Court Affirms Standard of Care in Beatty v Lewisham NHS Trust: Bolam Test Applied

Citation: [2023] EWHC 3163 (KB)
Judgment on


The case of Jacqueline Beatty v Lewisham and Greenwich NHS Trust provides an informative insight into the application of the Bolam test and the standard of care in clinical negligence cases within the UK’s legal framework. The judgment delivered by Mr Justice Jay, details the assessment and reasoning behind determining the standard of care in a specific medical scenario, examining the actions of medical professionals and the expert evidence presented to the court.

Key Facts

The claimant, Ms. Jacqueline Beatty, an in-patient at the Queen Elizabeth Hospital, suffered a loss of her right leg due to what she claimed was a failure to diagnose an embolism. The defense centered on a consultation on 13th April 2016, by a vascular surgeon, Mr. Niall Aston, who instead diagnosed a vasculitis condition rather than an embolism. By the time the embolism was diagnosed, amputation was considered the only viable treatment. The question for the High Court was whether a CT angiogram, which was not conducted, was mandatory to diagnose the embolism and whether failure to perform this test constituted negligence.

The court applied the “Bolam test,” a principle that stems from Bolam v. Friern Hospital Management Committee [1957] 1 WLR 582, which essentially sets out that a healthcare professional is not negligent if they acted in accordance with a practice accepted at the time as proper by a responsible body of medical opinion, even though others may disagree.

Another key legal principle referenced is the Bolitho addendum, derived from Bolitho v City and Hackney Health Authority [1998] AC 232, stipulating that the court is not bound to find for a defendant if the consensus among the relevant body of medical opinion is not capable of withstanding logical analysis.

In this case, the court also took into consideration the concept of a “diagnosis of exclusion” and the threshold for what constitutes a “realistic possibility” in diagnostic terms.


The analysis and conclusion of the court pivot on whether it was mandatory for Mr. Aston to order a CT angiogram on the claimant. The claim hinged on the assertion that the failure to perform this test was a breach of the duty of care owed to the claimant. The court found that Mr. Aston’s clinical judgment, which ruled out embolism in favor of a vasculitis diagnosis, was supported by a responsible body of medical opinion, as testified by Mr. Jonothan Earnshaw.

It was determined that in light of the claimant’s age, the unremarkable scan results, the absence of atrial fibrillation, and the diagnostic signs more consistent with vasculitis against the backdrop of a severe infection, it was not mandatory to perform a CT angiogram. Consequently, the claim of negligence was dismissed, as the judgment found that the claimant failed to establish that the decision not to conduct a CT angiogram fell below the accepted standard of care.


The case reaffirms the principles laid out in the Bolam test while also underlining the necessity for expert witnesses to provide detailed reasoning for their opinions, per the expectations of the Civil Procedure Rules. It illustrates the complexities associated with diagnosing medical conditions and the legal challenges in attributing negligence within the UK’s clinical care landscape. The case emphasizes the essential balance between the autonomy and discretion of clinical judgment with the accountability and expectations of the standard of care in healthcare practice.