Jacqueline Beatty v Lewisham and Greenwich NHS Trust

Under the Bolam test, expert evidence supporting a clinical judgment does not automatically determine the claim. The court must assess whether the supporting medical opinion is responsible and logically defensible.

A doctor is not required definitively to exclude every possible diagnosis. Where a serious condition is a realistic possibility, however, the doctor must investigate it appropriately. In this case, CT angiography would have been mandatory only if digital embolisation was a realistic possibility after assessment. The judge accepted that the clinician reasonably regarded it as very unlikely, and dismissed the claim.

The claimant alleged that a vascular surgeon negligently failed to diagnose embolic disease during a hospital consultation on 13 April 2016. She contended that CT angiography of the aorta was mandatory and would have identified the source of the emboli in time to avoid amputation.

The defendant argued that the clinician reasonably diagnosed vasculitis, relying on the claimant’s presentation, earlier normal vascular imaging, absence of atrial fibrillation and serious infection. The central issue was whether CT angiography was mandatory on the information available at the conclusion of the consultation.

1. Claim dismissed. The issue was whether a reasonable vascular surgeon was required to order CT angiography of the aorta on 13 April 2016.
2. Applying the Bolam test, the court had to decide not only whether a responsible body of medical opinion supported the clinical judgment, but also whether the reasoning supporting that opinion was logically defensible. The judge relied on ARB v IVF Hammersmith Ltd [2018] EWCA Civ 2803; [2020] QB 93.
3. The doctor’s duty was to examine and assess the claimant, form a clinical opinion, and devise a plan. It was not a duty definitively to rule out every alternative diagnosis. Given the seriousness of digital embolisation, the proper question was whether it remained a realistic possibility at the end of the assessment.
4. If embolisation had been a realistic possibility, CT angiography would have been the next mandatory investigative step. The judge nevertheless accepted that the doctor’s conclusion that embolisation was very unlikely was reasonably open on the evidence. Relevant matters included the claimant’s age, unremarkable scans, absence of atrial fibrillation at the material time, the ischaemic presentation being compatible with vasculitis, serious infection, smoking and absence of relevant medical history.
5. The claimant’s expert failed adequately to explain why no reasonable body of vascular surgeons could support the diagnosis or why the investigation was mandatory. The adjective optimal did not establish mandatory. The defendant’s expert’s reasoning was accepted as compelling. The claim therefore failed under the governing legal framework.

Not stated in the judgment.