Beech v Timney & Anor

In a clinical negligence claim, the claimant must prove the alleged breach and its causal relevance on the balance of probabilities. A single apparently normal blood-pressure reading may be reliable and may be consistent with moderately raised chronic hypertension. Later clinical features associated with hypertension do not establish the earlier blood-pressure level without sufficiently reliable scientific evidence. Where treatment would probably have made no material difference to the timing or occurrence of an indivisible injury, causation is not established.

The claimant suffered a permanent brain haemorrhage and alleged that it resulted from negligent failure by his general practitioner to identify and treat severe hypertension. The central questions were whether a blood-pressure reading recorded during an earlier consultation had been negligently misrecorded and, if so, whether treatment would probably have prevented the stroke. The claim also raised the potential application of the material-contribution approach in Bailey v Ministry of Defence, [2009] 1 WLR 1052.

1. The claim was dismissed. The court found on the balance of probabilities that the claimant’s blood pressure had been taken and recorded accurately. The reading of 110/80 was inherently unlikely to have been a transcription of a markedly elevated reading such as 180/100 or higher.
2. The general practitioner was properly criticised for failing to recognise early-morning headaches as a red-flag symptom, for inadequate record keeping and for initial confusion about a possible prescription. Those shortcomings did not establish that the blood-pressure measurement had been negligently recorded.
3. The later findings of left ventricular hypertrophy, a mildly dilated aortic root, possible retinopathy, headaches and blood in the urine or ejaculate did not reliably establish the claimant’s blood-pressure level in March 2003. The scientific evidence did not provide a sound basis for working backwards from those findings to the earlier consultation.
4. The evidence instead supported the conclusion that the stroke was caused by an arteriovenous malformation, capable of rupturing with moderate and short-term hypertension. A single low-normal reading was consistent with that conclusion.
5. As an alternative, the court held that even if severe hypertension had been missed and reasonable treatment had begun, treatment would probably have taken time to produce a meaningful reduction in stroke risk. The claimant would probably have suffered the stroke in any event. The case therefore fell within the principle applied in Gregg v Scott, [2005] AC 176.
6. The modified “but for” approach described in Bailey v Ministry of Defence, [2009] 1 WLR 1052, was not engaged because the claimant failed to establish that the injury would probably have been avoided without the alleged negligence. Material contribution therefore did not arise.