Anna Callaghan v South Tees Hospitals NHS Foundation Trust

In a clinical negligence claim, a court must apply the Bolam/Bolitho standard. It must decide whether the defendant acted in accordance with a responsible body of professional opinion and whether that opinion withstands logical analysis. Clinical guidelines inform, but do not automatically determine, the required standard of care. Where a newborn has a possible feeding difficulty but no red flags or other risk factors, the decision whether to monitor vital signs, impose a feeding plan or delay discharge remains a matter of responsible clinical judgment. Written discharge information supplements, but does not replace, oral advice. A claimant must prove both breach and causation on the balance of probabilities.

The claimant sued as administratrix of her deceased daughter’s estate and in her own capacity, alleging negligent midwifery care following the child’s birth and discharge from hospital. The child later developed fatal Group B Streptococcus meningitis and septicaemia.

The alleged breaches concerned overnight observations, feeding records and plans, the decision to discharge, and advice about feeding and signs of illness. The central questions were whether the defendant’s midwifery management and discharge decision fell below the applicable professional standard and, if so, whether earlier monitoring or advice would probably have prevented the death.

1. Applicable standard. The court applied the Bolam/Bolitho test, as summarised in Birch v University College London Hospital NHS Foundation Trust [2008] EWHC 2237 (QB). A professional practice is not negligent merely because another responsible body would have acted differently. The court may reject professional opinion only where it cannot withstand logical analysis.
2. Overnight management. The claimant failed to establish that the child had taken no milk between 19:00 and 09:45. The records and surrounding evidence supported the conclusion that some feeding had occurred. Nothing known at midnight required a further midwifery check, full observations or a formal feeding plan. The interaction with an unidentified midwife at about 03:00 should have been documented, but no breach arising from it had been pleaded.
3. Morning assessment and discharge. The midwife acted in accordance with a responsible body of midwifery opinion by discussing the overnight difficulty, feeding the child herself, assessing her condition and arranging a further feed by 13:00. The NICE neonatal infection guidance did not mandate monitoring because the midwife was entitled to conclude that the apparent feeding issue had resolved and did not amount to a clinical indicator requiring monitoring. Discharge was reasonably open to her.
4. Discharge advice. The claimant was advised to feed the child on demand and regularly, and about general wellbeing and seeking help if concerned. Written advice was an additional source of information, not a substitute for oral advice. However, the claimant should expressly have been told that demand feeding should occur approximately every three to four hours. That was a breach of duty, but it had no causative potency.
5. Causation and outcome. The evidence did not establish when the child first exhibited sepsis symptoms or that she would probably have returned to hospital by the time required for life-saving antibiotics. The claimant therefore failed to prove causation. The claim was dismissed.