Dalton v Southend University Hospital NHS Foundation Trust

In a clinical negligence claim, compliance with an established medical practice is not negligent merely because another responsible body would have acted differently. The court must determine whether the supporting professional opinion is capable of withstanding logical analysis. It is not the court’s role to choose between competing opinions which are each logically supportable.

Causation remains a matter for the claimant to prove on the balance of probabilities. A possibility that an earlier investigation would have detected disease is insufficient. Findings of contributory negligence in clinical negligence claims are likely to be rare and require a proper evidential basis.

The claimant alleged that the defendant hospital negligently failed to perform a core biopsy when she attended its breast clinic in March 2011 with a palpable breast lump. Breast imaging was assessed as benign, and she was reassured and discharged. Breast cancer was diagnosed in 2013 in the same general area.

The parties agreed quantum. The trial issues were breach of duty, causation and contributory negligence. The claimant relied on expert evidence that the clinical and imaging findings were discordant and mandated biopsy. The defendant relied on expert evidence that the management accorded with the applicable breast-diagnostic guidelines and responsible medical practice.

1. Claim dismissed. The claimant failed to establish breach of duty. The court also held that causation would not have been proved even if breach had been established.
2. The applicable standard was governed by Bolam v Friern Management Committee [1957] 1 WLR 582 and Bolitho v City and Hackney Health Authority [1998] AC 232. A claimant had to show that no responsible breast surgeon would have failed to undertake a core biopsy, which required demonstrating that the defendant’s supporting expert opinion could not withstand logical analysis.
3. The court preferred the interpretation of the national guidelines advanced by the defendant’s experts, but emphasised that it was not required to decide which competing interpretation was objectively correct. The defendant’s expert opinion was genuinely held, rationally explained and capable of logical support. The defendant’s clinician therefore acted within a responsible body of medical opinion.
4. On causation, the evidence established only that a biopsy might have detected the 3mm malignancy. The claimant had not shown that detection was probable. The court also accepted that, following a negative biopsy, failure to perform a repeat biopsy would not have been negligent because the clinical and imaging findings remained logically concordant with a benign condition.
5. The allegation of contributory negligence was rejected. The claimant had acted reasonably in seeking medical attention and returning when her symptoms changed. The court observed that such findings in clinical negligence claims would be rare and require a sufficient evidential foundation.

First-instance judgment. No prior appellate decision was stated in the judgment.