Key Facts
- •Mrs. Susan Alexander died at Southampton General Hospital on August 4th, 2018, after suffering a cerebral venous sinus thrombosis (CVST).
- •Her condition was initially misdiagnosed as an arterial ischaemic stroke (AIS).
- •She received alteplase (thrombolysis) instead of heparin, the appropriate treatment for CVST.
- •The claimant, Mr. Stuart Runciman, alleges that the misdiagnosis and treatment caused Mrs. Alexander's death.
- •The defendant, University Hospital Southampton NHS Trust, denies breach of duty, arguing the initial diagnosis was reasonable and that alternative treatment would not have changed the outcome.
Legal Principles
Bolam test for medical negligence: A doctor is not negligent if they acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art, even if a different body of opinion exists.
Bolam v. Friern Hospital Management Committee [1957] 1 WLR 583
Maynard v West Midlands RHA clarification of Bolam: Differences of opinion and practice exist in medical professions; a court may prefer one opinion, but that's not grounds for negligence.
Maynard v West Midlands RHA [1984] 1 WLR 634
Bolitho test: The court must consider whether the body of opinion relied upon is responsible, reasonable, and respectable and has a logical basis.
Bolitho v. City and Hackney HA [1988] AC 232
Bailey test for causation in cumulative cause cases: If the injury would have occurred due to non-tortious causes, the claimant fails; if the injury wouldn't have occurred 'but for' the tortious cause, the claimant succeeds; if medical science cannot establish 'but for' causation but establishes a more than negligible contribution, the 'but for' test is modified.
Bailey v Ministry of Defence [2009] 1 WLR 1052
Material increase in risk is insufficient to establish causation in clinical negligence; causation may be established if the breach more than doubled the risk of injury.
Gregg v Scott [2005] 2 AC 176; Sienkiewicz v Grief (UK) Ltd [2011] UKSC 10
Outcomes
Claim dismissed.
The court found no breach of duty by the treating clinicians. Their actions were deemed reasonable given the urgency of the situation and the rarity of CVST. Even if there had been a breach, it did not cause or contribute to Mrs. Alexander's death; her death was attributed to infarction secondary to CVST, which would have occurred regardless of the treatment provided.