the personal injury and clinical negligence blog

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How quickly should an emergency caesarian section be performed? Goncalves v Newham University Hospital Trust

The cerebral palsy case of Goncalves v. Newham University Hospital Trust (QBD, Mr. John Leighton Williams Q.C. sitting as a Deputy High Court Judge 24.11.10) discusses the important question of how quickly an emergency caesarean section should be performed. The Claimant, Macmillan, a second twin, was born at 19.47 hrs on 19.01.96 at Newham University Hospital and suffers from teraplegic dyskinetic cerebral palsy as a result of oxygen deprivation shortly before, during and after his birth.  Macmillan’s twin brother was born in a healthy condition at 19.10 hrs.  The case was complicated by the hospital’s loss of the mother’s clinical records, the obstetric and midwifery notes and cardiotocograph (“CTG”) records and failure to call witnesses who recollected the emergency that occurred. The agreed expert evidence was that brain damage was unlikely to have resulted from hypoxia of less than 10 minutes and Macmillan would have avoided brain damage if the period of acute hypoxia had been less than 15 minutes.  The bracket for the damaging period of hypoxia was agreed by the paediatric neurologists to be 16-25 minutes. The Deputy Judge held that Macmillan’s breech presentation should have been discovered shortly after his brother’s birth and the obstetric registrar should have been present by 19.20 hrs if not earlier and he would have been able to detect the cord prolapse and bradycardia (which would have shown on the CTGs) promptly.  He held that the cord prolapse and bradycardia occurred at about 19.25 hrs to 19.30 hrs and accepted that there was a panic in the delivery room (as the parents described) and delay in securing the attendance of the obstetric registrar.  He concluded that the likely period of unnecessary delay was likely to have been approximately 8-10 minutes. The Deputy Judge held that:  “With the onset of asphyxia/hypoxia at about 19.28 hrs, with the obstetric registrar present and with the team ready to act, the mother could and should have been taken to theatre very quickly. Given that CS incision to delivery would take about 2 minutes, the absence of any recorded problem attending Macmillan’s delivery, and that speedy resuscitation was possible, it seems to me quite reasonable to have expected Macmillan to have been delivered and resuscitated, if such was necessary, within about 10 minutes.”  His conclusion therefore was that, but for the hospital’s negligence, Macmillan would not have suffered damaging asphyxia/hypoxia and would have been delivered unharmed.  Macmillan’s claim therefore succeeded on liability and causation.  There will be an assessment of damages hearing on a later occasion.

Savage v South Essex Partnership NHS Foundation Trust: will the Court of Appeal agree with the first instance decision?

In Anna Savage v South Essex Partnership NHS Foundation Trust [2010] EWHC 865 (QB), the Claimant claimed a declaration and damages under the Human Rights Act 1998 after her mother Carol Savage (“CS”), a patient detained in a psychiatric ward under the Mental Health Act 1983, absconded and committed suicide in July 2004.  The case had already been to the House of Lords on a preliminary point on the correct test for determining whether the NHS trust had violated CS’s article 2 right to life (Savage v South Essex Partnership NHS Foundation Trust (2008) UKHL 74, (2009) 1 AC 681).  Applying the test laid down by the House of Lords, Mackay J held that the Trust had violated article 2 and awarded £10,000 damages for just satisfaction. The issues were (a) whether the Trust knew or should have known there was a real and immediate risk of CS committing suicide (b) whether the Trust should have taken steps that would have had a substantial chance of preventing the suicide (c) whether the Claimant was a “victim” entitled to bring proceedings under the 1998 Act and (d) what remedies should be granted. The Judge was critical of the Trust’s failure to comply with its policies on risk assessment and observation and decided (a) the Trust should have known there was a real and immediate risk of CS absconding and that this – because her mental state was so poor that “anything could happen” –amounted to knowledge of a real and immediate risk of suicide (b) 15 or 30 minute observations should have been imposed and would have had a substantial chance of preventing the suicide (c) the Claimant, as CS’s daughter, was a “victim” and entitled to bring proceedings (this aspect of the decision has been recently approved by the Court of Appeal in Rabone v Pennine Care NHS Trust [2010] EWCA Civ 698) and (d) the Claimant was entitled to both a declaration and damages. The Defendant has sought and obtained permission to appeal and the case is due to be heard in the Court of Appeal in February 2011.  Do you think the High Court reached the right conclusion?    

St William's Group Litigation - Claimants fail to establish liability on appeal

Claimants, in what has been described as one of Britain’s biggest sex abuse compensation claims, have failed to establish liability against a lay religious order providing Brothers to work at a residential institution known as St William’s, Market Weighton. The 150 Claimants failed to establish that the De La Salle Order was vicariously liable for the alleged acts of abusers at St William’s during the period 1965 to 1992. At a Preliminary Issue Hearing the judge had held that the managers of St William’s, a committee of lay men and women and the employers of all staff, ran the approved school between 1965 and 1973 and therefore were vicariously liable for alleged acts of physical and sexual abuse by staff during this period. He had also held that the Diocese of Middlesbrough’s children’s societies, which became the statutory responsible organisations for St William’s following its change of status to a Community Home in 1973, were vicariously liable for abuse by staff from 1973 until its closure in 1992. In addition, all liabilities of the managers of the approved school were statutorily transferred to these societies. The Court of Appeal dismissed appeals by the Claimants and the Diocese of Middlesbrough’s children’s societies. Lord Faulks QC and Alastair Hammerton acted for the De La Salle Order, instructed by Cumberland Ellis LLP.

