Welds v Yorkshire Ambulance Service NHS Trust & Anor

In an obstetric negligence claim, breach of duty does not itself establish liability where the claimant cannot prove avoidable delay causing the injury. The assessment of whether emergency treatment was provided within a reasonable time is a matter for the court, considering the evidence in the round. It is artificial to allocate fixed periods to individual tasks which may occur concurrently. An adverse inference from an absent witness is discretionary. It depends on whether the witness might reasonably be expected to have material evidence, whether there is a credible explanation for the absence, and whether there is already a case requiring an inference. Where witnesses are medically unfit, have no recollection, or are reluctant to assist, no adverse inference need be drawn.

The claimant suffered severe cerebral injury following an antepartum haemorrhage and placental abruption shortly before his birth. He alleged that the first defendant’s ambulance crew took too long to transfer his mother to hospital and that the second defendant’s midwives delayed calling an obstetrician.

The trial concerned breach of duty and causation. The court considered disputed evidence about the ambulance crew’s 13 minutes at the scene, the approximately 11 minutes between arrival at hospital and examination by the obstetric registrar, and the absence of evidence from two midwives. The central issues were whether either period involved negligent delay and whether any breach caused avoidable injury.

1. Ambulance crew. The crew’s management fell below the standard expected of a reasonably competent ambulance service. It failed adequately to investigate and record the vaginal bleeding, failed to check the mother’s pulse and blood pressure at the scene, and did not sufficiently appreciate the seriousness of a third-trimester antepartum haemorrhage. Failure to use emergency lights and the siren was further evidence of that lack of understanding, although it caused no loss.
2. Those breaches did not establish causative delay. The court assessed the 13-minute period in the round. It rejected an artificial division into one- or two-minute tasks and found that escorting the mother, preparing her, discussing treatment and transferring her into the ambulance could reasonably have taken that time. The claimant therefore failed to prove undue or unnecessary delay.
3. Hospital staff. The approximately 11-minute period before the obstetric registrar examined the mother was reasonable and consistent with standard practice. It allowed time for transfer from the ambulance, settling the mother, handover and an initial midwifery assessment. The hospital guideline requiring an obstetric registrar to be summoned immediately had to be applied consistently with reasonably competent medical practice.
4. Absent witnesses. No adverse inference was drawn from the absence of the two midwives. One was medically unfit to give evidence; the other had no recollection and was reluctant to assist. Those were credible explanations. The claimant could also have pursued the evidence or sought expert midwifery evidence.
5. On the agreed medical evidence, earlier examination could probably have led to delivery at 18.24 hours and milder injury. That did not affect the result because neither defendant was shown to have caused the relevant delay. There was judgment for both defendants.