Hussain v King Edward VII Hospital

The doctrine of res ipsa loquitur is not a principle of law and creates no presumption. It is a conventional description of facts which disclose a prima facie case of negligence and require a defendant to respond. The claimant retains the burden of proving negligence and causation at trial. A plausible explanation inconsistent with negligence may rebut the prima facie case. In medical negligence claims, expert evidence will commonly be required to show that the event would not ordinarily occur without negligence. On the evidence, an acute shoulder injury arose during anaesthesia but was probably caused by the relaxation of muscles and an underlying degenerative condition, without negligent handling. The claim was therefore dismissed.

The claimant developed severe shoulder pain immediately after undergoing a cystoscopy under general anaesthesia at the defendant hospital. He alleged that hospital staff had mishandled him during transfer or positioning, and pleaded res ipsa loquitur in the alternative to an inference of negligent conduct. The defendant relied on expert evidence that an asymptomatic degenerative shoulder condition could become acutely painful without trauma, and on evidence that appropriate handling procedures had been followed. The central issues were whether the circumstances established a prima facie case of negligence, whether that case had been rebutted by a plausible non-negligent explanation, and whether negligence and causation were proved on the balance of probabilities.

1. Res ipsa loquitur. The court held that res ipsa loquitur is not a legal principle and gives rise to no presumption. It is simply a conventional way of identifying facts which, at the pleading stage, raise a prima facie case requiring an answer. The claimant nevertheless retains the burden of proving negligence and causation at trial. This approach was explained in Ratcliffe v Plymouth & Torbay HA [1998] Lloyd’s Rep Med 162.
2. A defendant may rebut a prima facie case by offering a plausible explanation inconsistent with negligence. It need not establish that explanation on the balance of probabilities for that purpose. In medical negligence cases, expert evidence will usually be needed to show that the event relied upon would not ordinarily occur without negligence. The court also relied on the caution in Delaney v Southmead Hospital Authority [1995] 6 Med LR 355 that a recognised medical procedure may produce an unexpected result.
3. On the evidence, the claimant’s underlying degenerative shoulder condition had become acutely painful during anaesthesia. The most probable explanation was muscular relaxation and consequent biomechanical realignment, rather than negligent handling or trauma. The alleged bruising was not proved and there was no reliable evidence of a knock, fall, pulling of the arm or other untoward incident.
4. The defendant’s factual and expert evidence established that reasonable care had been taken during transfer, positioning and recovery. The claimant had not proved negligence or causation. The negligence claim was dismissed.