Davies v University Hospital of North Staffordshire NHS Trust & Anor

Medical negligence is assessed by the standard of the ordinary skilled practitioner. A doctor is not negligent merely because another responsible body of medical opinion would have adopted a different course. The supporting professional opinion must, however, have a logical basis and withstand logical analysis, including proper consideration of comparative risks and benefits where relevant.

On the facts, responsible medical opinion supported diagnosing sinusitis or migraine, undertaking appropriate examination, and arranging general-practitioner follow-up rather than an immediate brain scan. The existence of a brain tumour, and the fact that an earlier scan would have detected it, did not establish breach of duty.

The claimant, a child, brought a clinical negligence claim against the First Defendant concerning treatment at hospital on 6 and 28 January 2001. She alleged that the doctors should have arranged a brain scan or paediatric follow-up leading to such a scan, because she had recurrent headaches and vomiting. A brain tumour was present and would have been detected by a scan in early 2001.

The court tried the preliminary issue of breach of duty. It considered whether the doctors' diagnoses, examinations and follow-up arrangements fell below the applicable standard of reasonable skill and care.

1. Applicable standard. The doctors owed a duty to exercise reasonable skill and care. Under Bolam v Friern Hospital Management Committee [1957] 1 W.L.R. 582, the relevant standard was that of the ordinary skilled person practising the medical skill in question. A doctor following a practice accepted as proper by a responsible body of medical opinion is not negligent merely because another professional body would have acted differently.
2. Logical analysis. Following Bolitho v City and Hackney Health Authority [1998] A.C. 232, the professional opinion relied upon must have a logical basis. In a case involving competing risks and benefits, the experts must have directed their minds to those matters and reached a defensible conclusion. It is only in the rare case where the opinion cannot withstand logical analysis that the court may reject it.
3. 6 January 2001. The evidence supported sinusitis as a reasonable diagnosis. The symptoms and sinus X-ray were consistent with that diagnosis, and the lack of an immediate response to antibiotics did not exclude it. The history and examination did not require a brain scan or paediatric follow-up directed to arranging one. The treatment and general-practitioner follow-up accorded with a responsible and logically supportable body of professional opinion.
4. 28 January 2001. Dr Rao took a proper history, considered possible neurological causes, examined the fundus and neurological system, and found no clinical indication requiring a scan. Sinusitis or migraine remained reasonable diagnoses. The absence of papilloedema did not itself exclude intracranial pressure, but the overall assessment did not cross the threshold for arranging a scan. The proposed alternative opinion did not establish negligence.
5. The September 2001 events did not demonstrate what was required in January. By then sinusitis had been excluded as an explanation and the clinical context was materially different.
6. Disposition. There was no breach of duty. The claim against the First Defendant was dismissed. The claimant was ordered to pay the First Defendant's costs, subject to assessment and reservation of enforcement issues, and permission to appeal was refused.