The case of Bolitho v Hackney Health Authority ([1997] UKHL 46) is a landmark decision in the area of medical negligence, specifically concerning the standard of care owed by medical professionals. It refined the Bolam test, establishing that professional medical opinions must have a logical basis to be relied upon by the courts. This case significantly impacted how causation and breach of duty are assessed in medical negligence claims.
The decision underscored the judiciary’s authority to scrutinise expert testimony, preventing reliance on medical opinions that lack rational justification. As a result, Bolitho is a pivotal case in both UK tort law and medical malpractice litigation.
Facts of Bolitho v Hackney Health Authority
- The claimant was the mother of a two-year-old child who was admitted to the hospital with breathing difficulties.
- The doctor on duty (D) failed to attend to the child due to a low battery on her bleep (pager).
- The child suffered a respiratory failure, leading to brain damage, and subsequently died.
- The mother sued the City and Hackney Health Authority for negligence, alleging that had the doctor attended, the child would have been intubated and survived.
- The doctor later stated that even if she had attended, she would not have intubated the child.
- Expert witnesses supported the doctor’s claim that non-intubation would have been an acceptable medical decision under the Bolam test.
Legal Issues
The Bolitho vs Hackney Health Authority case raised two primary legal issues:
- Breach of Duty: Was the doctor negligent in failing to attend to the child?
- Causation: If the doctor had attended, would she have been under a duty to intubate, and if she did not, would this have been negligent?
The case required an examination of the Bolam test, which provides that a medical professional is not negligent if their actions are supported by a responsible body of medical opinion. However, Bolitho questioned whether the courts should accept medical opinions uncritically or assess their logical soundness.
Bolitho v Hackney Health Authority Judgement of the Court
The House of Lords dismissed the appeal in Bolitho versus Hackney Health Authority, ruling that there was no liability for the doctor or the Health Authority. Their reasoning can be broken down as follows:
Breach of Duty
- The House of Lords agreed that the doctor was negligent for failing to attend to the child.
- However, negligence alone is not sufficient for liability; the claimant also needed to prove that the negligence caused the harm.
Causation: Would Intubation Have Been Performed?
- The doctor testified that even if she had attended, she would not have intubated the child.
- Expert witnesses supported this view, stating that non-intubation would have been a reasonable medical decision.
- As a result, the failure to attend did not cause the harm, since the outcome would have been the same.
Refining the Bolam Test: Logical Basis for Professional Opinion
Lord Browne-Wilkinson introduced a crucial modification to the Bolam test, stating:
“A defendant cannot escape liability by saying that the damage would have occurred in any event because he would have committed some other breach of duty thereafter.”
- He emphasised that the courts must scrutinise medical opinions, ensuring that they are not only supported by a responsible body of opinion but also logically defensible.
- If a medical opinion lacks a logical basis, the courts are entitled to disregard it.
- However, in this case, the decision not to intubate was found to be logical, meaning there was no negligence.
Conclusion
Bolitho v Hackney Health Authority remains a landmark case in medical negligence law, refining the Bolam test to include an element of logical analysis. It reinforced the principle that expert medical opinions must be scrutinised, ensuring that irrational or outdated practices do not shield professionals from liability.
By strengthening judicial oversight and placing greater responsibility on courts to assess expert opinions, the case has influenced medical malpractice litigation significantly. However, it has also introduced challenges, particularly concerning judicial discretion and the burden of proof in negligence cases.
Ultimately, Bolitho ensures that medical standards evolve logically, protecting patients while maintaining fairness for medical professionals. Its legacy continues to shape modern tort law, ensuring that negligence claims are assessed on both expertise and reason.