Jones v Ministry of Defence

In a clinical negligence claim involving delayed diagnosis, the claimant must distinguish loss caused by the underlying condition from loss caused by the delay. A delayed diagnosis may cause substantial short-term injury without causing later symptoms, employment loss or reduced life expectancy. Causation must be established on the balance of probabilities by reliable medical evidence. Where treatment produces sustained clinical recovery, the court may find that the original condition no longer probably causes ongoing symptoms. An anonymity order is exceptional. The open justice principle remains the starting point, and privacy concerns must be sufficiently serious to make restriction necessary and proportionate.

The claimant, a serving soldier, sued the Ministry of Defence for the consequences of an admitted ten-month delay in diagnosing HIV. The defendant accepted responsibility for the claimant’s acute illness during the delay and for subsequent hospitalisations, but disputed that the delay caused persistent fatigue, medical discharge from the Army, reduced employment prospects, psychiatric injury or shortened life expectancy.

The court also determined an application for anonymity based on the claimant’s HIV status. The central questions were whether the delay caused the alleged continuing losses and whether the claimant’s identity should be withheld from public reporting.

1. Causation. The claimant had to separate the effects of HIV itself from the additional consequences of the negligent delay. The court accepted that the delay caused many months of severe symptoms, a period of grave medical risk and two hospital admissions.
2. Medical evidence. Professor Ross’s evidence was preferred to that of Dr Croft. The court found his analysis cogent, consistent with the epidemiology and supported by extensive clinical experience. Dr Croft’s reliance on WHO staging, his treatment of CD4 thresholds and his interpretation of the medical literature were materially flawed.
3. Persistent fatigue and discharge. In a patient responding well to antiretroviral treatment, with rising CD4 levels and an undetectable viral load, HIV would cease to be a probable direct cause of fatigue after approximately six months to one year. By the autumn of 2014, HIV was no longer the probable cause of the claimant’s fatigue. The fatigue therefore did not establish that the delay caused his medical discharge.
4. Psychiatric causation. The claimant did not prove that he suffered a major depressive disorder before 2015. Even if he had suffered depression or low mood earlier, the evidence did not establish that the delay, rather than the diagnosis itself, the consequences of living with HIV and other life events, was the effective cause of persistent fatigue.
5. Life expectancy and damages. The delay did not reduce life expectancy. General damages of £20,000 were awarded for the acute suffering and hospitalisations caused by the delay. Reasonable gratuitous care was also recoverable up to approximately mid-November 2014. Periodical payments were inappropriate.
6. Anonymity. Under the principles stated in Scott v Scott, Guardian News v Media Limited, R(C) v Secretary of State for Justice, JX MX v Dartford & Gravesham NHS Trust and Armes v Nottinghamshire CC, open justice is the starting point. The claimant’s privacy interests under article 8 were genuine but did not make anonymity necessary or proportionate. The application was dismissed.