Sophie Firth examines Williams v Cwm Taf University Hospital Board in which the Court of Appeal held that the Bolitho test had been satisfied.
The Claimant was a type-2 diabetic who developed critical ischaemia in his right foot. There were 3 treatment options: angioplasty, sympathectomy, or as a last resort, amputation.
After performing a Doppler scan but not an angiogram, an MDT recommended sympathectomy. This was performed non-negligently but ultimately did not solve the problem. Therefore, following an angiogram, in an attempt to avoid amputation, an angioplasty was performed, notwithstanding that the radiologist did not consider it would be successful.
Against expectations, the angioplasty was successful but the Claimant suffered numerous complications from the sympathectomy.
The Claimant (supported by expert evidence) argued that it was negligent to perform a sympathectomy without first doing an angiogram – had an angiogram been performed, angioplasty instead of sympathectomy would have been attempted first and the complications avoided.
The Defendant’s expert disagreed.
The Judge dismissed the claim on the basis that the MDT had reasonably selected sympathectomy as the best option. He did not rely on the Claimant’s expert because he had taken an extreme position that sympathectomy was hopeless.
Issue for the appeal
The Claimant accepted that the decision to perform sympathectomy satisfied the Bolam test i.e. that it met the standard of a responsible body of medical opinion.
The sole issue was whether it satisfied the Bolitho test i.e. whether there was a logical basis of that responsible body of opinion.
The appeal was dismissed:
The decision is a useful reminder of 3 principles set out in Bolitho itself: