Lillington v Ansell & Anor

A healthcare professional is not negligent where the treatment accords with a responsible school of medical thought. The court must assess the conduct in the circumstances confronting the individual practitioner. A doctor may reasonably provide treatment and safety-netting rather than hospital admission where examination excludes serious pathology and the patient’s presentation permits that course. The court also considered, provisionally, that legal causation may be established where the injury falls within the type of risk created by a failure to investigate, even though the precise medical condition was unforeseeable. The claim nevertheless failed because neither defendant breached the duty of care.

The claimant developed severe hyponatraemia after becoming unwell with cystitis symptoms and consuming substantial quantities of water. She alleged that two general practitioners negligently failed to arrange earlier hospital admission, which would have led to testing and treatment before seizures, encephalopathy and lasting symptoms occurred.

The claim raised issues of breach, legal and medical causation, amendment to plead an alternative psychological injury, and the claimant’s capacity to conduct the proceedings and manage her financial affairs. The defendants denied negligence and disputed permanent organic brain injury.

1. Breach of duty. The applicable standard was the Bolam test: a doctor is not negligent where the treatment accords with a responsible school of medical thought. Both defendants had examined the claimant sufficiently to exclude serious pathology on the presentation they encountered.

2. Dr Jennison was entitled to administer an antiemetic and give safety-netting advice rather than arrange immediate admission. The injection stopped the pattern of vomiting, and the claimant contacted the out-of-hours service when nausea worsened. Even if more specific advice had been required, the subsequent course would not have materially changed. Dr Ansell’s advice to use oral antiemetic treatment and contact the duty doctor was also reasonable. Neither defendant breached the duty of care.

3. Legal causation. Although not necessary to the decision, the judge’s provisional view was that the claim would not have failed on remoteness. The nausea and vomiting presenting when the defendants saw the claimant were at least arguably of the same type as the later consequences of hyponatraemia. The reasoning in Hughes v The Lord Advocate was therefore potentially applicable.

4. Medical causation. Had breach been established, the claimant would still have failed to prove permanent organic brain injury. The evidence more convincingly showed that acute hyponatraemia, without hypoxia, herniation or osmotic demyelination, had not caused the alleged frontal-lobe injury. The proposed late amendment to plead a purely psychological injury was refused because the defendants had prepared the case on the pleaded organic-injury basis.

5. Capacity. Applying sections 1(2), 2 and 3 of the Mental Capacity Act 2005, the claimant had not displaced the statutory assumption of capacity in relation to conducting the proceedings.

The claim was dismissed.