Britchford v Staffordshire And Stoke-On-Trent Partnership NHS Trust

In a clinical negligence claim, the standard of a nurse practitioner’s history-taking was reasonable where the evidence established that he had elicited the information reasonably available and had not been told of symptoms indicating a vascular emergency. A temporal link between an earlier presentation and a later stroke did not establish causation where the medical evidence supported the later event being a single event without prodromal symptoms. The claim failed because there was no breach of duty.

The claimant, who had suffered a serious stroke and permanent disabilities, claimed damages from an NHS Trust. She alleged that, during a consultation at the Trust’s walk-in centre, a nurse practitioner had failed to take an adequate history and should have recognised and referred a vascular problem affecting her hand and wrist.

The Trust denied breach, contending that the claimant had presented with non-vascular symptoms and that the nurse practitioner’s assessment and diagnosis of tendonitis were reasonable. The court determined liability only. The central issues were the facts communicated during the consultation, the adequacy of the history-taking, whether referral was required, and whether earlier treatment would probably have prevented the stroke.

1. The claim was dismissed. The court found no breach of duty, so it was unnecessary to determine causation.
2. The claimant’s and Mr Basnett’s accounts of the symptoms at the walk-in centre had materially changed and were inconsistent. The court rejected the suggestion that the claimant had presented with a cold, blue or intermittently discoloured hand, or that those symptoms had been communicated to the nurse practitioner.
3. The nurse practitioner was an honest and convincing witness with relevant vascular experience. His contemporaneous note recorded no peripheral cyanosis. His evidence as to his usual practice established that he would have asked appropriate general questions about the onset, type and severity of pain, aggravating factors and related symptoms.
4. History-taking was particularly important in the walk-in centre, but the applicable standard did not require the practitioner to elicit information that was not present or communicated. On the facts, he had elicited the information available and was not given information that should reasonably have caused him to suspect a vascular or circulatory problem requiring referral to a doctor.
5. The retrospective hospital note referring to a white painful hand was not probative of the hand’s condition at the earlier consultation. The medical evidence also established that the stroke could have been a single event without prodromal symptoms. The temporal proximity between the consultation and the stroke therefore did not establish a causal connection.