Bolam v Friern Hospital Management Committee is a leading English tort law decision concerning the standard of care expected of medical professionals. The case established what later became known as the Bolam test, which sets out how courts should assess negligence where a defendant possesses special skill or professional expertise.
The decision in Bolam v Friern Hospital Management Committee has had a lasting influence on professional negligence law in the United Kingdom.
Facts of Bolam v Friern Hospital Management Committee Case
In Bolam v Friern Hospital Management Committee, the claimant, Mr Bolam, was a voluntary patient at Friern Hospital, a mental health institution managed by the defendant committee. He agreed to undergo electro-convulsive therapy (ECT) as part of his treatment.
During the procedure, Mr Bolam was not given muscle relaxant drugs. His body was also not physically restrained. While the treatment was being administered, he flailed about violently before the procedure was stopped. As a result, he suffered serious injuries, including fractures of the acetabula.
Mr Bolam brought a claim in negligence against the Friern Hospital Management Committee. He alleged that the hospital had been negligent in three respects:
- Failing to administer muscle relaxant drugs;
- Failing to restrain him during the procedure;
- Failing to warn him of the risks involved in the treatment.
At the time of Bolam v Friern Hospital Management Committee, juries were still used in tort cases in England and Wales. The judge would direct the jury on the relevant legal principles, and the jury would then determine whether the defendant was liable.
Legal Issue
The central issue in Bolam v Friern Hospital Management Committee concerned the standard of care required of a medical professional in negligence.
In negligence claims, a claimant must establish that the defendant owed a duty of care, breached that duty, and caused damage as a result. The key question in this case was how to determine whether a doctor had breached their duty of care.
Specifically, the court had to decide how the standard of care should be assessed where medical opinion was divided. A substantial body of professionals supported one approach to treatment, while others opposed it. The question was whether a doctor could be found negligent merely because some professionals would have adopted a different practice.
Bolam v Friern Hospital Management Committee Judgement
In Bolam v Friern Hospital Management Committee, McNair J directed the jury on the applicable standard of care. Expert witnesses gave evidence that much medical opinion at the time was opposed to the use of muscle relaxant drugs during electro-convulsive therapy.
It was also stated that manual restraint could sometimes increase the risk of fracture. In addition, it was common professional practice not to warn patients of small risks associated with treatment unless specifically asked.
McNair J explained that what was common practice within a particular profession was highly relevant in determining the standard of care required. A person is negligent if they fail to do what a reasonable person would do in the circumstances. However, where a person professes to have special professional skill, the standard of care is that of a reasonably competent professional in that field.
He stated:
A medical professional is not guilty of negligence if acting in accordance with a practice accepted as proper by a responsible body of medical professionals skilled in that particular art.
He further clarified that a doctor is not negligent simply because there exists another body of opinion which would take a contrary view. At the same time, he made it clear that a medical professional cannot continue with a practice that is plainly contrary to what is substantially the whole of informed medical opinion.
After receiving these directions, the jury returned a verdict in favour of the defendant hospital. They concluded that the hospital had not been negligent in the manner in which the treatment was carried out.
The Bolam Test
The principle laid down in Bolam v Friern Hospital Management Committee became known as the Bolam test. This test provides that a professional will not be in breach of their duty of care if they have acted in accordance with a practice accepted as proper by a responsible body of professionals skilled in that area.
The test recognises that professional practice is not always uniform. There may be different acceptable approaches within a field of expertise. The existence of a body of professional opinion supporting the defendant’s conduct is sufficient to defeat a claim of negligence, even if another body of professionals disagrees.
The reasoning in Bolam v Friern Hospital Management Committee therefore shifted the focus from what a lay reasonable person would do, to what a responsible body of professionals would consider appropriate.
Conclusion
Bolam v Friern Hospital Management Committee is a landmark case in English tort law that defined the standard of care for skilled professionals. The case established that a medical professional is not negligent if acting in accordance with a practice accepted as proper by a responsible body of professionals skilled in that field.
The jury’s verdict in favour of the hospital confirmed that the absence of muscle relaxants, restraint, and warnings in the circumstances of the case did not amount to negligence, given the state of medical opinion at the time.
The rule developed in Bolam v Friern Hospital Management Committee, known as the Bolam test, became the central principle governing professional negligence for many years. Although later developments have refined its application in certain areas, the case remains one of the most important authorities in the law of negligence.