Bolitho v City & Hackney Health Authority [1997] UKHL 46

Facts

• A child with severe respiratory difficulties suffered brain damage and death after the attending physician failed to respond to repeated calls.
• The child’s mother brought a claim against the Health Authority, alleging negligence by the physician.
• The defense contended that even if the physician had attended, the child would not have been intubated, so the outcome would not have changed.
• The trial judge applied the Bolam test, finding negligence in the failure to attend, but determined that causation was not established due to lack of negligence in the hypothetical failure to intubate.

Issues

1. Whether a medical professional’s conduct should be judged solely by expert opinion under the Bolam test, or whether courts must consider if those opinions are logically defensible.
2. Whether the Health Authority was liable for the child’s harm, considering the hypothetical situation that the physician would not have intubated even if present.
3. To what extent courts can scrutinize the reasoning behind professional medical opinions in the context of negligence.

Decision

• The House of Lords dismissed the appeal but substantially refined the Bolam test’s application.
• The court held that professional opinions must be subject to judicial scrutiny for logical analysis and defensibility.
• It determined that expert evidence can only be accepted if it withstands logical scrutiny, including evaluation of comparative risks and benefits.
• In this case, the court examined the hypothetical decision not to intubate and assessed whether that decision would itself have amounted to negligence.
• The judgment affirmed that a doctor is not negligent if their hypothetical actions conform to a practice supported by a reasonable and logically defensible body of medical opinion.

Legal Principles

• The Bolam test requires that a medical professional is not negligent if acting in accordance with a practice accepted by a responsible body of medical opinion.
• Bolitho introduced the qualification that courts may reject an expert opinion if it is not logically defensible.
• The logical basis test mandates that expert reasoning must consider comparative risks and benefits and be objectively supportable.
• This principle applies beyond medicine to other professions where expert opinion is adduced as evidence for the standard of care.
• Subsequent cases, such as Adams v Rhymney Valley DC [2000] Lloyd’s Rep PN 777, and Secretary of State for the Home Department v MN and KY [2014] UKSC 30, have referenced the Bolitho approach in evaluating professional standards and evidentiary opinions.
• The Bolitho modification curtails uncritical judicial deference to professional standards, providing greater safeguards for patients.

Conclusion

Bolitho v City & Hackney Health Authority established that courts are not bound to accept a responsible body of professional opinion in medical negligence cases unless that opinion is logically defensible, refining the Bolam test and enhancing judicial scrutiny of expert evidence to better protect patients and others owed a duty of care.