Ali Shah v North West London Hospital NHS Trust

In a clinical-negligence claim, a doctor is not negligent merely because another clinician would have undertaken an additional examination. The applicable professional practice must be assessed under the Bolam test, subject to the requirement in Bolitho that the supporting opinion has a logical basis. The court must evaluate the evidence in the clinical context, including the rarity of the alleged condition, the patient’s presentation and the treatment already arranged. Causation must be established on evidence; a chain dependent on speculation about what clinicians would have done and when is insufficient. Where gratuitous care is claimed as dependency, the assessment must reflect reasonable loss without overcompensation, and a customary reduction from commercial care rates may be appropriate.

The claimant, the widower and executor of the estate of Mrs Ome Shah, brought a negligence claim against the NHS Trust responsible for Northwick Park Hospital. Mrs Shah died after an undiagnosed rupture of the right common iliac artery following childbirth. The claim focused on whether an emergency doctor, during a second assessment, should have palpated the peripheral pulses in Mrs Shah’s legs, investigated further, or involved the surgical team. The claimant alleged that earlier diagnosis and laparotomy would have saved her life. Breach, causation and quantum were disputed. The court also assessed dependency damages despite rejecting liability.

1. Claim dismissed. The claimant failed to establish breach of duty or causation.
2. The court applied the principles in Bolam v Friern Hospital Management Committee [1957] 1 WLR 583, as qualified by Bolitho v City and Hackney Health Authority [1998] A.C. 232. A professional practice can provide the standard of care only where the supporting expert opinion is responsible, reasonable and capable of logical support. The court should not choose between two logically supportable clinical views merely because it prefers one.
3. The defendant’s expert evidence was preferred. At the second assessment Mrs Shah appeared warmer, better perfused and clinically more stable; her leg symptoms had improved; haemorrhage and arterial compromise were exceptionally unlikely; and the obstetric team was already involved. There was no clinical indication requiring palpation of the peripheral pulses or immediate surgical involvement. The criticisms concerning sensory testing, investigation for deep-vein thrombosis and the provisional diagnosis of sepsis also failed.
4. Causation was not established. Even if the pulses had been palpated and an abnormality found, the evidence did not establish who would have been called, what action would have followed, or that life-saving surgery would have occurred before 14.00. That conclusion depended on speculation.
5. Although liability failed, the court assessed quantum. Applying Bordin v St Mary’s NHS Trust [2000] Lloyd’s Med 287 and Evans v Pontypridd Roofing Limited [2002] PIQR Q5, gratuitous care was discounted by 25 per cent. The court preferred the defendant’s care calculation, increased it by 15 per cent, and quantified past and future dependency losses, but entered judgment dismissing the claim.

First-instance decision. The judgment does not state any prior appellate decision.