XYZ v Warrington & Halton NHS Foundation Trust

In a clinical negligence claim concerning spinal surgery, the court applied the Bolam test as qualified by Bolitho. A surgeon is not negligent where the treatment accords with a responsible body of medical opinion and that opinion has a logical and defensible basis, including appropriate consideration of comparative risks and benefits.

Where the treating psychiatrist has expressly supported surgery, the surgeon may reasonably treat that communication as positive support without further consultation, depending on the circumstances. A second opinion is not necessarily required where the decision is one of clinical judgment and the treating surgeon is best placed to balance the relevant factors.

The claimant brought a personal injury claim against the defendant NHS foundation trust arising from a lumbar microdiscectomy performed by an employed orthopaedic surgeon. She alleged that her consent was inadequately obtained and that the surgeon should have discussed the proposed operation with her treating psychiatrist or obtained a second opinion.

The claimant also alleged that the operation caused cauda equina syndrome and consequential physical and psychiatric injury. The central questions were whether there had been a breach of duty, and, if so, what injury and prognosis were attributable to the operation.

1. Consent. The claimant was provided with written information about lumbar microdiscectomy and its risks. The court accepted that the risks and complications were explained before the consent form was signed. Consent was therefore properly obtained.
2. Applicable standard. Applying Bolam v Friern Hospital Management Committee (1957) 1 WLR 582, as explained in Sidaway v Governors of Bethlem Royal Hospital [1985] AC 871 and qualified by Bolitho v City and Hackney Health Authority [1998] AC 232, the question was whether the treatment accorded with a responsible body of medical opinion and whether that opinion had a logical and defensible basis.
3. Decision to operate. Persistent leg pain, the MRI findings and the failure of injections supported surgery. The claimant’s psychiatric condition was a significant counter-indication, but the treating psychiatrist’s letter was a clear encouragement not to delay surgery because of mental-health problems. The surgeon was entitled to treat it as positive support and was not required to consult the psychiatrist further.
4. A second opinion was not required. The decision involved balancing clinical factors rather than resolving a technical issue, and the surgeon had detailed knowledge of the claimant’s history. A responsible body of competent medical opinion could reasonably proceed without obtaining a second opinion. No breach of duty was established, and the claim failed.
5. Alternative findings. The court nevertheless found that the claimant probably sustained organic cauda equina syndrome as a recognised, non-negligent complication of the operation. The evidence, particularly concerning the perianal reflex and neurological testing, supported an organic explanation. Without the operation and resulting syndrome, she would probably have avoided the most severe psychiatric and lower-limb symptoms, including the paralysis and loss of sensation she later experienced.