Sumbulu v Sarker & Ors

A doctor making an out-of-hours home visit must take all reasonably available steps to obtain the patient’s relevant medical history, including both general history and the history of the presenting illness. History-taking is an essential part of clinical assessment and may determine the scope and significance of the physical examination. For a premature or very young infant, the doctor must assess comparative risks rather than rely solely on the absence of classic symptoms. Where the available information shows a significant risk of sudden deterioration requiring hospital facilities, immediate admission may be the only proper course. Professional opinion which fails to take proper account of comparative risks does not provide a responsible basis for the decision.

The claimant, a very premature infant, brought a medical negligence claim arising from an out-of-hours home visit by the first defendant, a general practitioner. The preliminary issue concerned whether the doctor was in breach of duty on 2 November 1997. The claimant alleged that he failed to obtain relevant background and illness history and failed to arrange immediate hospital admission. It was accepted that the precise illness suffered at the time could not be determined on the preliminary issue, and allegations based on a specific diagnosis of bronchiolitis were not pursued. The central questions were what information the doctor should have obtained, whether the available information would have required hospital admission, and whether his clinical decisions met the standard of a reasonably competent general practitioner.

1. History-taking. A general practitioner must take all steps reasonably open in the circumstances to ascertain both the patient’s general medical history and the history of the presenting illness. This obligation is particularly important for an out-of-hours or deputising doctor who has no access to the patient’s ordinary medical records. History-taking should precede and inform the physical assessment. The first defendant breached that duty by failing to ask questions which would have disclosed the child’s prematurity, recent hospitalisation, earlier consultation and worsening condition, and by failing properly to use the available Personal Child Health Record.
2. Physical examination and advice. The court found that the doctor carried out a sufficient general examination, including examination of the respiratory system. The prescription of antibiotics was a reasonable precaution against secondary infection. The advice given and the question of further emergency arrangements did not alter the conclusion.
3. Hospital admission. The proper approach was to assess the risks facing the child, not merely to seek a precise diagnosis or wait for classic symptoms. A premature and very young infant may deteriorate suddenly without displaying those symptoms. If the doctor had obtained and considered the information available, including the child’s corrected age and prematurity, immediate hospital admission was required. The court rejected any professional opinion which failed to take proper account of the comparative risks and benefits of admission and home treatment, applying the reasoning in Bolitho v City and Hackney HA [1998] AC 323.
4. The preliminary issue was therefore determined in favour of the claimant against the first defendant in respect of breach of duty.