ZZZ v Yeovil District Hospital NHS Foundation Trust

A hospital may breach its duty by failing to consider a trauma call where information suggests a high-speed collision, even though the applicable protocol does not mandate a call. A patient presenting after a serious accident should also be managed on the assumption that significant spinal injury may exist, with appropriate spinal precautions.

Those breaches do not establish causation where the medical evidence shows that the disabling injury was complete or inevitable from the accident, and that subsequent deterioration resulted from continuing structural and chemical changes rather than additional trauma. The evidential approach in Keefe v Isle of Man Steam Packet Company Limited did not permit an inference of causation in the face of compelling contrary scientific evidence.

The claimant, ZZZ, sought a contribution from the defendant NHS trust after settling a personal injury claim arising from a road collision involving XXX. XXX sustained a severe spinal fracture-dislocation while wearing a lap belt. ZZZ alleged that the Hospital failed to recognise the risk of spinal injury, failed to initiate a trauma call, and failed to maintain adequate spinal precautions, causing or contributing to the subsequent paralysis.

The central issues were whether the Hospital was in breach of duty and, if so, whether any breach caused additional spinal injury or neurological deterioration.

1. Disposition. The contribution claim was dismissed.
2. Trauma call. The Hospital’s protocol did not mandate a trauma call on the evidence available. However, once Nurse Guy was told that the collision had involved a combined speed of approximately 60 mph, she or her managers were required to consider making one. That obligation was breached, although the court found that a trauma call probably would not have been required and that the breach had no consequence.
3. Spinal precautions. The Hospital also breached its duty by failing consciously to manage XXX on the assumption that she might have suffered significant spinal injuries and by failing to introduce the full range of spinal precautions.
4. Causation. The breaches did not cause loss. XXX’s spine was not subjected to significant extension, flexion or rotation while at the Hospital. The medical evidence established that the spinal cord was already severely compromised at the collision and that paralysis was inevitable. The subsequent loss of remaining movement resulted from continuing pressure, structural distortion and chemical changes in the injured cord, not from additional negligent trauma at the Hospital.
5. Keefe v Isle of Man Steam Packet Company Limited [2010] EWCA Civ 603. The evidential approach in that case did not apply. Unlike Keefe, there was compelling scientific evidence explaining the deterioration, and the court could not accept the initial nursing assessment of normal limb power at face value or infer that the deterioration would probably have been avoided by proper precautions.
6. It was unnecessary to determine quantum or apportionment. The court expressed only provisional views on those matters and directed that counsel be heard on consequential orders.