Bolam vs Friern Hospital Management Committee
Reference : [1957] 1 WLR 583
Jurisdiction : England
Plaintiff : John Hector Bolam
Defendant : Friern Hospital Management Committee
Facts :
The plaintiff, who was suffering from depression, was a voluntary patient at the Friern Hospital. He was under the care of Dr. Allfrey, who had suggested the plaintiff a method of treatment called Electro-Convulsive Therapy (ECT). During this therapy, a mild electric current would be used which might cause the patient to experience muscular contractions and spasms. The plaintiff underwent ECT on August 19, 1954, and then on August 23. According to his normal practice, Dr. Allfrey had not used any relaxant drug or manual restraint on the plaintiff during the ECT. Such an unmodified and unrestrained method of ECT was also practiced by his chief, Dr. Bastarrechea. During the ECT on August 23, the plaintiff suffered from a bilateral “stove-in” fracture of the acetabula.
The plaintiff sued the hospital claiming damages for negligence during the treatment. The plaintiff pointed out three instances of negligence –
- Not informing the plaintiff beforehand about the risks of fracture.
- Not using relaxant drugs before the therapy.
- Not providing any manual restraint on the plaintiff during the therapy after deciding not to use relaxant drugs.
The suit was brought before the Queen’s Bench Division to be tried by a jury under the supervision of McNair J. Dr. Randall, a psychiatrist, presented the evidence on behalf of the plaintiff while Dr. Bastarrechea presented the evidence on behalf of the defendant. Several other expert medical practitioners were also present to give their respective opinions.
Issues :
- Did the procedure of treatment followed by the defendant fall below the reasonable standard of concurrent medical practitioners?
- Did the defendant fall below the reasonable standard of concurrent medical practitioners by failing to mention the risks of fracture to the plaintiff before the treatment?
Decision :
Dr. Randall, on behalf of the plaintiff, supported the practice of using relaxant drugs before ECT. However, he also admitted that there is another group of experts who do not use relaxant drugs. Similarly, he supported the practice of using some sort of manual restraint if a relaxant is not used. He also criticized the lack of manual control as “foolhardy”. On the question of warning, he supported the idea of warning the patient of all relevant risks before the treatment.
Dr. Bastarrechea, on behalf of the defendant, argued that it was not desirable to scare away the patient by warning him about a 1 in 10,000 risk of fracture unless asked. He also argued that the use of a relaxant drug with anesthetic came with a higher possibility of risks, including mortality in comparison to the minor possibility of fracture in case of not using it and, the defendant had merely taken the safer option. On the question of manual restraint, he mentioned that the hospital stopped using manual control at the end of 1951 as there was an expert opinion that suggested that putting more restraints increased the risk of fracture.
From the respective expert opinions of the doctors present during the trial, the jury decided on behalf of the defendant, as it was clear that there were multiple valid practices followed by various medical practitioners in similar cases, and, the defendant could not be reasonably held liable for negligence just because he had followed one procedure instead of the other.
The Bolam Test :
The Bolam Test for identifying negligence of experts in a certain profession was developed from this suit. According to this test –
- A professional with specialized skills in a certain field would be judged according to the standard of other reasonable expert professionals in that field.
- There may be multiple standards, but if the defendant conforms to any one of them, then he would not be negligent.
- Mere personal belief with no grounds is not a valid defense.
Author :
1. S.M. Monzur Morshed
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