The doctor knows best. . It states that if a doctor has acted according to proper and accepted practice, he is not guilty of medical negligence. For treatment the Bolam test applies. To satisfy the Bolam test, a medical professional must show that he acted in a way that a responsible body of medical professionals in the same field would regard as acceptable. Dr McLellan, the obstetrician had failed to warn her of the risks and did not offer caesarean section, which might have prevented this. Register now to enjoy more articles and free email bulletins. She sued Dr Hanley alleging negligence. It ultimately required surgical drainage and multiple surgical interventions; following which, microbiology evidence confirmed actinomyces. Every healthcare professional and doctor should carefully read a report in The Times of 9 October 2002.1 This is a powerful and moving account of a mishap in the NHS that led to the death of a Ã…Â½ veyear- old girl. The Bolam test The Bolam test was first recognised in the case of Bolam vs Friern Hospital Management Committee. A number of important cases have taken place since that have further shaped the legal landscape. In this post, Christopher Fleming of 12KBW discusses the recent decision in Metcalf v Royal Devon and Exeter NHS Foundation Trust  EWHC 3549 (QB). By referring to the importance of the accepted practice of other doctors, the Trust used the Bolam test. The ruling. 1. The Supreme Court ruled in favour of Mrs Montgomery despite attempts to defend her treatment based on the Bolam test. There have been many trials and tribulations denting the Bolam principle, but its core still remains intact. The court based its decision in part on GMC guidance on consent, which advises doctors to 'tailor your approach to discussion with patients according to (a) their needs, wishes and priorities, (b) their level of knowledge about and understanding of their condition, prognosis and treatment options, (c) the nature of condition, (d) the complexity of treatment and (e) the nature and level of risk associated with investigation/treatment'. The case was dismissed because the court found that the doctor's only failure was not to attend - and that because she could reasonably have made the decision not to intubate she was not responsible for the boy's death. Sorted by The NHS stands for National Health Service and provides its users with a quality standard of healthcare, irrespective of wealth. St Annes, Lytham St Annes, Lancashire, Castle Medical Centre 18 August 2017. Bolam sets out that a doctor is not negligent if they have acted in accordance with a responsible body of opinion. A doctor is not guilty of negligence if he or she has acted in accordance with a practice accepted as proper and responsible by a responsible body of medical practitioners skilled in t… The defence for the doctor argued that even if she had attended, she would not have intubated. While treating Mrs Hunter for bronchitis, Dr Hanley gave a course of penicillin injections. Published by phg foundation (phgf), 31 March 2013. This site is intended for healthcare professionals, By Dr Thomas Abraham on the Published by Royal College of Emergency Medicine, 01 November 2017, Published by Society of Radiographers (SCoR), 17 January 2018. Nothing in this briefing constitutes legal advice. Bolitho narrowed the scope of the test, stating that the court must be satisfied that the body of opinion relied upon has a logical basis. The Montgomery decision redefined the standard for informed consent and disclosure. Some experts felt that more restraint meant more likelihood of fracture. The Bolam test is then described and how it has come to play such a prominent role in assisting the courts to assess if an appropriate standard has been achieved in medical negligence litigation. the standards of care provided to … Conversely the “but for” test does not provide a complete or exclusive test of causation in the law of tort (Stapleton, 2015). 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The House of Lords ruled for the Health Authority in this case and within the ruling they applied a further element to the Bolam test: that of logic of a medical opinion. Two decades ago, two-year-old Patrick Bolitho - while in hospital - developed obstruction of the airway and suffered cardiac arrest, which resulted in brain damage and subsequently death. Sort by Date. It also considered DH guidance on consent for examination or treatment, which warns healthcare practitioners to 'remember their duty to keep themselves informed of legal developments that may have a bearing on their practice', highlighting human rights cases that have set out doctors' duty to involve patients in decisions relating to their treatment. Although the original case was related to the alleged negligence of a doctor, the test has become the universal yardstick applicable to all health professionals. Instead, doctors must provide infor… Bolam (Bolam v Friern Hospital Management Committee  2 All ER 118) principle is not