Jones v Taunton And Somerset NHS Foundation Trust

In a clinical negligence claim concerning tocolysis, the court must assess breach by reference to the standards reasonably applicable at the time of treatment. A responsible body of medical opinion attracts substantial weight, but the court remains responsible for deciding whether that opinion is logical and defensible. The diagnosis of threatened preterm labour may properly be made on relatively soft criteria because delay may make treatment ineffective. Tocolysis should not be used prophylactically, but a doctor need not await certainty where the clinical picture reasonably indicates true preterm contractions. In 1995 it was not negligent to prescribe Nifedipine rather than Ritodrine where a responsible body of obstetricians could regard Nifedipine as an acceptable treatment. Nor was it negligent, on the evidence, to administer it sublingually, omit a pre-treatment intravenous line, or give a second dose where continuing contractions were reasonably inferred.

The claimant, Luc Jones, brought a claim through his mother alleging that negligent antenatal care at Musgrove Park Hospital in November 1995 caused brain injury. The claim was tried on breach of duty only. It concerned the administration of Nifedipine to Mrs Harris at about 31 weeks’ pregnancy. The allegations were that she was not in threatened preterm labour, that Nifedipine should have been confined to a clinical trial, that it was administered contrary to the hospital’s protocol, and that a second dose should not have been given.

The central questions were whether the diagnosis and use of tocolysis were reasonable by the standards of November 1995, whether Nifedipine was an acceptable drug, whether an intravenous line was required beforehand, and whether the second dose was justified.

1. Applicable standard. The court applied the Bolam and Bolitho principles. Appropriate expert opinion attracts substantial weight, but the court must decide the issue itself and must test the opinion for logic, reasonableness, internal consistency and consistency with the evidence. The assessment is made by reference to the state of knowledge and practice at the time of treatment.
2. Threatened preterm labour. Tocolysis was reasonable only after a diagnostic threshold had been reached and was not to be used prophylactically. That threshold could nevertheless be assessed on relatively soft criteria because established labour might become irreversible. Mrs Harris had true early uterine contractions, rather than Braxton Hicks contractions, together with a possible show and cervical findings consistent with early labour. It was reasonable to diagnose threatened preterm labour and prescribe tocolysis.
3. Choice and administration of Nifedipine. The evidence showed increasing concern about Ritodrine’s maternal side effects and a developing body of evidence supporting Nifedipine. Although Nifedipine was unlicensed for tocolytic use, that was only one factor. A responsible body of obstetricians could reasonably use Nifedipine in 1995. Sublingual administration was not negligent where that was the reasonable interpretation of the applicable regimen.
4. Intravenous line. The evidence of Professor Thornton was logical and consistent with later guidance and other evidence. A reasonable body of clinicians would not necessarily have established an intravenous line before administering Nifedipine.
5. Second dose. On the balance of probabilities, continuing contractions were indicated by the reference to abdominal pain in waves. In any event, even if the contractions had ceased, it was reasonable in the circumstances to administer a second dose.
6. Disposition. The claimant failed to prove breach of duty. The claim therefore failed. The question whether a clinician’s conduct should be judged differently where later developments vindicate treatment was left open.