Eastwood v Wright

In clinical negligence, certainty that an anaesthetic event was drug-induced is not required before further action becomes necessary. The need to investigate may be assessed by timing in relation to intubation, the intensity of bronchospasm and its response to treatment. Severe bronchospasm in a non-asthmatic patient may create a reasonable suspicion of an adverse drug reaction even where intubation-related irritation is a plausible alternative. Once suspicion arises, responsible practice requires investigation and appropriate warning about future use of the suspected drug. An appellate court will not overturn a trial judge’s factual conclusion merely because another conclusion was possible; intervention requires the conclusion to be plainly wrong or outside the permissible range of disagreement.

Mrs Stephanie Wright brought a clinical negligence claim against her anaesthetist, Dr Derek Eastwood. Following a bronchospasm during a 1995 hysterectomy, he diagnosed irritation caused by intubation and did not arrange investigation or warn her about a possible adverse drug reaction. She later suffered a serious reaction to a related muscle relaxant during surgery in 1999.

On 5 April 2004, Her Hon. Judge Elizabeth Steel DL, sitting as a Deputy Judge of the Queen’s Bench Division, found liability and entered judgment for damages to be assessed. Dr Eastwood appealed, challenging the finding that the bronchospasm occurred before intubation and the conclusion that the circumstances required suspicion, investigation and warning.

Lord Justice Ward gave the judgment of the court. Lord Justice Rix and Lord Justice Maurice Kay agreed. The appeal was dismissed.

1. The appellate court should not interfere with a trial judge’s findings of fact merely because another judge might have reached a different conclusion. The appellant had to show that the judge was plainly wrong or had reached a conclusion outside the generous ambit within which reasonable judges may disagree.
2. There was evidence supporting the finding that the bronchospasm occurred before, and very shortly before, intubation. Dr Eastwood had no independent recollection and the trial judge was entitled to choose between the competing expert opinions. Her errors in recording two matters as agreed between the experts did not materially undermine her reasoning.
3. In assessing whether a possible drug-related cause required investigation, the relevant factors included timing in relation to intubation, the intensity of the bronchospasm and the response to treatment. The judge was entitled to find that the intensity of the reaction, the need for intravenous aminophylline, the absence of asthma and the close timing made an adverse drug reaction a distinct possibility.
4. The 1990 guidance of the Association of Anaesthetists of Great Britain and Ireland applied in 1995. The obligation to report and investigate was triggered by suspicion, not certainty. Once suspicion arose, appropriate advice and warning should have been given so that the suspected drugs were not administered on later occasions.
5. The judge was also entitled to accept the claimant’s alternative case: even if the bronchospasm had occurred after intubation, its severity and circumstances justified investigation. The experts’ disagreement on that issue was a matter for the trial judge. On the agreed evidence, proper investigation and warning would have prevented the later reaction to cisatracurium, so causation was established.

• Court of Appeal (Civil Division): On 19 May 2005, dismissed Dr Eastwood’s appeal against the liability judgment: [2005] EWCA Civ 564.
• Queen’s Bench Division: On 5 April 2004, Her Hon. Judge Elizabeth Steel DL found for Mrs Wright on liability and entered judgment for damages to be assessed.