The Bolam Test is a means of assessing clinical negligence in Court. Blacktown, Prospect Health This rule is known as the Bolam test, and states that if a doctor reaches the standard of a responsible body of medical opinion, they are not negligent. Published by Royal College of Emergency Medicine, 01 November 2017, Published by Society of Radiographers (SCoR), 17 January 2018. Does the Chief Medical Officer’s report into clinical negligence in the NHS signal the end of the Bolam test? Why do patients decide to sue their doctor? • According to the Bolam test, modified by Bolitho, the doctor won’t have acted negligently if they acted in accordance with practice accepted as proper by a reasonable body of medical opinion, if that opinion is capable of withstanding logical analysis. Previously, the Bolam test 14 in England and the Hunter v Hanley test 15 in Scotland were used to determine what should be disclosed. 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. These tests ask whether a doctor’s conduct would be supported by a responsible body of clinicians. There have been many trials and tribulations denting the Bolam principle, but its core still remains intact. The medical profession has for a long time been a petri dish for paternalistic practices and attitudes. After 60 years, and almost since the NHS began, this case continues to play an important role in the lives of doctors and patients. In the United Kingdom, the standard of care required successfully to defend a negligence claim derives from the case of Bolam v Friern Hospital Management Committee (1957): “The test is the standard of the ordinary skilled man exercising and professing to have that special skill.” Case Five: David Spencer v Hillingdon Hospital NHS … The ruling. The information in this briefing is for general guidance on the principles of informed consent and the impact of recent case law. 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. Lord President Clyde directed the jury: 'The true test in establishing negligence in diagnosis or treatment on the part of the doctor is whether he has been proved to be guilty of such failure as no doctor of ordinary skill would be guilty of if acting with ordinary care.’ The jury returned verdict in favour of Dr Hanley, although a retrial was ordered on technical grounds. 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. He pursue… 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. Register now to enjoy more articles and free email bulletins. In this post, Christopher Fleming of 12KBW discusses the recent decision in Metcalf v Royal Devon and Exeter NHS Foundation Trust [2019] EWHC 3549 (QB). The Bolam test The Bolam test was first recognised in the case of Bolam vs Friern Hospital Management Committee. News, insights and clinical education. It does not matter that other medics would have delivered a different treatment. by Dr Thomas Abraham The court accepted that if Mrs Montgomery been told about the risk of dystocia, she would have chosen to have a caesarean. Over time, it can result in linked abscesses, pain and inflammation. It ultimately required surgical drainage and multiple surgical interventions; following which, microbiology evidence confirmed actinomyces. 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. The defence for the doctor argued that even if she had attended, she would not have intubated. Nicholas Wilkes discusses the merits of the old method as against new plans On 30 June 2003, Chief Medical Officer Sir Liam Donaldson (main picture) published his long-awaited consultation paper, entitled ’Making Amends’. Conversely the “but for” test does not provide a complete or exclusive test of causation in the law of tort (Stapleton, 2015). Bolam was rejected in the 2015 Supreme Court decision of Montgomery v Lanarkshire Health Board. The doctor’s judgment is not to be questioned. For many years the accepted practice around informed consent to treatment, including medication, was based on  the “Bolam” test. This is a constant problem within quasi-judicial bodies that often take every opportunity to accept unchallenged the lowest standards of expert opinion. 08 October 2020 For many years the accepted practice around informed consent to treatment, including medication, was based on the “Bolam” test. The voice for today's GP. Faversham, Kent, Only 15% of legal claims against doctors succeed, Government review not bold enough to reverse rising indemnity costs, say MDOs. Published by Scottish Parliament, 10 January 2019. Sorted by Perth, Prospect Health 1. This discussion concerns breach of duty and the Bolamdefence. 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. The test to be applied was set out by Lord Browne-Wilkinson… Waterlooville, Hampshire, Fylde Private GP Nothing in this briefing constitutes legal advice. 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 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'. At the trial, the expert witnesses said that a large body of medical opinion was not in favour of using relaxant drugs. During the 12th injection, the needle broke and part of it was left embedded in her buttocks. Relevant themes: montgomery v lanarkshire health board, informed consent, bolam test. • Having established a breach of duty, there must be proof of causation of damages. This was known as the Bolam test. Relevance Prospect Health A number of important cases have taken place since that have further shaped the legal landscape. It states that if a doctor has acted according to proper and accepted practice, he is not guilty of medical negligence. Showing results 1 to 10. For treatment the Bolam test applies. In accordance with the hospital’s usual practice of not administering a relaxant or applying manual restraint, the psychiatrist Dr Allfrey gave him electro convulsive therapy (ECT). The Bolam principle, which is the keystone of the defence against medical negligence, is celebrating sixty years. During the treatment, he sustained violent muscle spasms causing him to fracture both hips. Although a doctor was called upon to attend, she failed to do so. Free online information about Clinical Negligence at patient.co.uk, Published by Royal College of Surgeons of England (RCS), 01 November 2016. The Bolam test was established in 1957 following the decision of the court in Bolam v Frierm Barnet HMC in which the court concluded that a doctor might be able to avoid a claim for negligence if he can prove that other medical professionals would have acted in the same way. The Bolam Test. Ipswich City, Menlo Park Recruitment The Montgomery decision redefined the standard for informed consent and disclosure. In Penney , three claimants had undergone cervical smear tests which health screeners had determined to be negative. Published by Royal College of Emergency Medicine, 25 January 2018. Published by Royal College of Surgeons of England (RCS), 02 September 2019. 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. Between May 2013 and February 2014 the claimant developed a left-sided psoas abscess containing gas and fluid. 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. While treating Mrs Hunter for bronchitis, Dr Hanley gave a course of penicillin injections. This was recognised in the classic direction of McNair J. to a jury in Bolam vs Friern Hospital Management Committee. 