Haywood v University Hospitals Of North Midlands NHS Trust

A postnatal patient should not be discharged after persistent tachycardia, including red-flag readings, merely because one later pulse measurement is normal. Where infection remains a possible explanation and monitoring has not followed the hospital’s own protocol, reasonable care requires further assessment before discharge.

The court applied the Bolam standard. Further pulse, temperature and blood-pressure checks were required, followed by blood testing and CRP testing if indicated. A breach was established where no reasonable body of doctors would have discharged the patient without those investigations, and the evidence showed that timely antibiotics would probably have prevented the later injury.

The claimant suffered a stroke after a post-operative wound infection developed following an emergency caesarean section. The parties agreed that the infection caused the stroke and that antibiotics administered on 19 February 2010 would have prevented it. The dispute concerned whether infection was already developing when she was discharged on 19 September 2010, whether further investigations would probably have detected it, and whether discharge without those investigations fell below the required standard of care.

The claim was therefore concerned with breach of duty and causation. Quantum was reserved.

1. Applicable standard. The court applied the familiar medical-negligence test stated by McNair J in Bolam v Friern Hospital Management Committee [1957] 1 WLR 582 at p 587.
2. Cause of the clinical signs. On the balance of probabilities, the claimant’s persistent tachycardia on 18 and 19 September 2010 and her elevated white-cell and neutrophil counts were caused by the developing post-operative infection. The absence of significant pyrexia did not exclude infection, particularly given its atypical course.
3. Further investigations. Further testing on 19 September would probably have shown that infection was present or likely to be present. At a minimum, the claimant’s pulse, temperature and blood pressure should have been rechecked. The results would then have justified further blood testing and CRP measurement, leading to broad-spectrum antibiotics.
4. Breach. The hospital’s care plan required frequent MEWS observations, but the chart was not completed as required and the escalation pathway was not followed after high pulse readings. The later reading of 80 bpm did not satisfactorily explain or exclude the preceding 24 hours of tachycardia. The clinician’s assumption that mild anaemia explained the tachycardia lacked an adequate foundation. Discharge to community midwife care did not cure that failure.
5. Causation and order. No reasonable body of doctors would have discharged the claimant without further tests. Those tests would probably have led to antibiotics, which would have treated the infection and prevented the thrombocytosis, stroke and continuing consequences. Judgment was accordingly entered in the claimant’s favour. Consequential orders were reserved for written submissions.