KJY v University College Hospital NHS Foundation Trust

In a pure diagnostic negligence case, the court must determine for itself whether the image disclosed an abnormality which no reasonable and responsible practitioner would have failed to identify. The Bolam standard applies, subject to the logical scrutiny required by Bolitho, but the court must not delegate the ultimate issue to experts.

A radiologist must examine the whole image with equal professional diligence and report an identified abnormality or possible abnormality, including an incidental finding unrelated to the referral question. A definitive diagnosis is unnecessary where the image gives rise to a sufficient indication of possible abnormality. The court found breach of duty where neonatal hip abnormalities were sufficiently clear that all reasonable and responsible radiologists would have identified or reported them.

The claimant, a child represented by his mother and litigation friend, brought a clinical negligence claim against the defendant NHS foundation trust concerning three neonatal abdominal x-rays taken shortly after his birth. The images were obtained for choking and feeding problems, not suspected hip dysplasia. The claimant was later diagnosed with bilateral developmental dysplasia of the hips.

The parties agreed that the images showed abnormal hip alignment. The dispute was confined to breach of duty: whether the reporting radiologists should have identified and reported the abnormalities, including whether the referral question limited the scope of their review and whether the abnormalities were sufficiently clear to require reporting.

1. Outcome. The claimant proved on the balance of probabilities that both reporting radiologists breached their duty of care. The issue of causation and other consequential matters remained unresolved.
2. Scope of radiological review. The governing professional standards required the whole image to be reviewed with equal professional diligence. Radiologists had to identify and report clear abnormalities and possible abnormalities, including incidental findings unrelated to the clinical question. The defendant’s suggestion that the hips fell outside the scope of review was abandoned and was inconsistent with the applicable standard.
3. Applicable legal standard. The court applied the Bolam test, qualified by the logical and defensible-basis requirement in Bolitho. The reasoning in Penney, as considered in Muller, was relevant to pure diagnosis cases. The court had to determine the factual appearance of the images and whether the abnormalities were sufficiently clear that no reasonable and responsible radiologist would have failed to identify or report them.
4. Expert evidence. Expert evidence assisted the court but did not determine the issue. The court preferred Dr Landes’s evidence and rejected Dr Raghavan’s evidence where it was inconsistent with the professional standards, overstated the difficulty of identifying possible abnormalities, and adopted an implausibly high threshold for reporting.
5. Application. The court found clear indications of possible hip abnormality in the images, excluding the left hip on the 15.33 image because of Dr Landes’s concession. The radiologists were not required to make definitive measurements or diagnose developmental dysplasia. They were required to recognise and report a possible abnormality. No reasonable and responsible radiologist would have failed to do so.
6. Bias and evidence evaluation. The court considered hindsight and outcome bias but found no evidential basis for concluding that they materially impaired Dr Landes’s opinion. It applied the ordinary principles that findings must be evidence-based, evaluated holistically, and determined decisively on the balance of probabilities.
7. Further conduct of proceedings. The court encouraged cooperation and alternative dispute resolution in relation to outstanding issues, referring to the active case-management duties under the Civil Procedure Rules 1998.

First-instance decision. No prior appellate decision is stated in the judgment.