Rathore v Bedford Hospitals NHS Trust

A defendant is liable only for loss proved, on the balance of probabilities, to have been caused or materially contributed to by the admitted negligence. A physical injury may materially contribute to a subsequent somatoform disorder, but later widespread pain must be separately proved and may be attributed to independent stressors. Where causation is established for only part of the claimed period, damages must be confined accordingly. Gratuitous care is recoverable only where the services go distinctly beyond the ordinary regime of family life.

Satveer Rathore claimed damages from Bedford Hospitals NHS Trust after the Trust admitted failing to inform her of a positive chlamydia test and to ensure appropriate treatment. She alleged that the untreated infection caused pelvic inflammatory disease, pain, an ectopic pregnancy, removal of a fallopian tube, a somatoform pain disorder, chronic widespread pain, facial excoriation and extensive care needs.

The central issues were the extent of the physical consequences of the infection, whether the somatoform disorder and later chronic widespread pain were causally connected to the negligence, and the recoverability of claimed care and other losses.

1. The claim succeeded in part. The claimant recovered £68,742.38, but the defendant was not liable for future pain and suffering, care, loss of earnings or other losses flowing from chronic widespread pain diagnosed by May 2011.
2. The court accepted that the untreated chlamydia caused the ectopic pregnancy and loss of the left fallopian tube. After 27 February 2007, however, the evidence did not establish continuing pelvic inflammatory disease. Two laparoscopies, including one with a visible record, provided substantial evidence against ongoing inflammation. Pain alone was insufficient to establish pelvic inflammatory disease.
3. The claimant had developed a somatoform disorder by February 2007. The abdominal pain caused by the untreated infection materially contributed to that disorder, and the psychologically induced facial rash was also materially contributed to by the negligence. The defendant failed to prove that the disorder would probably have arisen by that date in any event.
4. The claimant failed to prove that chronic widespread pain from May 2011 was materially contributed to by the negligence. The more probable explanation was the operation of independent stressors, including the 2008 and 2011 road accidents, matrimonial conflict and other psychosocial factors, against a pre-existing vulnerability. The claimant’s evidence concerning the later condition was materially unreliable and exaggerated.
5. For gratuitous care, the recoverable services had to go distinctly beyond the ordinary regime of family life, applying the approach in Mills v British Rail Engineering Ltd [1992] 1 PIQR. Care was allowed only for the supported period from 4 September 2006 to 28 February 2007. The wider claims were rejected on the evidence.