Taaffe v East of England Ambulance Service NHS Trust

In assessing alleged clinical negligence, the court must consider the individual facts and expert evidence while avoiding hindsight. The existence of a body of competent practitioners who would have acted similarly does not establish reasonableness where the supporting opinion is not logical or defensible. Paramedics assessing chest pain must obtain an adequate history, consider the whole clinical picture and recognise that a normal ECG, or the absence of ST-wave elevation, does not exclude acute coronary disease. Where cardiac disease cannot safely be excluded, the patient should be strongly advised to attend hospital. A later routine GP consultation cannot necessarily operate as a safeguard if it occurs in materially different circumstances.

The claimant, as personal representative of Eleanor Taaffe’s estate, claimed damages from the defendant ambulance trust. Paramedics attended Mrs Taaffe after an episode of severe indigestion-type chest pain. They considered that she was suffering a panic attack and did not advise hospital attendance. She attended her GP the following day and died of a myocardial infarction several days later.

The defendant admitted that hospital attendance on the day of the ambulance call would have led to diagnosis and avoided the death. The central issue was whether the paramedics’ failure to advise hospital attendance was negligent. Quantum issues included dependency, the risk of marital breakdown and the appropriate heads of loss.

1. Liability. The claim succeeded. The paramedics’ care fell below the standard expected of a reasonably competent paramedic.
2. Paramedics dealing with chest pain were required to maintain a high index of suspicion, obtain a proper history and assess the whole picture. The history taken was inadequate. Relevant matters were not elicited, including previous chest pain, the severity and circumstances of the episode, sweating and pallor, lack of significant indigestion, and the family history of heart disease.
3. The absence of ST-wave elevation did not exclude acute coronary syndrome. The computer-generated report recording an abnormal ECG should not have been ignored, although the ECG trace remained more important. The paramedics’ over-reliance on the ECG findings and their failure to appreciate the significance of hypertension and panic symptoms were material failures.
4. The defendant’s Bolam argument could not succeed. Applying Bolam and Bolitho, the court held that the supporting expert opinion was not reasonable, logical or defensible in light of the need to consider all relevant information. The fact that the task was difficult did not mean that either decision was necessarily reasonable.
5. The later GP appointment did not provide a safeguard or demonstrate that the paramedics’ decision was reasonable. It occurred after the crisis had apparently passed, without current chest pain or the same symptoms, and probably without the abnormal ECG report.
6. Mrs Taaffe should have been strongly advised to attend hospital. On the balance of probabilities, she would have attended, been diagnosed and treated, and her life would have been saved.
7. For quantum, the court applied a 40% discount for the substantial risk that the marriage would have ended. Damages were assessed at £119,048.13, including dependency and loss of services, with no award for spouse’s love and affection or miscellaneous losses.