Negligent doctor liable only for losses within the doctor’s “scope of duty”

Medico-legal Minder previously reported on the decision of a judge to award against a doctor, who wrongly reassured a mother who wished to establish if she carried the haemophilia gene, damages in relation to the cost of bringing up a child with haemophilia and autism.  The Court of Appeal has considered the case (Khan v MNX [2018] EWCA Civ 2609) and has ruled that the judge’s decision was wrong.

The purpose of the mother’s consultation with the doctor was to enable her to make an informed decision in respect of any child she conceived who was subsequently found to be carrying the haemophilia gene.  The doctor was liable for the risk of a mother giving birth to a child with haemophilia because there had been no foetal testing and consequent upon it no termination of the pregnancy.  However the mother took the risks of all other potential difficulties of the pregnancy and birth.  The doctor had no duty to prevent the child’s birth and the risks of a child being born with autism was not increased by the doctor’s advice.

In legal terms, the Court of Appeal ruled that the judge had failed to apply the “scope of duty” test set out in South Australia Asset Management Corp v York Montague Ltd [1997] AC 191 but instead had applied the “but for” causation test.  The South Australia case required there to be an adequate link between the breach of duty (the negligent advice) and the particular type of loss claimed, and laid down a 3-stage test: (i) what was the purpose of the advice which was negligently provided? (ii) what is the appropriate apportionment of risk? and (iii) what losses would have been sustained if the correct information had been given?  At the first stage, the purpose was to put the mother in a position to enable her to make an informed decision in respect of any child she conceived who was subsequently found to carry the haemophilia gene.  At the second stage, the doctor was liable for the risk of a mother giving birth to a child with haemophilia because there had been no foetal testing and consequent upon it no termination of the pregnancy.  At the third stage, the loss which would have been sustained if the correct information had been given and appropriate testing performed would have been that the child would have been born with autism, which risk was not increased by the doctor’s advice.

A number of rules limit or define the damages which may be recovered where there is a breach of duty.  This case illustrated (so the Court of Appeal found) the link that there must be between the scope of the duty and the damage sustained (which here limited damages to the issue of haemophilia) whereas the trial judge had, wrongly on the facts of the case, applied the “but for” causation test in awarding damages for the additional costs of an autistic child which costs would not have been incurred “but for” the breach of duty as a result of which the pregnancy had not been terminated.

In Chester v Afshar the misfortune which befell the claimant was the very misfortune that the defendant had a duty to warn against prior to surgery.  The claimant recovered damages for that event arising.  That was not, however, the case here.  In Southern Australia there was discussion of the contrasting facts of the ‘mountaineer’s knee’.  A mountaineer about to undertake a difficult climb is concerned about the fitness of his knee. He goes to a doctor who negligently makes a superficial examination and pronounces the knee fit. The climber goes on the expedition, which he would not have undertaken if the doctor had told him the true state of his knee. He suffers an injury which is an entirely foreseeable consequence of mountaineering (such as from an avalanche) but has nothing to do with his knee.

The facts of Khan v MNX are more akin to the ‘mountaineer’s knee’ than to the failure to warn of a risk of surgery which in fact occurs.

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Clinical practice and the law – a legal primer

Mediclinical-practice book picco-Legal Minder has written another book!

This book was initially conceived of as being a guide for junior doctors.  It does this by doing 3 things.

Firstly it explains, so far as it impacts on the clinician’s life, how a lawyer’s mind works – the lawyer’s approach to investigating events, how a lawyer decides what weight any particular evidence carries and why, how evidence should be presented to any third party and the difference between factual and expert evidence.

Secondly the book explains in simple terms the law as it impacts on issues and events a doctor is likely commonly to experience, including confidentiality, capacity and consent, and interactions with the police, and helps the doctor to prepare for them and to record relevant observations, actions and decisions for future reference, whether by other clinicians or in court.

Thirdly it seeks to take some of the fear out of what happens ‘when things go wrong’ by explaining the different proceedings and inquiries which may result from an unexpected death, a serious complaint, or an accusation of negligence, and the legal framework in which they operate, and which will all be far less troubling if the lessons given earlier in the book have been put into practice.

After 40 years working professionally with clinicians from many specialities and of varied experience, I have no doubt that their professional lives would have been easier if they had started with the knowledge that this book would have given them (if it had been written then); they would have been better prepared, they would have worried less, they would have been better witnesses, whether witnesses of fact or expert witnesses, and whether on behalf of themselves or on behalf of others, and they would have left a much clearer and more comprehensible trail of notes and records for others to interpret than the countless thousands of entries I have spent a career trawling through, trying to interpret and understand.  Therefore there is much in this book that the senior colleagues of the junior doctors would benefit from even at this stage of their careers.

To see the forewords – from James Badenoch QC, Mike Foy, Consultant Orthopaedic and Spinal Surgeon, and Dr Jan Wise MSc FRCPsych IDFAPA – and the contents pages, and to order a copy, click here