Watts v The Secretary of State for Health

In a clinical-negligence claim, the defendant’s conduct must be judged by the professional standards prevailing when the treatment occurred, not by later knowledge or practice. The applicable standard is that of the reasonably competent practitioner exercising the relevant skill. A brachial plexus injury does not, by itself, prove excessive traction. Such injuries may result from maternal propulsive forces, and the claimant must provide factual evidence of excessive force or other inappropriate management. The court must assess the evidence as a whole, including contemporaneous records and expert evidence.

The claimant sustained a permanent right brachial plexus injury during her birth in 1993, when shoulder dystocia complicated delivery. She alleged that the right shoulder was anterior and that excessive traction had caused the injury. The defendant contended that the right shoulder was posterior and that the injury was caused by maternal propulsion during a rapid delivery, with no negligent force being used.

The court considered the contemporaneous labour records, witness evidence, the hospital’s shoulder-dystocia protocol, and expert obstetric and orthopaedic evidence. The central issues were the shoulder position, whether excessive traction had been used, causation, and the standard of care applicable in 1993.

1. Applicable standard. The claim was dismissed. The standard of care had to be judged by the knowledge and practice applicable in 1993, rather than by contemporary standards. The relevant test was the standard of the reasonably competent doctor, nurse or midwife carrying out the functions expected in a general district hospital maternity unit. The principles in Bolam v Friern Hospital Management Committee [1957] 1 WLR 582 and Bolitho v City & Hackney Health Authority [1998] AC 232 supplied the legal framework.
2. Causation. The presence of a brachial plexus injury did not establish that excessive traction had been applied. Maternal propulsive forces could cause such an injury. A claimant had to demonstrate factual evidence of excessive force or other inappropriate management. The court accepted the contemporaneous record that the right shoulder was posterior and found that the injury was likely to have resulted from maternal propulsion during a rapid delivery.
3. Evidence. The parents were honest and sincere, but their recollections had to be assessed cautiously against the contemporaneous records and expert evidence. The defendant’s expert was preferred. The claimant’s expert had failed to maintain the required independence and objectivity and had advanced opinions without adequate explanation.
4. Application. Help was summoned promptly when shoulder dystocia was encountered. An episiotomy and suprapubic pressure were used, consistently with the hospital protocol, and delivery followed within three minutes. Even if the right shoulder had been anterior, the evidence did not establish that excessive traction had caused the injury. The claim therefore failed and was dismissed.