Wells & Anor v University Hospital Southampton NHS Foundation Trust

Clinical negligence requires proof of breach and causation. A doctor is not negligent merely because another professional opinion takes a different view, provided the treatment accords with a proper, responsible and logical practice. Guidance is important evidence of reasonable practice, although it does not mechanically determine every clinical decision. A practice may nevertheless be negligent if it lacks a logical basis or a proper understanding of risks and benefits. In assessing alleged negligence, expert criticism must be tested against the perspective of a reasonably competent practitioner at the time, without hindsight. Where psychiatric injury is claimed following the death of a child, the classification of the claimant as a primary or secondary victim depends on when the negligence and injury occurred. Secondary victims must satisfy the control mechanisms, including a sudden and shocking event.

The claim arose from the death of Layla Wells shortly after her delivery by caesarean section. Her parents claimed bereavement damages, funeral expenses and damages for psychiatric injury. They alleged that the defendant NHS Trust’s doctors should have delivered Layla by caesarean section earlier, principally because of the cardiotocograph trace and the presence of thick meconium.

The Trust denied breach and causation. The court considered the interpretation of the trace, the timing of delivery, the decision to obtain a fetal blood sample, causation, and whether the parents could recover for psychiatric injury. A proposed claim based on failure to advise about the risks of continuing the pregnancy was not pleaded and was not pursued.

1. Clinical negligence. The applicable standard required the claimants to prove breach of duty and causation. The doctors’ treatment was consistent with reasonable practice. The court rejected criticisms based on hindsight and on interpretations of the trace which would not have been shared by a reasonably competent practitioner at the time.
2. Cardiotocograph and meconium. The deceleration following maternal vomiting could reasonably be treated as having resolved into a new baseline, because the fetal heart rate recovered into the normal range and variability remained good. The presence of meconium required continuous electronic fetal monitoring, which was provided; it did not itself require immediate caesarean delivery.
3. Fetal blood sampling. Obtaining a fetal blood sample in response to the pathological trace was reasonable. Although the evidence relied on by the claimants did not show improved outcomes, the procedure provided better information about fetal condition and was supported by the relevant NICE guidance. The accepted practice therefore had a logical basis within the principle in Bolitho v City and Hackney HA [1998] AC 232.
4. Causation. The judge nevertheless considered that, if there had been a breach in failing to arrange delivery by 1020 hours, causation would have been established. The evidence made it likely that meconium aspiration occurred after 1100 hours and resulted from hypoxia.
5. Psychiatric injury. The conclusions on psychiatric injury were alternative findings. Mrs Wells would have been a primary victim because the alleged negligence occurred while she and Layla were still treated as one person. Mr Smith was a secondary victim and had to satisfy the control mechanisms in Alcock v South Yorkshire Police [1992] 1 AC 310. He failed because there was no sudden, shocking event. The claim was dismissed for want of breach.

First-instance decision. No earlier decision or appeal is stated in the judgment.