SC v University Hospital Southampton NHS Foundation Trust

A hospital clinician who diagnoses a recognised condition must still consider whether the whole presentation indicates a concurrent serious bacterial infection. A positive diagnosis of tonsillitis does not exclude that possibility where earlier findings indicate serious illness and intervening antibiotics may have masked symptoms. In such circumstances, reasonable medical care may require further investigation, including lumbar puncture, and intravenous antibiotics. The standard is that in Bolam v Friern Hospital Management Committee [1957] 1 WLR 582, as explained in Bolitho v City and Hackney HA [1998] AC 232: professional opinion must withstand logical analysis. Doctors are judged by the standard applicable to their level of seniority and specialisation.

The claimant was a 15-month-old child who developed pneumococcal meningitis after being assessed by a general practitioner and then treated at hospital for tonsillitis. The general practitioner had identified lethargy, floppiness, a glazed or vacant appearance, high fever and vomiting, administered intramuscular antibiotics, and referred her urgently to hospital.

Hospital clinicians diagnosed tonsillitis, observed an apparent improvement, and discharged her with oral antibiotics. She was later readmitted, diagnosed with partially treated meningitis, and suffered permanent neurological injury. The central issue was whether the hospital’s management on 26 January 2006 fell below the standard of reasonable paediatric care and caused the injury.

1. Liability established. The claimant proved that the defendant breached its duty of care and that treatment with intravenous antibiotics on 26 or 27 January 2006 would have prevented the subsequent infarction and cerebral palsy. Judgment was therefore entered for the claimant on liability, with damages to be assessed.
2. The applicable standard was the Bolam test as explained by Bolitho. A practice supported by responsible medical opinion must also be capable of withstanding logical analysis. Under FB v Princess Alexandra Hospital NHS Trust [2017] EWCA Civ 334 [2017] PIQR P17, the standard was that of a reasonably competent doctor of the same seniority and specialisation. No allowance was made for the relative inexperience of a newly appointed consultant.
3. The diagnosis of viral tonsillitis was reasonable on the hospital examinations, but it did not explain the earlier findings of serious illness. The absence of neck stiffness or rash did not exclude meningitis in a young child. The clinicians could not safely disregard the general practitioner’s positive findings, particularly because the intramuscular antibiotics might have masked the symptoms.
4. Dr Rowley’s care as a paediatric SHO was not shown to fall below the required standard. However, the hospital failed to implement the plan for adequate observation and fluid monitoring. That breach did not cause the injury.
5. Dr Roe, assessed as a consultant, should have treated the continuing possibility of serious bacterial infection as real. Further investigation, including lumbar puncture, was required, and intravenous antibiotics should have been given by 27 January at the latest. Any professional opinion supporting exclusion of serious bacterial infection on the facts was incapable of withstanding logical analysis.
6. The subsequent NICE and sepsis guidance was not treated as retrospectively binding, but it supported the conclusion that the presentation fell within a high-risk category requiring consideration of lumbar puncture and parenteral antibiotics.