Connolly v Croydon Health Services NHS Trust

A patient must receive sufficient and accurate information to make an informed decision about medical treatment. Material risks and reasonable alternatives must be explained by reference to the particular patient. A patient with capacity may withdraw consent during a procedure, but the court must determine whether words or conduct amount to withdrawal and whether medication has affected capacity. In an emergency, treatment may continue without consent where delay would threaten life and the treatment is reasonably necessary in the patient’s best interests. Clinical negligence remains governed by Bolam, subject to the requirement in Bolitho that professional opinion have a logical basis.

The claimant brought a personal injury claim against the NHS Trust arising from an angiogram which developed into an angioplasty. She alleged that her consent had been vitiated by misleading information and that staff continued the procedure after she withdrew consent, thereby committing a battery. The defendant disputed breach, causation, withdrawal of consent and the claimant’s capacity, and relied on the medical emergency created by an occluded coronary artery.

The court determined the adequacy of the information given, the timing of the arterial dissection and severe pain, whether consent was withdrawn, whether the claimant had capacity, the effect of the emergency, and the counterfactual consequences of stopping the procedure.

1. Consent and information. The information sheet was misleading because it implied that serious complications did not arise where the arteries were healthy. Nevertheless, on the evidence, the claimant’s consent was not vitiated. The experts agreed that there was no breach of duty in the information provided before the angiogram, and the claimant would not have refused the procedure even if better information had been given.
2. Clinical negligence. The court applied Bolam, subject to the logical-analysis qualification in Bolitho. The claimant failed to establish that the dissection occurred after the femoral approach. The medical records, timing of analgesia, chronological procedure report and expert evidence established that the severe pain and dissection occurred before that approach.
3. Withdrawal of consent. Although the claimant experienced severe pain and anxiety, the court was not persuaded that she withdrew consent. The evidence of the staff and the surrounding circumstances did not support that conclusion. In any event, the claimant lacked capacity to withdraw consent at the material time because of the medication administered.
4. Medical emergency. Once the occluded LAD was detected, a substantial portion of the heart was deprived of blood and delay risked permanent damage or death. It was reasonable for the operator to proceed rapidly with further treatment. The staff were not in breach of duty by continuing the procedure in those circumstances.
5. Causation and outcome. Had the procedure been halted, the likely consequence would have been the claimant’s death. The claim therefore failed on breach of duty and causation. The court also assessed general damages at £25,000 and miscellaneous losses at £250, rejected the claims for loss of earnings and care, and dismissed the claim.