extended, they still have an innate reluctance to abandon it in resp View options for downloading these results. The test is essentially a peer review of the doctor's behaviour - if others would have acted in a similar way, then the doctor is unlikely to have breached his duty of care. The information in this briefing is for general guidance on the principles of informed consent and the impact of recent case law. Relevant themes: montgomery v lanarkshire health board, informed consent, bolam test. Her baby developed hypoxia, leading to cerebral palsy. Ensuring quality and consistency of expert witnesses available to civil and criminal courts is in the interests of both the public and the medical profession. News, insights and clinical education. The doctor’s judgment is not to be questioned. The jury returned the verdict in favour of the defendants in the court case, heard in 1957, in a verdict that has become a key test for breach of professional duty. The test to be applied was set out by Lord Browne-Wilkinson… ECT was delivered without any muscle relaxant drugs and the patient was unrestrained apart from the presence of nursing staff to prevent him from falling off the bed. He pursue… Expert witnesses gave different views - some saying they would have intubated, others that they would not. Her appeal was successful and the judgment held that the assessment of whether consent was adequate in a clinical negligence claim would not be assessed by the Bolam test. Free online information about Clinical Negligence at patient.co.uk, Published by Royal College of Surgeons of England (RCS), 01 November 2016. High Court judge McNair J directed the jury: ‘A doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art…putting it the other way round, a doctor is not negligent, if he is acting in accordance with such a practice, merely because there is a body of opinion that takes a contrary view.’. Ipswich City, Menlo Park Recruitment Faversham, Kent, Only 15% of legal claims against doctors succeed, Government review not bold enough to reverse rising indemnity costs, say MDOs. Perth, Prospect Health McNair J set out the test for determining the standard of care owed by medical professionals to their patients (sometimes referred to as the ‘Bolam test’). The Hunter v Hanley case, in Scotland, preceded the Bolam case by two years, but illustrated the same principle. The Bolam test also defaults to a standard that can be supported by those with special skills (and of course interests) which may fall short of what is reasonably acceptable. by Dr Thomas Abraham Duri… Bolam holds that the law imposes a duty of care between a doctor and his patient, but the standard of that care is a matter of medical judgement. Quick Reference Where clinical negligence is claimed, a test used to determine the standard of care owed by professionals to those whom they serve, e.g. Previously, the Bolam test 14 in England and the Hunter v Hanley test 15 in Scotland were used to determine what should be disclosed. The court accepted that if Mrs Montgomery been told about the risk of dystocia, she would have chosen to have a caesarean. The claimant argued that rather than applying the Bolam test, the relevant authority for alleged misdiagnosis cases was Penney v East Kent Health Authority  PNLR 323. In other words, the Bolam test states that “If a doctor reaches the standard of a responsible body of medical opinion, he is not negligent”. Relevance It is based on... Click export CSV or RIS to download the entire page or use the checkbox in each result to select a subset of records to download. At the trial, the expert witnesses said that a large body of medical opinion was not in favour of using relaxant drugs. Published by Royal College of Surgeons of England (RCS), 02 September 2019. The voice for today's GP. This is the Bolam test, first formulated in Bolam v Friern Hospital Management Committee.2 What makes it potentially (and what made it actually) a high road to paternalism is the fact that it is a test not just of substantive law (setting out the elements of an actionable breach of duty) but also of evidence. This was a case in which the issue of when to hold a discussion of options for management was a matter of medical judgment – and one therefore which would be governed by the Bolam test rather than by the principles in Montgomery. Case Five: David Spencer v Hillingdon Hospital NHS … Although many challenges and amendments have occurred, still the over-riding gold standard of defence in medical negligence is the Bolam test. Bolam was rejected in the 2015 Supreme Court decision of Montgomery v Lanarkshire Health Board. It does not matter that other medics would have delivered a different treatment. These tests ask whether a doctor’s conduct would be supported by a responsible body of clinicians. Before Montgomery, a doctor's duty to warn patients of risks was based on whether they had acted in line with a responsible body of medical opinion.
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