Long v Western Sussex Hospitals NHS Trust

In clinical negligence, a clinician must take reasonable steps to exclude an imminently life-threatening and treatable condition, even where another diagnosis appears more likely. The Bolam standard remains subject to logical scrutiny under Bolitho. Where differential diagnoses remain reasonably possible, the clinician should reduce the risks associated with each serious possibility. A breach does not justify damages unless the claimant proves consequential loss. Applying the damage test in Johnston, the claimant must show that the negligence left him appreciably worse off.

The claimant developed a postoperative infection after surgery to repair a fractured hip. He was readmitted with severe pain and raised inflammatory markers, but was discharged without arrangements for the planned repeat blood test. The infection later progressed to septicaemia.

The defendant admitted a later delay in undertaking debridement but denied that the earlier discharge was negligent or that either breach caused recoverable damage. The principal issues were whether discharge without a blood test on 1 May 2008 breached the duty of care and whether any delay caused compensable injury.

1. Breach of duty. The court applied the principles in Bolam v Friern Hospital Management Committee [1957] 1 WLR 583, subject to the logical scrutiny described in Bolitho v City and Hackney Health Authority [1998] AC 232. A responsible clinician faced with differential diagnoses must take appropriate steps to eliminate an imminently life-threatening and treatable condition, even where the clinical picture points more strongly towards an alternative diagnosis.
2. The raised CRP, WCC and ESR were consistent with infection, although not conclusive. The hospital had identified infection as a differential diagnosis and had planned repeat blood testing. The junior doctor was not entitled, acting alone, to abandon that plan. In the circumstances, the hospital should have arranged a repeat blood test on 1 May 2008, either as an inpatient or outpatient. Discharge information should also have recorded the results, the differential diagnosis and the need to seek urgent advice if the condition deteriorated.
3. Causation and damage. The claimant’s septicaemia would have occurred even without the breaches. The evidence did not establish that antibiotics would have been administered materially earlier, or that earlier debridement would have made his condition materially better. He therefore failed to prove damage capable of supporting a quantified award.
4. Applying the approach in Johnston v NEI International [2007] UKHL 39, the claimant had not shown that the delay made him appreciably worse off. The claim was dismissed.