Thornton v Homerton University Hospital NHS Trust

Medical negligence is assessed by the Bolam standard, subject to the Bolitho requirement that the supporting clinical opinion has a logical basis. The court must assess the conduct against responsible medical opinion prevailing at the time, without hindsight. The test is not a head-counting exercise, and a small body of appropriately qualified opinion may suffice. A first episode of food-bolus obstruction that resolves spontaneously does not create an automatic requirement for endoscopic investigation. The appropriate response depends on the information reasonably available to the clinician, including relevant symptoms, history and examination findings.

Carol Thornton, as executrix of William Thornton’s estate, claimed damages against Homerton University Hospital NHS Trust for alleged negligent treatment in the Emergency Department on 9 January 2012. Mr Thornton had attended with a food bolus lodged in his throat, but the obstruction cleared spontaneously before he was seen by Dr Candler. He was examined, questioned and discharged with safety-net advice.

The claimant alleged that Dr Candler should have elicited further swallowing and oesophageal history and arranged upper gastrointestinal investigation. The central issue was whether the assessment and decision not to refer Mr Thornton for endoscopy fell below the standard of a reasonable and responsible emergency clinician.

1. The claim was dismissed. Dr Candler’s conduct fell within a range of reasonable responses to the information available to him.
2. Under Bolam v Friern Hospital Management Committee, the relevant standard was that of the ordinary skilled clinician exercising the particular skill. A clinician is not negligent merely because another body of medical opinion would have taken a different view.
3. Under Bolitho v Hackney HA, the supporting medical opinion had to be respectable, responsible and reasonable, with a logical basis. Where comparative risks were involved, the clinicians supporting the practice had to have directed their minds to the relevant matters and reached a defensible conclusion.
4. The assessment was not a head-counting exercise. A small number of suitably qualified specialists could constitute a responsible body of medical opinion. The conduct had to be judged by the standards prevailing when the acts or omissions occurred, without applying hindsight, consistently with Eckersley v Binnie.
5. The court accepted that Dr Candler had taken a reasonable history, carried out an appropriate examination and considered the possibility of malignancy. The evidence did not establish that he had been told of previous swallowing difficulties or Barrett’s oesophagus.
6. There was no golden rule requiring endoscopic referral after every food-bolus obstruction. In particular, where a first or isolated obstruction had cleared spontaneously and the patient was well, further referral was not automatically mandatory. The decision depended on the clinical information and circumstances available at the time.