Bolitho vs City and Hackney Health Authority
Citation : [1997] 4All ER771
Jurisdiction : United Kingdom
Appellant : Patrick Bolitho (by his mother)
Respondent : City and Hackney Health Authority
Facts :
Patrick Bolitho, a two-year-old child, suffered two severe respiratory episodes while hospitalized. Nurses urgently informed Dr. Horn, the responsible pediatric registrar, but she failed to attend on both occasions. Although Patrick temporarily recovered after each episode, he later suffered a final respiratory obstruction at around 2:30 p.m., leading to cardiac arrest and severe brain damage and eventually resulting in death. His mother sued the Health Authority, claiming that the doctor was negligent for not attending and for failing to intubate him.
Issues :
1. Whether Dr. Horn would have intubated him if she had attended to Patrick before he collapsed.
2. Whether the non-intubation would have constituted breach of duty according to the Bolam Test.
3. Whether courts may reject a medical opinion if it is not held to be logical, reasonable, or responsible by experts.
4. Whether the Bolam test applies to issues of causation or is limited only to assessing the breach of duty in professional negligence.
Arguments :
Appellant’s Arguments:
The appellant claimed that any competent doctor faced with Patrick’s recurrent respiratory crises would have intubated him as had been testified by most of the medical experts. They argued that the only effective means of avoiding the fatal obstruction was through intubation. The appellant further argued that the opinions of the defense experts were not logically supported considering the symptoms he had and the obvious risk of a relapse.
Respondent’s Arguments:
The respondent accepted that Dr. Horn was negligent in failing to attend but argued that causation was not established because she would not have intubated even if she had attended. Their experts, especially Dr. Dinwiddie stated that Patrick’s rapid recovery after each episode indicated no progressive deterioration and that intubation being invasive and risky was not clinically justified. Since a responsible, reasonable, and logically defensible body of medical opinion supported non-intubation, they argued that Dr. Horn’s hypothetical decision would not have been negligent.
Decisions :
The House of Lords held that although courts may reject medical opinions that lack logical foundation, the defense view against intubation was rational and responsible. They confirmed that the Bolam test does not apply in cases deciding what the doctor would have done (causation), but only to whether that hypothetical action would have been negligent. Since Dr. Horn would not have intubated Patrick, and since non-intubation fell within an acceptable standard of medical practice, causation was not established. The House of Lords refined the Bolam test by introducing a new proviso: that any practice accepted as proper by a responsible body of professional opinion must be based on logical and defensible grounds. The appeal was therefore dismissed.
Relevant Legal Principle :
Bolam Test: The Bolam Test for identifying negligence of experts in a certain profession was developed from this suit. According to this test –
1. A professional with specialized skills in a certain field would be judged according to the standard of other reasonable expert professionals in that field.
2. There may be multiple standards, but if the defendant conforms to any one of them, then he would not be negligent.
3. Mere personal belief with no grounds is not a valid defense.
Bolam Test for identifying negligence of experts in a certain profession was developed from the suit of Bolam v Friern Hospital Management Committee (1957).
Author :
1. Md. Ferdaus Hasan Purno
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