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Negligent failure to perform caesarean section in time (UK)

Published

2020

Thu

06

Feb

 

The claimant, suing the UK National Health Service, had a medical history of having undergone two caesarean sections and a tear to her womb. Her fourth pregnancy was therefore regarded as “high risk” and her treatment plan provided for an elective caesarean section. She brought a claim against the hospital on the grounds of alleged negligence on the part of the hospital staff on the basis that they failed to perform a caesarean section timeously.

The claimant presented at the hospital at 2:30am on 11 December 2014 in the latent stage of labour. She was experiencing contractions but her cervix had not dilated by more than 4cm. She was assessed by the hospital staff at 2:40am, 4:10am, 5:35am and 7:05am. The decision to perform a caesarean section was taken after the last assessment and she gave birth to a baby boy at 8:36am. Shortly thereafter, it was discovered that the claimant suffered a tear to the posterior wall of her uterus which could not be repaired, and a hysterectomy was performed.

The trial court was faced with deciding whether a decision should have been made to perform a caesarean section at 4:10am. The trial judge found in favour of the claimant and awarded damages against the defendant. The defendant appealed the decision of the trial court on various grounds.

One of the grounds of appeal was that the trial judge failed to consider the balancing factors that a doctor would have to take into account when prioritising patients’ needs. The appeal court stated that a balance has to be struck between the seriousness and urgency of a patient’s condition in circumstances where there are no other conflicting factors which will enable the hospital staff to act swiftly in attending to the patient, and the needs of a patient which must be deprioritised to allow the hospital staff to attend to other demands in a busy labour ward, as a matter of priority.

The defendant’s Emergency Caesarean Section Guidelines state that the degree of promptness with which an emergency caesarean section ought to be carried out must take into consideration other pregnancies that might be exposed to undue risk. Put differently, there may be cases where the risk to the patient is low which justifies postponement of treatment of that patient to allow hospital staff to attend to other patients in a busy labour ward. Where the risk is significant and increasing, one must consider the competing considerations more closely to determine which patient must be prioritised.

The hospital records did not indicate that there were any other emergencies that required attention at 4:10am. The defendant’s expert’s evidence that there were competing demands which had arisen at the time were general assumptions which were irrelevant to the period in question. The defendant’s expert’s evidence did not apply to the facts of this case and were merely generalised comments regarding labour wards.

As such, the defendant did not present any evidence to suggest that there were competing priorities that required attention when the claimant was examined at 4:10am and at which time a caesarean section should have been performed. This was confirmed by the senior registrar of the hospital in her witness statement, which made no reference to such factors.

The appeal court was therefore in agreement with the findings of the trial court that the claimant was experiencing contractions from 2:32am and that the contractions had become more intense. It was apparent by 4:10am that the contractions were frequent and the claimant in fact expressed that she was in severe pain. The appeal court furthermore stated that the claimant was, in any event, to undergo a caesarean section in terms of her treatment plan.

As such, failure on the part of the hospital staff to perform the caesarean section at 4:10am amounted to a breach of duty in circumstances where there were no other competing priorities which the hospital staff were faced with.

It is apparent from the judgment that where a witness provides evidence which is speculative, and it is clear that the witness has no knowledge of the specific facts and circumstances that prevailed, such evidence will not be given any weight by a court.

 

The case is Morrison v Liverpool Women’s NHS Foundation Trust [2020] EWHC 91 (QB).

 
Source: Norton Rose Fulbright South Africa Inc
 
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