Harding v Scott-Moncrieff

A general practitioner who makes a differential diagnosis including life-threatening conditions must respond to the risk of sudden deterioration. Where myocardial infarction or pulmonary embolism is among the possibilities, standard practice may require urgent hospital transfer, remaining with the patient, and appropriate immediate treatment. A private ambulance is not an adequate alternative where its prompt arrival is uncertain. Causation may be established on the balance of probabilities by showing that timely intervention would have created a sufficient opportunity for effective treatment, even where medical experts disagree about the precise pathology. A patient choosing between treatment or transfer options should ordinarily receive information material to that choice, subject to a narrowly framed medical exception.

The claimant, acting as widow and administratrix of the estate, claimed damages against the defendant general practitioner following the sudden death of Sir Christopher Harding. The claim alleged that the defendant had failed to remain with the patient, summon an emergency ambulance promptly, and administer aspirin and a diuretic after attending him with symptoms consistent with serious cardiac disease.

The central issues were breach of duty, the cause of death, whether earlier hospital treatment would probably have saved the deceased, and the resulting dependency and other damages.

1. Breach of duty. The court found that the defendant’s differential diagnosis included myocardial infarction and pulmonary embolism, both life-threatening conditions carrying a risk of sudden deterioration. It was standard practice to remain with the patient in those circumstances. The defendant’s failure to do so was a breach.
2. The defendant should have summoned a “blue light” ambulance urgently. A private ambulance could only have been acceptable if the doctor remained with the patient and there was a reasonable basis for believing that it would arrive within about half an hour. No such basis existed.
3. The failure to administer aspirin and a diuretic was also a breach. The evidence established that this was standard treatment, subject to contraindication in the case of aspirin. The treatment was potentially life-saving and would at least have provided an additional window of opportunity.
4. Causation. The court preferred Professor Oakley’s evidence that the deceased had suffered an acute myocardial infarction. The absence of obvious recent infarction or thrombosis at post mortem did not exclude that diagnosis. Even if fulminating myocarditis had been the cause, the prognosis following prompt treatment would still have been good. Earlier transfer would probably have placed the deceased in hospital before cardiac arrest and materially improved his prospects of survival.
5. The court made an obiter finding that a patient is entitled to information material to a proposed choice, unless the doctor withholds it for medical reasons supported by a responsible body of practitioners. The court found that, if informed of the urgency and risks, the deceased would initially have agreed to transfer to St Mary’s.
6. The claim therefore succeeded. The court awarded £7,500 bereavement damages, £7,000 funeral expenses and £1,500 for the deceased’s pain and discomfort. The remaining dependency claim was to be calculated using the court’s findings on reduced future work and a multiplier of 2.8.