Christopher Isaac Singh (A minor, suing by his mother and next friend, Nicole Singh Nee Mohammed) v Dr Prakashbhan Persad (Trinidad and Tobago)

A medical consultant directing an operative delivery has a personal duty to ensure that he and the team obtain the fetal information needed for timely decisions. That duty exists even where hospital staff carry out monitoring and the consultant is not vicariously liable for their failings. If monitoring would reveal fetal distress, failure to obtain that information may make the consultant responsible for resulting delay and injury, including delay caused by missing hospital support staff. Where proper monitoring shows no distress or other urgency, it may be reasonable to take extra time for the safer form of anaesthesia. An appellate court may interfere with a trial judge’s conclusions where the inferences drawn from accepted facts are unreasonable in light of the whole evidence.

Christopher Singh claimed damages for severe brain injuries suffered during his birth by emergency caesarean section. The Hospital was found liable for systemic delays, but that finding was not appealed to the Board. The trial judge dismissed the claim against Dr Persad, the privately engaged consultant obstetrician. The Court of Appeal of Trinidad and Tobago allowed Christopher’s appeal, holding that Dr Persad was responsible for ensuring fetal heart rate monitoring in the operating theatre and for responding urgently to the resulting evidence of distress. Dr Persad appealed to the Privy Council, challenging appellate interference with factual conclusions, the pleading and fairness of the monitoring allegation, causation, and the alleged delay in delivery.

1. Disposition. Dr Persad’s appeal was dismissed. The Court of Appeal was entitled to overturn the dismissal of the claim because the trial judge’s conclusions on Dr Persad’s responsibility were inconsistent with the evidence and her own findings.
2. Appellate review. The relevant principles were stated in Beacon Insurance Co Ltd v Maharaj Bookstore Ltd [2014] UKPC 21; Bahamasair Holdings Ltd v Messier Dowty Inc [2018] UKPC 25. The Court of Appeal had addressed inferences drawn from accepted facts rather than impermissibly substituting findings of fact. Intervention was justified because the conclusions were unreasonable in light of the whole evidence and the legal duty owed.
3. Consultant’s responsibility. The agreed standard was the Bolam standard, described in Bolam v Friern Hospital Management Committee [1957] 1 WLR 582. Once operative delivery was contemplated, Dr Persad had an overarching supervisory duty to ensure that he and his team remained informed of the fetal heart rate. That was his own duty, distinct from vicarious liability for the Hospital or its midwives.
4. There had been no fetal heart rate monitoring during the approximately 50 minutes in the operating theatre. Monitoring by stethoscope was possible and necessary, and the guidance required monitoring every five minutes during the relevant stage of labour. The only rational conclusion was that Dr Persad’s conduct fell below an acceptable standard.
5. The allegation was fairly available for decision. The pleadings, defence, written evidence and cross-examination made clear that the issue was whether Dr Persad had ensured that he and the team received sufficient information to identify fetal distress. He had ample opportunity to answer it.
6. The failure was causative. Had distress been identified, Dr Persad would have escalated the procedure, and the team could have proceeded without the theatre assistant and used general anaesthesia. That would have reduced the period of hypoxia. The Hospital remained responsible for providing supportive services.
7. The Board rejected separate aspects of the Court of Appeal’s reasoning. There was no basis for liability founded on an alleged need to notify the Hospital of a possible caesarean section at 7 am, and Dr Persad’s absence from the theatre during anaesthetic administration did not itself establish negligence. Conversely, where proper monitoring showed no distress or other urgency, taking extra time to use spinal rather than general anaesthesia was reasonable.

• Privy Council: Dr Persad’s appeal was dismissed.
• Court of Appeal of Trinidad and Tobago: Christopher’s appeal against the dismissal of his claim against Dr Persad was allowed. The Hospital’s appeal against the finding of liability was dismissed.
• Trial court: The claim against Dr Persad was dismissed, while the Hospital was found negligent.