FE v St George's University Hospitals NHS Trust

In a clinical negligence claim, the standard is that of a reasonably competent practitioner carrying out the relevant functions at the time in question. A hospital team must respond reasonably to the combined significance of clinical indicators and properly communicated concerns from experienced staff. A reassuring test result does not necessarily justify delay where other evidence indicates increasing risk. Where doctors are detained by another emergency, an appropriate management plan and effective communication remain necessary. The court may find breach where the response to concerns is inadequate and delivery is unreasonably delayed. Causation is established where the evidence shows that earlier delivery would probably have avoided the injury.

The claimant suffered neurological injury following an acute hypoxic-ischaemic insult shortly before his birth at the defendant’s hospital. It was agreed that delivery by 03.11 would have avoided the injury. The claim concerned the management of labour, including the timing of obstetric review, communication between the midwifery and obstetric teams, cessation of Syntocinon, the doctors’ continuing involvement with another patient, and the time taken to deliver the claimant after assessment.

The defendant argued that the injury was caused by an unforeseeable acute cord event. The claimant relied on gradual deterioration caused by delayed delivery and inadequate management. The issues were liability and causation.

1. The claim succeeded. The court found that the defendant’s system of communication and response between the midwifery and obstetric teams failed to ensure a reasonable standard of care.
2. The applicable standard was the standard of the day, namely 2001. Applying the principles stated in Bolam v Friern Hospital Management Committee [1957] 1 WLR 582, Bolitho v City and Hackney Health Authority [1998] AC 232, and summarised in Sardar v NHS Commissioning Board [2014] EWHC 38, the question was whether the care accorded with that of a reasonably competent practitioner performing the relevant functions.
3. The management at 01.35 was appropriate, and the second foetal blood sample gave the doctors some reassurance. However, that result could not reasonably be relied on for almost an hour in the face of increasing concerns expressed by an experienced midwife. Those concerns should have been communicated to, and understood by, the obstetric doctors.
4. If the doctors treating another patient could not respond, the midwifery team should have secured review by another senior practitioner. If Dr Hussain appreciated the level of concern, she could have left the other patient’s care to Dr Wayne after the uterus had been closed.
5. The approximately 45-minute interval between Dr Hussain’s arrival and delivery was unreasonably and unjustifiably long, even allowing for assessment, consultation and attempted instrumental delivery. FE could and should have been delivered before 03.11.
6. The court also criticised the unreliable records, particularly the failure properly to record the administration and cessation of oxytocin. The claimant therefore established breach and causation.