Micklewright v Surrey County Council - Causation in the context of tree branch cases

His Honour Judge Reid QC yesterday handed down judgment in the case of Joanne Micklewright (as Executrix of the estate of Christopher John Imison, Deceased) v Surrey County Council in the Guildford County Court. The Claimant was the executrix of the Deceased, who had tragically been killed when struck by a large branch which fell onto him from an oak tree on the verge of Wick Road, Virginia Water, as he unloaded a bicycle from his car parked in an adjacent lay-by. The Defendant accepted that it was responsible for the tree in question for the purposes of the trial. The main issue at trial concerned the condition of the tree prior to the failure of the branch (which failure occurred on a still, dry, sunny August day in 2007). Damages were agreed at £500,000, subject to liability. In his judgment HHJ Reid QC reiterated that the duty on the Defendant was to take such care as was reasonable in all the circumstances of the case, but that there is no obligation on an occupier or landowner to make his land completely safe. As regards trees on land, there must be some assessment of the potential risks presented by those trees, which requires inspection at appropriate intervals by a person with some training. The judge confirmed that there is no remedy in nuisance in such circumstances. See Noble v Harris [1926] 2KB 332. Further, the judge confirmed that causation is a live issue, so that there will not be automatic liability on a tree owner if he fails to make inspections, as it may be that the tree was suffering from a defect that would not have been revealed in any event. See Caminer v Northern & London IT [1951] AC 88 at 103. As HHJ Reid QC explained in paragraph 18 of his judgment: “It is necessary for the claimant to show that if the owner or occupier had complied with his duty on the balance of probability the defect or danger in the tree would have been noticed. It is important when considering whether the owner or occupier has complied with his duty to avoid using the benefit of hindsight.” In paragraph 21 the judge held that the applicable duty of inspection is a duty to perform “a quick visual check, carried out by a person with a working knowledge of trees as defined by the HSE”. The question for the court was as to whether such a check would have revealed the defect in this particular oak tree prior to the accident, leading to the removal of the offending branch. HHJ Reid QC found that the Defendant’s inspection regime at the time of the accident was inadequate, albeit steps had been taken since 2004 to put in place an effective inspection scheme, but there remained a backlog as regards inspections at the time of the accident, which needed to be cleared in order to meet the annual or bi-annual inspection regime that was suggested as appropriate for a tree at this location by the experts. Accordingly, the “central point in the case” was whether or not the accident would have been avoided had an adequate inspection system been in place at the time of the accident. On that issue, the judge effectively preferred the Defendant’s evidence. The experts disagreed as to whether the cause of the branch failure was internal decay or a phenomenon known as “summer branch drop”, whereby trees sometimes shed branches on warm, dry summer days. The judge held that it was of little importance what caused the branch to fall, as on any view the internal decay was certainly a factor in its failure. The judge held that the pruning wounds visible on the 200 year old oak tree were not defects that required any additional inspection. He similarly preferred the Defendant’s expert as regards a small area of discoloured bark on the tree, and with regard to the various further “defects” below. There was visible decay within the cut section of the branch that had fallen from the tree, and the judge held that there was “irrefutable evidence of significant internal decay. However this does not assist in resolving the question whether there were indicia from which on an appropriate inspection the internal decay and the danger to the integrity of the branch should have become apparent.” When considering the discoloured bark and cracking within the fallen tree branch that could be seen in some photographs the judge held that “On this state of the evidence I am not satisfied that the Claimant has established that there would have been an external crack visible on an appropriate inspection…I am prepared to assume in the Claimant’s favour that the discolouration was such that it could have been seen from the ground on inspection. However this is of little assistance to the Claimant since [the Claimant’s expert’s] evidence was that discolouration of the bark would not of itself prompt a detailed inspection by a trained arboriculturalist”. As regards the Claimant’s expert’s contention that there would have been discoloured foliage to be seen on the tree prior to the accident, the judge accepted the evidence of the Defendant and held that “In my judgment the Claimant has failed to show on the balance of probabilities that there were discoloured leaves on the failed branch”. HHJ Reid QC additionally held that the evidence did not support the contention of the Claimant’s counsel to the effect that the presence of extensive ivy on the tree should have resulted in an expert inspection, whether taken alone or in conjunction with other factors. The conclusion of the court was that “…the Claimant has failed to discharge the burden of proof on her. The balance of probabilities is that [the Defendant’s expert] was correct in his view expressed to the Coroner that this was an unforeseeable accident. Even if there had been a proper system of inspection in place, the defect in the branch would not have been revealed so as to enable the accident to be avoided. Whilst I have every sympathy for the Claimant in this tragic case, as the law stands and with there being no absolute liability for damage caused by highway trees, the result is that her action must fail.” So the claim was dismissed, notwithstanding the finding of a breach of duty. The lesson here is that causation can be a powerful tool in such cases, and that the court can and will understand the dangers of judging matters with the benefit of hindsight. Permission to appeal has been granted. Veitch Penny and Angus Piper acted for the Defendant