Alison Marie Tarrant v Simon Monkhouse

In a clinical negligence claim, the court must assess the defendant’s treatment against the standard of the ordinary competent practitioner in the relevant speciality. A responsible body of professional opinion may support the treatment, but the court must decide the issue for itself. The opinion must have a logical and defensible basis, particularly where it weighs competing risks and benefits. A court should not find negligence merely because it prefers one logically supportable professional view over another. The claimant must prove breach and causation on the balance of probabilities.

The claimant brought a liability-only negligence claim arising from complications after sleeve gastrectomy surgery. The pleaded issues were whether the defendant had failed to provide reasonable post-operative care, whether he was negligent in performing balloon dilatation after investigating the claimant’s symptoms, and whether any breach caused injury.

The court found that the contemporaneous records reliably recorded the relevant post-operative contacts. It dismissed the post-operative-care allegations up to the gastroscopy and considered the remaining issues concerning the period after the gastroscopy and the decision to undertake balloon dilatation.

1. Applicable legal principles. The court applied the Bolam standard: a doctor is not negligent if acting in accordance with a practice accepted as proper by a responsible body of medical practitioners skilled in the relevant speciality. Following Maynard, the court should not establish negligence merely by preferring one respectable body of professional opinion over another.
2. Logical basis of expert opinion. Under Bolitho, the court must assess whether the supporting professional opinion is reasonable and logically defensible. It must consider whether the experts addressed the relevant risks and benefits and must decide the issue itself. The principles adopted from C v North Cumbria University Hospitals NHS Trust required attention to good faith, competence, responsibility, respectability, consistency with the evidence, and logical analysis.
3. Evidence and breach. The court accepted the records of the bariatric multidisciplinary team as complete and reliable. The team’s arrangement, with the bariatric nurse as the primary contact and access to the other specialists and surgeon, provided a reasonable equivalent to the guidance relied upon. The evidence did not show that dietetic or psychological input was indicated immediately after the gastroscopy.
4. The court preferred the defendant’s expert evidence. The claimant’s expert evidence was undermined by inconsistent terminology and an insufficiently coherent basis for requiring confirmed stricture before dilatation. The defendant’s expert gave a coherent explanation, supported by the medical literature, for treating the symptoms and findings as indicating narrowing at the gastro-oesophageal junction.
5. There was no breach in failing to involve other members of the multidisciplinary team after the gastroscopy and before dilatation. Even if that allegation had been established, causation was not proved on the balance of probabilities. The claimant also failed to prove that performing the balloon dilatation was negligent in the circumstances. The claim was dismissed.

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