problematic. For example, if a patient receives a succession of poor care decisions, it may be impossible to establish which error caused the patient's injury. It may also be that the compound effect of multiple successive errors ultimately led to the claimant's injuries.
Beyond the ‘but for' test...
In cases where the ‘but for' test is inadequate, the court will consider whether the care a patient received ‘materially contributed' to their injuries. This approach enables the court to look at the overall situation, rather than individual components of the treatment.
In the case of Bailey v Ministry of Defence, the claimant was admitted to hospital for a complex gallstone operation. After the operation, Mrs. Bailey (the claimant) contracted severe pancreatitis and became very weak. Unable to clear her airways, she choked on her own vomit and suffered brain damage.
The question facing the court was; did the patient choke because of the defective care she received (a negligent act that the defendant admitted) or as a result of her pancreatitis (a non-negligent consequence of the surgery)?
On a straight ‘but for' test, the claim would fail. Mrs. Bailey's solicitor could not prove that the negligent surgery caused her injury, as her pancreatitis might have been responsible for the injury.
The court then considered the issue of material contribution. They accepted that the patient could have choked for two possible reasons, but did not feel the need to ascribe blame either way. In all likelihood, Mrs. Bailey's negligent care contributed to the choking incident, and this was enough to prove her claim.
In summing up, the Judge set out the test for causation:
- If the injury would have happened anyway, the claim will fail
- If the injury would not have happened ‘but for' negligence, the claim will succeed.
- If the claimant can show that the negligent actions contributed to the injury in more than a negligible way the claim will succeed, even if other conditions may also have aggravated the injury.
Have you experienced medical negligence?
If you have suffered an illness or injury as a result of a breach of duty by a medical professional, you may be able to pursue a claim for compensation.
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Chris Salmon, Director
About the author
Chris Salmon is a co-founder and Director of Quittance Legal Services. Chris has played key roles in the shaping and scaling of a number of legal services brands and is a regular commentator in the legal press.