Jarman v Brighton and Sussex University Hospitals NHS Trust

In assessing clinical negligence, the Bolam test requires consideration of whether the defendant’s treatment was supported by a responsible body of medical opinion applicable at the relevant time. Under Bolitho, the court may reject such opinion where it cannot withstand logical analysis, but it must not choose between competing views that are each logically defensible.

For suspected cauda equina syndrome, an immediate MRI scan is appropriate once the condition is suspected. However, symptoms without objective clinical signs did not establish that an immediate scan was required in March 2015 where a responsible body of orthopaedic opinion supported a longer urgent timescale, safety-netting advice, or no immediate scan. Causation also requires proof of actual injury or measurable damage, not merely increased risk.

The claimant, a primary school teacher, developed permanent neurological impairment after delayed diagnosis and decompression surgery for cauda equina syndrome. She alleged that the defendant Trust negligently failed to recognise suspected cauda equina syndrome when she attended its A&E department on 3 March 2015, failed to arrange an urgent MRI scan, and thereby caused a worse outcome.

The court tried preliminary issues concerning breach of duty and causation. The central questions were whether the Trust’s decision to arrange an urgent but non-emergency MRI scan was negligent under the standards applicable in March 2015, and, if so, whether the delay caused additional injury.

1. Disposition. The preliminary issue was determined in favour of the Trust and the claim was dismissed.
2. Breach of duty. The applicable standard was that of a competent general orthopaedic specialist in March 2015. Applying Bolam v Friern Hospital Management Committee [1957] 1 WLR 582, the question was whether a responsible body of medical opinion supported the Trust’s approach. The court had to assess that evidence itself.
3. Under Bolitho v City and Hackney Health Authority [1997] UKHL 46; [1998] AC 232, professional opinion could be rejected if it was incapable of withstanding logical analysis. That did not permit the court simply to prefer one logically supportable medical view over another.
4. The claimant had several concerning symptoms, but thorough examination disclosed no objective signs of cauda equina syndrome. The court accepted that, in March 2015, a responsible body of orthopaedic opinion supported an urgent MRI scan on an approximately two-week timescale with safety-netting advice. The absence of contemporaneous guidelines or literature requiring immediate scanning, the then higher scanning threshold, and supporting evidence from a reputable clinical paper reinforced that conclusion. The Trust was therefore not negligent.
5. The court accepted the principle in Tahir v Haringey Health Authority [1998] Lloyd's Rep. Med. 104 that causation required proof of actual injury or measurable damage rather than merely an increased risk. In any event, the evidence did not establish material neurological deterioration during the relevant period from 10 to 19 March 2015, nor that any such deterioration caused quantifiable additional loss.

First-instance judgment. No appellate history was stated in the judgment.