Beech v Timney & Anor

In a clinical negligence claim, proof of earlier shortcomings by a general practitioner does not, without more, establish that a particular medical record was negligently made. The court must assess the disputed entry in the context of all the evidence, including the inherent likelihood of the alleged mistake and the reliability of the scientific evidence. A single normal blood-pressure reading may be inconsistent with severe chronic hypertension but may remain compatible with moderate hypertension. Where the evidence shows that the injury would have occurred in any event, the modified material-contribution test is not engaged. On the evidence, the claimant failed to prove both negligent recording of the blood pressure and causation.

The claimant suffered a permanent brain haemorrhage in November 2003. He alleged that his general practitioner had negligently failed to identify and act upon severely raised blood pressure during an earlier consultation, and that appropriate treatment would probably have prevented the stroke. The defendants contended that the recorded blood-pressure reading was accurate and that, in any event, treatment would not have prevented the injury.

The High Court determined preliminary issues concerning breach of duty and causation. The claimant accepted that the disputed earlier blood-pressure reading was the only potentially causative act or omission.

1. Disposition. The claim was dismissed. The court found on the balance of probabilities that the claimant’s blood pressure had been taken and recorded accurately.
2. The general practitioner had been properly criticised for failing to recognise early-morning headaches as a red-flag symptom, for inadequate record keeping and for initial confusion about the hypothetical prescription of Adalat. Those shortcomings did not make it probable that he had measured a pressure of approximately 180/100 or higher and then recorded a materially lower reading.
3. The clinical evidence did not justify working backwards from later findings of left ventricular hypertrophy, a mildly dilated aortic root, possible retinopathy, or blood in the urine and semen to establish the claimant’s blood pressure months earlier. The evidence concerning the timing and significance of those findings was indirect or speculative.
4. A single low-normal reading had limited predictive value. It militated against severely raised background blood pressure, but was not inconsistent with moderately raised chronic hypertension. The court accepted the evidence that an arteriovenous malformation could rupture in conditions of moderate and short-term hypertension and found that explanation consistent with the scientific literature.
5. As to causation, the court made additional findings on the hypothetical basis that negligent failure to act on a severely raised reading had been proved. Treatment would probably have been introduced gradually. The scientific evidence showed negligible reduction in stroke risk during the first few months of treatment. The claimant would therefore have suffered the stroke in any event. The case fell within Gregg v Scott [2005] AC 176.
6. The modified approach to cumulative causes described in Bailey v Ministry of Defence [2009] 1 WLR 1052 was not engaged because the claimant failed at the ordinary causation hurdle. No issue of material contribution arose.