Sanderson v Guy's And Thomas' NHS Foundation

In a clinical negligence claim, compliance with a professional guideline does not determine the appropriate treatment automatically. Guidelines must be read as a whole and applied with clinical judgment. A pathological fetal heart trace may properly lead to fetal blood sampling rather than immediate delivery where the trace, considered overall, does not indicate acute hypoxia and the proposed emergency procedure carries a serious risk of failure without access to Caesarean section. The Bolam test requires assessment of whether the treatment was supported by a responsible body of professional opinion. The court must decide the issue itself and must not simply defer to an expert. In an exceptionally busy clinical setting, it may also be reasonable for the responsible consultant to obtain equipment and make urgent inquiries personally rather than delegate those tasks.

The claimant, who suffered cerebral palsy following hypoxia shortly before birth, brought a clinical negligence claim against the defendant NHS foundation. The trial concerned whether the consultant obstetrician breached her duty by obtaining a fetal blood sample rather than immediately attempting instrumental delivery, and whether she caused culpable delay by leaving the room to obtain equipment, inform colleagues and investigate alternative facilities.

The court also considered whether the consultant’s assessment of the fetal trace, the fixed malpositioned head and the practical conditions on the labour ward justified her decisions. Issues of causation, material contribution, prognosis and quantum were left for determination if necessary.

1. Claim dismissed. The claimant failed to establish breach of duty on either pleaded basis.
2. The court applied the Bolam test. The relevant question was whether the decisions were supported by a responsible body of competent obstetric opinion. The court also applied Bolitho: it had to assess the evidence itself and consider whether the expert opinion relied upon was reasonable and logically defensible.
3. The NICE guidance did not provide an automatic rule requiring urgent delivery whenever a prolonged deceleration occurred. Its provisions appeared to point in different directions, including fetal blood sampling where appropriate or feasible and expedited delivery where sampling was inappropriate or impossible. The guidance therefore had to be interpreted in context and used with clinical judgment.
4. The trace was pathological but, viewed as a whole, showed a stressed fetus suffering chronic rather than acute hypoxia. Recovery between contractions and during vaginal examination were relevant positive features. Fetal blood sampling was therefore a reasonable response.
5. The consultant reasonably believed that immediate instrumental delivery in the small first-stage room might fail because the fetal head was fixed, malpositioned and only partly descended. Without a facility for Caesarean section, failure could have caused catastrophic harm. Her caution was therefore reasonable.
6. It was also reasonable for her to obtain the necessary equipment and make inquiries personally. The exceptional staffing conditions, the layout of the unit and her knowledge of the staff meant that delegation was not required. The evidence did not establish that either absence from the room was culpably long or that the final preparations caused unreasonable delay.
7. The court made alternative hypothetical timing findings, but those findings did not alter the conclusion that the claim was dismissed.