Jones v Conwy and Denbighshire NHS Trust

A doctor is not negligent merely because another responsible body of medical opinion would have adopted a different course. The court must assess whether the relied-on professional opinion has a logical basis, particularly where experts weigh competing risks and benefits. In treating suspected orbital cellulitis, immediate CT scanning is not automatically required where clinical findings show no significant visual or ocular-mobility impairment, no clear intracranial involvement, and the scan is unlikely to alter immediate management. Where a small subperiosteal abscess is present without visual compromise, an initial period of intravenous antibiotics may also be a reasonable course, provided that treatment ends if visual impairment develops or there is no improvement within 24 to 48 hours.

The claimant, aged 12 when treated in March 1995, developed orbital cellulitis following sinus infection. The infection later produced a subdural empyema, requiring neurosurgery, and caused epilepsy. She alleged that the defendant hospital negligently failed to obtain an immediate CT scan on admission and failed to drain an abscess promptly.

The principal issues were whether an immediate CT scan was required, what it would have shown, whether surgery would have followed in time to prevent epilepsy, and whether failure to operate was negligent.

1. Applicable standard. The court applied the Bolam v Friern Hospital Management Committee test, as refined by Bolitho v City and Hackney HA. A professional practice may provide the relevant standard only if the supporting expert opinion is capable of logical analysis, including proper consideration of comparative risks and benefits.
2. CT scanning. There was no established bright-line rule requiring an immediate CT scan in every case of suspected orbital cellulitis. On the evidence, a responsible and reasonable body of medical opinion could treat the child initially with intravenous antibiotics and observation. Her normal or near-normal visual acuity, reactive pupils, full eye movements, lack of significant proptosis and absence of convincing intracranial signs meant that an immediate scan was not mandatory. Its result was unlikely to alter immediate management.
3. What the scan would have shown. It was not established that a scan on the night of admission would have revealed a subperiosteal abscess or other drainable pus. The absence of restricted eye movements and significant visual impairment supported that conclusion.
4. Surgical treatment. Even if a small subperiosteal abscess had been present, immediate drainage was not shown to be mandatory. A respectable body of surgical opinion supported an initial trial of intravenous antibiotics, particularly in the absence of visual compromise. Expectant treatment could not continue if significant visual impairment or restricted eye movements developed, or if there was no improvement within 24 to 48 hours.
5. Disposition. The alleged breach of duty was not established. The court therefore gave judgment for the defendant.