Key Facts
- •Mr. Shally underwent surgery for a large calcified prolapsed thoracic disc at T10/11.
- •The surgery resulted in incomplete paraplegia.
- •The Claimant alleged negligence in abandoning the costotransversectomy, adopting the surgical approach, and in the retraction/manipulation of the spinal cord.
- •The Defendant denied negligence.
- •A costotransversectomy was initially planned, but an intraoperative decision was made to proceed with a transdural approach due to the disc's adherence to the dura.
- •Neurophysiological monitoring (MEPs and SSEPs) was used during surgery.
- •A second operation was performed to remove remaining disc material, but there was no significant improvement.
Legal Principles
A clinician is not negligent if they acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that art.
Bolam v Friern Hospital Management Committee [1957] 1 WLR 583
A court may prefer one body of opinion to another, but that is no basis for a conclusion of negligence. Differences of opinion and practice exist and will always exist in the medical profession.
Maynard v West Midlands RHA [1984] 1 WLR 634
If a professional departs from accepted methods of treatment, they must justify it if injury results. The burden of proof may shift to the defendant.
Clark v MacLennan [1983] 1 All ER 416
A court can reject professional opinion if it cannot be logically supported. The court, not medical opinion, determines the standard of care.
Bolitho v City and Hackney HA [1997] UKHL 46
Factors to consider when assessing expert opinion: good faith, responsibility/competence/respectability, and logic/reasonableness.
C v North Cumbria University Hospitals Trust [2014] Med. L.R. 189
Outcomes
Claimant's claim fails.
The defendant's actions were found to be in accordance with a responsible body of medical opinion. The intraoperative change of approach and spinal cord manipulation were deemed not negligent.