Anderson v North West Strategic Health Authority

In assessing alleged clinical negligence, recognised classifications of cardiotocography traces do not dictate the appropriate intervention. The trace must be assessed with the whole clinical picture, including the timing and evolution of abnormalities, other risk factors, and the risks of intervention. A clinician is not negligent where the chosen conservative course falls within the range of reasonable professional opinion, even though another competent clinician might have chosen urgent delivery. The Bolam v Friern Hospital Management Committee test remains decisive: the claimant must show that no reasonably competent clinician would have followed the course adopted. The claim therefore failed.

The claimant, who suffered cerebral palsy following oxygen deprivation before birth, alleged that the defendant was vicariously liable for negligent obstetric management of his mother’s labour in 1989. He contended that the combination of suspected placental abruption, ruptured membranes, prematurity and deteriorating cardiotocography required an emergency caesarean section before 12.30. The defendant maintained that the clinical decisions were reasonable and that vaginal delivery remained appropriate. The central issue was whether the clinicians’ failure to arrange urgent caesarean delivery fell outside the range of reasonable professional practice.

1. Claim dismissed. The claimant failed to prove that the clinicians’ decision not to arrange an emergency caesarean section was one which no reasonably competent body of clinicians would have made.
2. Under Bolam v Friern Hospital Management Committee [1957] 1 WLR 582, breach required proof that the clinicians acted outside the range of reasonable professional opinion. The competing experts were both capable of supporting reasonable clinical approaches.
3. Premature rupture of the membranes, without more, did not require expedited labour. Once labour had begun, the earlier rupture was a relatively modest factor. Suspected placental abruption remained relevant, but the risk had not increased during labour. Prematurity and earlier trace abnormalities also required clinical judgment and did not, cumulatively, make urgent caesarean delivery indisputable.
4. FIGO classifications and other published guidance assisted interpretation but did not prescribe the clinical response. A trace falling within an abnormal category did not automatically require intervention. The pattern had to be assessed over time and in the context of all information available to the clinicians. A mechanistic approach based solely on the duration or classification of individual decelerations was inappropriate.
5. The clinicians had recognised the deterioration shown by the trace and discussed the appropriate course with knowledge of the relevant complicating factors. Although a different clinical judgment could reasonably have been reached, the conservative approach remained within the range permitted by the Bolam standard. The judge observed that changes in baseline rate and variability might have produced a different result, but expressly treated that as a hypothetical example rather than a requirement for urgent action in every case.