Hibbert v The Ministry of Defence

In a clinical negligence claim, the question is whether the clinician’s assessment and management fell outside the range accepted by a reasonable and responsible body of relevant practitioners. A claimant need not establish that a particular diagnostic label was correct if the alleged breach concerns management of symptoms. Conversely, failure to make a formal diagnosis is not negligent where the symptoms did not satisfy the applicable diagnostic criteria and the clinical response was acceptable. The court must avoid hindsight and assess the patient’s condition at the relevant time. A suggested review before renewed operational exposure, together with advice and an opportunity to seek further assistance, may constitute an adequate response. Causation must be considered separately, including whether earlier treatment would probably have produced a better outcome.

The claimant, a former Army lance corporal, alleged that an Army psychiatrist negligently assessed and managed him during consultations on 12 May and 8 June 1994. He had experienced traumatic events during service in Bosnia and Northern Ireland and later developed severe post-traumatic stress disorder.

The issues were whether he probably had PTSD at the first consultation, whether the psychiatrist’s diagnosis and management fell below the required standard, whether the second consultation created a further breach, and what outcome reasonable treatment would probably have produced.

1. The claim was dismissed. The claimant failed to prove any culpable want of care at either consultation.
2. The applicable standard was whether the psychiatrist had fallen below the standard accepted by a reasonable and responsible body of military psychiatrists, applying [1957] 1 WLR 582 and [1998] AC 232. The court assessed the diagnosis and management without hindsight.
3. The claimant had experienced traumatic events and symptoms suggestive of PTSD, but the court was not satisfied that he probably met the DSM III R criteria on 12 May 1994. His condition was instead characterised as sub-clinical PTSD or an adjustment reaction. The psychiatrist’s rejection of PTSD was a clinical judgment supported by the contemporary records and did not itself establish negligence.
4. The psychiatrist’s management was within the acceptable range. He advised that the claimant should not return to Northern Ireland on that tour, recommended review before any further operational deployment, and offered time and an opportunity to discuss his experiences. In the circumstances, it was reasonable to expect further medical assistance to be sought if symptoms deteriorated.
5. The 8 June consultation was not a negligent lost opportunity. The claimant appeared to have improved, there was no material deterioration, and a further review would not probably have produced a different diagnosis or management plan.
6. Although it was unnecessary to decide causation, the court considered it unlikely that earlier treatment would have succeeded. The treatment framework included CBT and possible drug therapy, but the claimant’s persistent inability to tolerate exposure-based treatment made recovery at that stage no more likely than after treatment in 1996–97.