Khan v Meadows is a landmark judgment delivered by the UK Supreme Court in June 2021, addressing the scope of duty of care in clinical negligence, particularly relating to liability for losses arising from negligent medical advice. The case centres on whether a medical practitioner is liable for the costs of all disabilities affecting a child born following negligent advice, or only for those related to the specific risk about which the advice was sought.
The Supreme Court unanimously dismissed the appeal and provided important clarification on applying the principle established in South Australia Asset Management Corpn v York Montague Ltd ([1997] AC 191), commonly known as the SAAMCO principle, in clinical negligence claims.
Facts of Khan v Meadows
Ms Meadows consulted her general practitioner, Dr Khan, before becoming pregnant, seeking advice about whether she carried the haemophilia gene. This concern arose because Ms Meadows had a nephew diagnosed with haemophilia, a hereditary bleeding disorder. Dr Khan arranged tests that could confirm whether Ms Meadows suffered from haemophilia itself but did not arrange for genetic testing to determine if she was a carrier of the gene.
Following these tests, Ms Meadows was led to believe that her children would not be at risk of haemophilia. However, she was in fact a carrier of the gene and, as a result, gave birth to a son, Adejuwon, who suffered from haemophilia. Additionally, Adejuwon was diagnosed with autism, a condition unrelated to haemophilia and unconnected to Dr Khan’s negligence.
Ms Meadows claimed damages for the costs associated with caring for her son. Dr Khan accepted liability for the additional costs arising from haemophilia but disputed liability for costs related to autism. The difference was significant, with compensation for haemophilia alone estimated at approximately £1.4 million, whereas including autism increased the claim to approximately £9 million.
Legal Issues
The core legal issue in Khan v Meadows was whether Dr Khan was liable for the full extent of the costs associated with both haemophilia and autism or whether liability was confined to losses arising from haemophilia alone. This raised the broader question of how to define the scope of a defendant’s duty of care in clinical negligence cases where negligent advice results in harm.
Specifically, the case required consideration of whether the SAAMCO principle, developed originally in financial and property valuation contexts, applied to clinical negligence and, if so, how the court should apply it to determine which losses fall within the scope of the duty of care.
The SAAMCO Principle
The SAAMCO principle, established in South Australia Asset Management Corpn v York Montague Ltd ([1997] AC 191), provides that a defendant who provides advice or information is liable only for losses that fall within the scope of their duty. It recognises that imposing liability for all consequences flowing from negligent advice, regardless of foreseeability or directness, could lead to disproportionate and unfair outcomes.
In SAAMCO, the House of Lords held that a valuer was liable for losses directly attributable to negligent valuation but not for broader economic losses resulting from the client’s subsequent commercial decisions. This principle imposes limits on the extent of damages recoverable in negligence claims based on advice.
Supreme Court Judgement in Khan v Meadows
The Supreme Court upheld the Court of Appeal’s ruling in a unanimous decision. It rejected Ms Meadows’ argument that the SAAMCO approach was inappropriate in clinical negligence cases, affirming its applicability where advice or information forms the basis of the duty.
The Supreme Court framed the analysis through six sequential questions designed to clarify the scope and limits of duty of care and liability:
- Is the harm actionable in negligence?
- What are the risks of harm against which the law imposes a duty of care?
- Was there a breach of duty by act or omission?
- Is the loss causally connected to the breach?
- Is there a sufficient nexus between the harm and the duty?
- Are any elements of harm irrecoverable due to remoteness or other legal principles?
Applying these questions, the Court concluded that:
- The economic costs of caring for a disabled child were actionable.
- Dr Khan owed a duty to advise specifically on the risk of haemophilia.
- There was a breach of that duty.
- The negligent advice factually caused the birth of Adejuwon.
- There was no sufficient legal nexus between Dr Khan’s duty and the unrelated risk of autism.
- Therefore, liability was confined to losses connected to haemophilia alone.
A particularly notable point was made by Lord Burrows, who emphasised the potential for an “absurd result” if liability were extended to autism-related losses. He noted that if such an extension were allowed, liability might be imposed even if the child had autism but not haemophilia, which was not the risk about which advice was sought.
Conclusion
Khan v Meadows clarifies that in clinical negligence claims involving advice, the scope of duty governs the extent of recoverable damages. The decision reaffirms the SAAMCO principle’s role in ensuring fairness and proportionality by limiting liability to losses connected to the risks the defendant undertook to advise upon.
The case underlines the importance for medical professionals to clearly understand and communicate the scope of their advice and the associated risks. For claimants, it emphasises the necessity of demonstrating not only factual causation but also a sufficient legal nexus between the claimed losses and the defendant’s duty.
