Hamed v Mills & Ors

A medical practitioner must meet the standard of a reasonably competent practitioner in the relevant field. An employer’s duty requires all reasonable steps to safeguard an employee from reasonably foreseeable injury, with more meticulous precautions required where the potential harm is death or catastrophic injury. Where cardiac screening reveals an abnormality that leaves a material, however small, risk of serious cardiac disease, a sports physician cannot properly infer that no risk exists merely because one suspected condition has been excluded. The risk must be communicated so that the athlete or, where appropriate, the parents can make an informed decision. The responsible organisation must also ensure that recommended clinical review and follow-up occur and that adequate medical records are maintained.

Radwan Hamed, a young professional footballer, suffered catastrophic brain damage after a cardiac arrest while playing for Tottenham Hotspur’s youth team. He claimed against Dr Peter Mills, the cardiologist who assessed his cardiac screening, and the Club, whose medical staff included Dr Charlotte Cowie and Dr Mark Curtin.

Dr Mills accepted liability. The remaining issues were whether the Club had breached its duties of care and, if so, how liability should be apportioned between the defendants. Causation was conceded by both defendants.

1. Duty and applicable standards. The Club owed duties arising from both the doctor-patient relationship and the employer-employee relationship. The medical duty was assessed under the Bolam standard. The employer’s duty required all reasonable steps to safeguard the claimant from reasonably foreseeable injury, with the burden increasing in proportion to the seriousness of the potential harm.
2. Risk assessment and communication. The claimant’s ECG was unequivocally abnormal. The later MRI excluded manifest hypertrophic cardiomyopathy but could not exclude other cardiac pathology or a future manifestation of disease. The claimant therefore remained at a very small risk of death or catastrophic injury. Dr Cowie’s conclusion that there was no cardiac risk was one to which no reasonably competent sports physician could have come. She was negligent under both applicable duties.
3. Clinical review and informed decision. Had the risk been appreciated, the claimant and his parents should have been informed, ordinarily through a clinical review by a cardiologist, so that they could decide whether he should continue playing. They would have stopped his professional football career, and the cardiac arrest would have been avoided.
4. Other allegations. The Club was not negligent in failing to refer the claimant to the FA cardiologist panel or in failing to complete the annual follow-up screening before the cardiac arrest. However, its medical records were inadequate for their purpose and failed to make clear that no clinical review had occurred.
5. Dr Mills and apportionment. Dr Mills breached his duty by failing in his September 2005 letters to make clear that the recommended clinical review remained required. Applying the principles of blameworthiness and causative potency, liability was apportioned 30% to Dr Mills and 70% to the Club. Both defendants were accordingly in breach, with causation conceded.

First-instance decision of the High Court (Queen’s Bench Division). No appellate history is stated in the judgment.