Karen Spellman v Portsmouth Hospitals University NHS Trust

In a clinical-negligence claim concerning MRI reporting, the court must first determine as a matter of fact what the images show. It must then assess whether the radiologist’s interpretation and communication of those findings fell below the required standard of care. The Bolam test, subject to the Bolitho qualification, applies to the professional judgment involved in reporting imaging. Descriptive terms such as mild or moderate stenosis are necessarily subjective where no fixed or standardised grading system exists. The absence of a surgically remediable cause of cauda equina compression, and a report that was reasonably open to a competent radiologist, preclude liability.

The claimant alleged that the defendant NHS Trust negligently reported an MRI scan taken on 6 June 2017. She contended that the scan showed cauda equina compression requiring urgent decompression surgery and that the radiologist wrongly described the findings as mild central canal stenosis.

The defendant denied breach and causation. The court determined whether the scan demonstrated acute cauda equina compression, whether the report was reasonably prepared, and whether any reporting error would have affected treatment and outcome. Damages had been agreed at £300,000, subject to proof of breach and causation.

1. Disposition. The claim was dismissed. The claimant failed to establish any breach of duty by the reporting radiologist.
2. The court adopted the distinction between the factual interpretation of image content and the subsequent legal assessment of whether the report was reasonable. The first question required the judge to determine what the MRI showed, assisted by expert evidence. The second required assessment against the standard applicable to a reasonably competent radiologist.
3. The scan was of sufficient diagnostic quality for a consultant radiologist to provide a definitive report. Movement artefact did not require repeat imaging, particularly since further scanning might not have produced better images and the claimant was in pain.
4. The court found that the scan showed moderate stenosis at L2-3 and L3-4, epidural lipomatosis, and possible contribution from a facet-joint cyst, but that cerebrospinal fluid remained present and the nerve roots were not sufficiently constricted or clumped to establish cauda equina compression. The court preferred Dr Rankine’s radiological interpretation.
5. The terms mild stenosis and slightly tight were within the range reasonably open to a competent radiologist. There was no fixed, standardised or reliably quantifiable system requiring different terminology. The report also referred to reduced cerebrospinal fluid and the contribution of epidural fat.
6. Because the scan did not demonstrate acute cauda equina compression, the failure to report such compression was accurate rather than negligent. In any event, the report was reasonably prepared applying the Bolam/Bolitho principles. Causation therefore did not arise for determination.