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. The claimant’s case concerned the delayed diagnosis of actinomycosis; a rare, infectious disease in which bacteria spreads from one part of the body to another through body tissues. Bolam (Bolam v Friern Hospital Management Committee [1957] 2 All ER 118) principle is not extended, they still have an innate reluctance to abandon it in resp The NHS stands for National Health Service and provides its users with a quality standard of healthcare, irrespective of wealth. 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. In a 2015 case, Mrs Montgomery, a type 1 diabetic of small stature, developed shoulder dystocia when going into labour. View options for downloading these results. Instead, doctors must provide infor… 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. The case concerned a hypothetical situation that would have existed had the Claimant been referred for necessary investigations sooner. In England alone, the NHS deals with over a million patients every 36 hours. This site is intended for healthcare professionals, By Dr Thomas Abraham on the 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.’. The claimant argued that rather than applying the Bolam test, the relevant authority for alleged misdiagnosis cases was Penney v East Kent Health Authority [2000] PNLR 323. Although many challenges and amendments have occurred, still the over-riding gold standard of defence in medical negligence is the Bolam test. She sued Dr Hanley alleging negligence. He agreed to undergo electro-convulsive therapy. | 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. The Hunter v Hanley case, in Scotland, preceded the Bolam case by two years, but illustrated the same principle. 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. On these facts the judge found that the claimant had established a causal link between the breach and the injury she had sustained and held that the defendant was liable in damages (Parliament, 2003). 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. Expert witnesses gave different views - some saying they would have intubated, others that they would not. The guideline is mainly written for clinicians working in England and... Clinical negligence was formerly known as medical negligence. The Supreme Court ruled in favour of Mrs Montgomery despite attempts to defend her treatment based on the Bolam test. 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. Bolam sets out that a doctor is not negligent if they have acted in accordance with a responsible body of opinion. The doctor knows best. 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 Ž veyear- old girl. 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. Mr Bolam was a voluntary patient at mental health institution run by the Friern Hospital Management Committee. Prescribing and Technical Information (1), Faculty of Dental Surgery, Royal College of Surgeons (1), National Institute for Health Research - NIHR (1), Public Health Institute, Liverpool John Moores University (1), Royal College of Emergency Medicine - RCEM (2), Royal College of Paediatrics and Child Health - RCPCH (1), Royal College of Physicians of London - RCP (1), View options for downloading these results, Publications - Medicines related conversations: changes to informed consent, The surgeon as an expert witness: a guide to good practice, Consent in Adults, Adolescents and Children in Emergency Departments, Consent: Supported Decision-Making: a guide to good practice, Consent, capacity and restraint of adults, adolescents and children in emergency departments, Obtaining consent: a clinical guideline for the diagnostic imaging and radiotherapy workforce, Factors that influence decision making by 8-12 year olds in child and adolescent mental health services (CAMHS): a systematic review, Managing incidental and pertinent findings from WGS in the 100,000 Genomes Project, SPICe briefing : informed consent in healthcare settings. Bolam v Friern Hospital Management Committee (Queen's Bench Division) Facts : During the course of electro-convulsive therapy administered to him at the defendants' mental hospital, the plaintiff, a voluntary patient, sustained bilateral "stove- in" fractures of the acetabula. 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. the standards of care provided to … A short history of the Bolam test - a keystone of medical negligence law for 60 years Hull GP Dr Thomas Abraham looks back at the 60-year history of the Bolam test, which has underpinned doctors' defence against medical negligence claims almost since the NHS began. Saltash, Rowans Hospice Charity Duri… 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. In 1954, John Bolam was admitted to Friern Hospital with relapse of depression. He sued, alleging that the hospital was negligent in (a) not giving muscle relaxant (b) failing to provide manual restraint during convulsions and (c) failing to warn him of the risks. Castlebar, Mayo (IE), Faversham Medical Practice Treatment is not negligent if there is a responsible body of specialists practising that discipline who would have done the same, provided the view of that responsible body is capable of logical analysis (the Bolitho qualification). Nurses were present on either side to prevent him from falling off the couch, but Bolam suffered acetabular fracture of both hips. The famous case of Bolam v Friern Hospital Management Committee[1957] 1 WLR 582 concerned a patient who was suffering from depression and was voluntarily admitted to the defendant hospital to undergo electroconvulsive therapy (ECT). This guideline offers guidance for clinicians working in Emergency Departments in the United Kingdom about obtaining consent. The Bolam test: on borrowed time?, Mayur Lakhani. Published by phg foundation (phgf), 31 March 2013. The new NHS Redress Act, which returns an element of beneficence to the compensation equation, appears to be a natural and logical response, but it is a gamble as yet untested. Published by Social Services Research Group (SSRG), 01 March 2016. Given the complexities of modern medicine it is possible, and even likely, that a dissenting g… Rockingham, Prospect Health The body of doctors Bolam test was subsequently lifted and adopted by the Court of Appeal and High Court in cases like Maynard v West Midlands RHA 1984 1 WLR 634 and Sidaway v Bethlem and Maudsley Hospitals 1985 AC 871 to become “the Bolam test”. . 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. Some experts felt that more restraint meant more likelihood of fracture. 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Commissioned because of […] Sort by Date. 18 August 2017. By referring to the importance of the accepted practice of other doctors, the Trust used the Bolam test. Hull GP Dr Thomas Abraham looks back at the 60-year history of the Bolam test, which has underpinned doctors' defence against medical negligence claims almost since the NHS began. St Annes, Lytham St Annes, Lancashire, Castle Medical Centre 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. Dr McLellan, the obstetrician had failed to warn her of the risks and did not offer caesarean section, which might have prevented this. 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