Ganz v Childs & Ors

A medical professional’s practice is not negligent merely because another respectable practice could have been adopted. The court must assess whether the relied-on professional opinion has a logical basis and, where relevant, whether it weighs comparative risks and benefits. A GP who identifies a genuine possibility of rapidly progressive pneumonia in a child must arrange prompt investigation. Where hospital admission is the only practical means of obtaining that investigation, admission should follow without delay. Causation requires proof that the breach materially caused the injury. Where negligent delay forms part of a continuing damaging process, the claimant must still prove that intervention would probably have prevented irreversible damage.

The claimant suffered permanent brain damage after developing mycoplasma pneumonia and encephalitis-like neurological symptoms. She alleged that Dr Childs negligently failed to arrange hospital admission on 18 December 1999, that Dr Lloyd negligently failed to attend during the early hours of 19 December, and that Kingston Hospital delayed assessment, monitoring, investigation and treatment after admission.

The trial concerned breach of duty and causation. The central questions were whether the GP defendants should have arranged earlier admission, whether the hospital treatment fell below the required standard, and whether any breach caused or materially contributed to the irreversible brain damage.

1. Applicable standard. The court applied the approach in Bolitho v City and Hackney Health Authority [1998] AC 232. A body of professional opinion must have a logical basis. In particular, experts must address comparative risks and benefits where those matters are material. The court must avoid choosing between competing opinions merely because it prefers one, and must not judge conduct with hindsight.
2. Dr Childs. Once pneumonia had become a genuine possibility, it was necessary to exclude it promptly because pneumonia in a child could progress rapidly and have serious consequences. The proposed investigations were delayed until Monday, and the only practical means of obtaining them promptly was hospital admission. The delay was therefore a breach of duty. Had the claimant been admitted on the Saturday, competent monitoring and treatment would probably have prevented the damaging combination of hypoxia and hypocapnia. Judgment was therefore entered against Dr Childs.
3. Dr Lloyd. Dr Lloyd should have attended during the early hours of 19 December. Earlier admission would probably have led to close monitoring and timely oxygen and other treatment, preventing the damaging process. Judgment was therefore entered against Dr Lloyd.
4. Kingston Hospital. The hospital breached its duty by failing to ensure earlier attendance by Dr Driver, by failing to monitor and investigate the claimant while she deteriorated, and by delaying the call to the anaesthetic team. However, the evidence did not establish when irreversible cell death occurred. The claimant could not prove that earlier hospital intervention would probably have prevented the permanent damage. The claim against the hospital was dismissed.
5. Causation. The court rejected mycoplasma pneumoniae encephalitis as the probable cause or a contributory cause of the brain damage. It found that hypoxia and hypocapnia operated together and materially contributed to the injury. The claimants’ underlying susceptibility did not relieve a tortfeasor of responsibility for damage caused to the claimant as found.

Judgment for the claimant against the first and second defendants, with damages to be assessed. Judgment for the third defendant.