XM (By His Father and Litigation Friend FM) v Leicestershire Partnership NHS Trust

In clinical negligence claims, a healthcare professional must apply the guidance governing the task with appropriate skill and judgment. Where head-circumference measurements are taken only four weeks apart, the professional cannot safely apply a two-centile red-flag threshold derived from measurements six weeks apart. A further measurement or medical referral may be required.

The standard for interpreting measurements is the same for any healthcare professional undertaking that task, although the standard expected from a nursery nurse differs where the task falls outside that worker’s training and delegated role. A health visitor may also owe a duty to identify a missed medical examination and recommend that it be completed late where the examination remains important.

The claimant suffered catastrophic brain injury after untreated hydrocephalus caused by a choroid plexus papilloma. He alleged that health visitors and nursery nurses negligently failed to recognise abnormal head growth, arrange further measurement or referral, ensure completion of the six-to-eight-week general-practitioner examination, and recognise disproportion between his head and body.

The claim was tried on liability. The trial was adjourned after the initial evidence and resumed after amendments concerning the claimant’s visual appearance and head size. The central questions concerned the applicable standards of care, the interpretation of the growth-chart guidance, and whether the alleged omissions caused the injury.

1. Claim succeeded. The defendant was liable for breaches by Mrs Furmage and Mrs Kirkpatrick. Causation was not in issue once breach was established.
2. Under Bolam v Friern Hospital Management Committee [1957] 1WLR 582, refined by Bolitho v City and Hackney Health Authority [1998] AC 232, the court must assess whether the supporting professional opinion is logical and capable of withstanding analysis. The court is not required to accept an opinion merely because it is held by responsible experts. Applying that approach, Ms Gooch’s evidence concerning head-growth monitoring was illogical and was rejected.
3. The Healthy Child Programme, WHO guidance, Hall & Elliman and the defendant’s SOP required head circumference to be measured around birth and again at six-to-eight weeks, with further action where growth was abnormal. The relevant red flag was crossing two centile spaces over the appropriate six-week baseline period. Because the claimant’s available measurements were only four weeks apart and showed a steep upward trajectory, Mrs Furmage should have arranged a further measurement so that the proper interval could be assessed, or referred the claimant to a GP.
4. The standard for measuring and initially interpreting head-growth data was the same for the healthcare professional assigned to that task, whether GP or health visitor. The standard expected from a nursery nurse was different because nursery nurses were not trained to measure or interpret head circumference and were performing delegated weight-related tasks.
5. At the four-month contact, Mrs Kirkpatrick should have noticed the incomplete GP-check records, asked the parents whether the examination had occurred, and recommended a late appointment while explaining its importance. The examination remained relevant to detecting cardiac, hip and testicular abnormalities.
6. Mrs Kirkpatrick also breached duty by failing to recognise the substantial disproportion between the claimant’s head and body and arrange remeasurement or medical review. The nursery nurses were not in breach on the visual-appreciation allegation. The GP attendances in December did not establish breach because they were for unrelated complaints and did not involve an appropriate unclothed growth assessment.

The judgment was a first-instance liability decision following a trial which was adjourned part heard and later resumed. No prior appellate decision is stated.