Holdsworth v Luton And Dunstable University Hospital NHS Foundation Trust

In a clinical negligence claim, a treatment choice is not negligent merely because another competent expert would have chosen differently. The relevant question is whether a responsible body of professional opinion would support the decision. The court must also be satisfied that the supporting opinion has a logical basis, particularly where risks and benefits are being weighed. A patient’s insistence on treatment cannot itself justify its provision. Informed consent requires reasonable care to ensure that the patient understands material risks and reasonable alternatives. However, a failure in consent will not establish liability without causal significance. The claim failed because the clinical decisions were supported by responsible and logically defensible expert opinion, informed consent was given, and any alleged consent deficiencies would not have changed the decision to undergo surgery.

The claimant brought a clinical negligence claim against the defendant NHS foundation trust concerning three matters: the decision to perform a unicompartmental knee replacement, the adequacy of her consent to that procedure, and the alleged use of an oversized femoral component during a later total knee replacement. The claim concerned liability and causation only.

The court considered whether the treatment decisions satisfied the Bolam test as refined by Bolitho, whether the claimant received the information required for informed consent under Montgomery, and whether the selected femoral component was negligent.

1. First issue—unicompartmental knee replacement. The question was whether a responsible body of orthopaedic surgeons would have offered the procedure and whether that opinion could withstand logical analysis. The court accepted that the arthroscopic findings could legitimately have been regarded as contributing to the claimant’s pain and that a responsible body of surgeons would have considered the procedure to have reasonable prospects of success. The defendant’s expert overstated those prospects, but that did not undermine the broader legitimacy of his opinion. The claimant’s insistence on surgery was relevant to the clinical context but could not itself justify treatment. The decision was therefore not negligent under Bolam and Bolitho.
2. Second issue—informed consent. Applying Montgomery, the court found that the claimant had been warned about the risks and potential benefits of the procedure and had been offered reasonable alternatives, including injections, physiotherapy, further arthroscopy and microfracture. Her written consent form also identified serious or frequently occurring risks. The court accepted the treating surgeon’s evidence and found that informed consent had been given. In any event, even if information had been omitted, the claimant would have undergone the surgery, so any deficiency lacked causal significance.
3. Third issue—femoral component. Although the prosthesis appeared to be towards the large side, the evidence did not establish that it was the wrong size or that no reasonably competent surgeon would have selected it. The claim therefore failed on this issue also.
4. There was judgment for the defendant.

Not an appeal. No prior appellate decision is stated in the judgment.