KembaraXtra-Case Law-Bolitho v City and Hackney HA (1997)

Bolitho v City and Hackney HA (1997): Study Guide
I. Core Principle:

When a doctor's negligence involves an omission (failure to act), the Bolam test can be used to determine if that omission caused the patient's harm. Bolam is relevant when deciding if the course of action the doctor would have taken (had they not been negligent) would have been considered reasonable medical practice.

II. Facts of the Case:

Patient: A young boy admitted to the hospital with a respiratory infection (croup).
Negligent Omission: Doctors failed to attend to the boy when requested, despite his deteriorating condition. This was admitted as a breach of duty.
Harm: The boy suffered a cardiac arrest, resulting in severe brain damage.
Plaintiff's Argument: Intubation would have prevented the cardiac arrest.
Defendant's Argument: Even if the doctor had attended, they would not have intubated, and that decision not to intubate would have been reasonable.

III. Key Issue: Causation

The central question was whether the doctor's failure to attend caused the boy's brain damage. This hinged on what the doctor would have done had they attended, and whether that action (or inaction) would have been negligent.

IV. The House of Lords' Decision:

The appeal was dismissed because causation was not proven. The House of Lords addressed the issue of causation in a two-step approach:
1. Factual Question: What would the doctor have done if they had attended the patient?
2. Negligence Question (Applying Bolam): If the doctor would not have intubated, would that decision have been negligent (i.e., would a responsible body of medical opinion have supported that decision)?

V. Application of the Bolam Test:

The Bolam test doesn't apply to the first question (what the doctor would have done). This is a question of fact.
The Bolam test is central to the second question (whether the hypothetical decision not to intubate would have been negligent). The court assesses whether a reasonable body of medical opinion would have supported the doctor's hypothetical decision.

VI. Importance of Bolitho:

Clarifies how Bolam applies in omission cases.
Emphasizes that even if a doctor breaches their duty of care, the breach must cause the harm for liability to arise.
Highlights the two-stage process for determining causation in omission cases.

VII. Key Takeaways:

In omission cases, first determine what the doctor would have done. Then, use the Bolam test to assess whether that hypothetical action (or inaction) would have been negligent. Causation must be established to prove negligence, even if a breach of duty is admitted.

LAW