Edward Graham (a child, by his Litigation Friend, Rebecca Graham) v Dr Simone Altaf

In a clinical negligence claim, the applicable standard is the ordinary standard of the competent practitioner exercising the relevant skill. A practice supported by a responsible body of professional opinion must also have a logical basis, including proper consideration of comparative risks and benefits where relevant. The court must assess the evidence as a whole, including contemporaneous records, witness recollection and expert evidence. On the facts, it was reasonable for a general practitioner to diagnose tonsillitis, prescribe antibiotics, provide safety-netting advice and refrain from immediate referral where the child was reported to be slightly better and no new pathology was apparent. The claim failed because no breach of duty with causative effect was established.

The claimant sought damages for neuropsychological sequelae allegedly caused by negligent general-practice treatment on 14–16 June 2010. He alleged that the defendant should have arranged an urgent assessment on 15 June because his condition had deteriorated, he was not retaining antibiotics and an earlier capillary refill finding was concerning. The trial concerned breach of duty and causation as preliminary issues.

The court determined whether the defendant’s management was negligent in light of the information available to her at each consultation and, if so, whether any breach caused avoidable injury.

1. Applicable standard. The court applied the ordinary competent practitioner standard in Bolam v Friern Hospital Management Committee [1957] 1 WLR 582, subject to the requirement in Bolitho v City and Hackney Health Authority 1997 UKHL 46 that the relied-on professional practice must be logically defensible.
2. Assessment of evidence. In resolving disputed recollections, the court considered the approach discussed in Gestmin SGPS S.A. v Credit Suisse (UK) Limited, Credit Suisse Securities (Europe) Limited [2013] EWHC 3560 (Comm). The contemporaneous notes, referral letter and surrounding probabilities supported the finding that the claimant was reported on 15 June to be slightly better and no worse. The court preferred Dr Shutkever’s and Dr Thomson’s evidence where it differed from that of Dr Boyd and Dr Conway.
3. Breach. On 14 June, the defendant reasonably diagnosed tonsillitis and prescribed antibiotics. The capillary refill entry recording “>3” was a typographical error; the refill time was less than three seconds. On 15 June, the information that the claimant was improving, despite difficulty taking antibiotics, did not require referral or reassessment. The defendant’s further safety-netting was consistent with a responsible body of general practitioners. On 16 June, direct hospital referral without first arranging a face-to-face consultation, and without emergency ambulance transfer, was not negligent in the circumstances.
4. Disposition. No causative breach of duty was established. The claim was dismissed.