What is the standard of care a patient can expect from a junior hospital doctor?
Posted by : Dave Briggs
In any claim for medical negligence against a Junior Doctor, the Court has to consider whether the clinician has breached a duty of care to the patient. One of the questions is what is the level of care that the clinician owes to the patient?
The Court of Appeal had to consider this question earlier this year. The case in question concerned a one-year-old baby. The baby became unwell as long ago as September 2003. By 29 September 2003, she was admitted to hospital in a very unwell state and on 1 October 2003 she was transferred to Great Ormond Street Hospital where bacterial meningitis was diagnosed as well as corresponding brain injuries from the illness. The baby was assessed by Dr. Rushd who was a junior doctor in the Accident & Emergency Department of the Princess Alexandra Hospital. The baby arrived at the hospital via ambulance at 4.45am and was seen by Dr. Rushd at 5.20am. Dr. Rushd felt that the child was not seriously unwell and had an upper respiratory tract infection. The baby’s mother was told that she could go home with her baby. Unfortunately, during the course of that day her condition worsened and she was back in hospital at 5.53pm via emergency ambulance and was thereafter referred to the specialist paediatric team. Antibiotics were then administered but by then it was too late to stem off the serious illness and subsequent brain injuries which this child suffered.
One of the criticisms of Dr. Rushd was that she failed to take a proper history from the baby’s mother. When the case first went to the High Court, the High Court Judge hearing the case felt that Dr. Rushd had displayed the standards of a reasonably competent junior doctor and it was only a more experienced eye, such as that of a consultant or a more senior doctor, such as a Registrar, who would have picked up on the signs which would have led to an onward referral to the paediatric team in the morning.
The Court of Appeal disagreed with the Trial Judge and felt that Dr. Rushd had not acted to a reasonable standard. The principal reason for the breach in duty was that she failed to take an adequate history which was a basic skill for all hospital doctors, therefore the appeal was allowed.
The Court of Appeal however did take the opportunity of restating the law as to the standard to be expected of hospital doctors. The law acknowledges that there is a hierarchy of doctors in a hospital but the basic principle is straight-forward.
Whether doctors are performing their normal role or “acting up to a higher role” they are judged by reference to the post which they are fulfilling at the time. The hospital will be liable if the doctor it puts into a particular position does not possess, and therefore does not exercise, the correct degree of skill for the task in hand. In other words, the doctor is assumed to be competent for the job which they are doing. It was therefore irrelevant that Dr Rushd was only aged 25 and relatively inexperienced; the law assumed her to be competent.
Finally, the Court did acknowledge that junior hospital doctors do work long hours under considerable pressures which often involve life and death decisions. It recognised that doctors are human and even good and conscientious doctors may from time to time fall short of the requisite standard. However, that did not mean that the Hospital Trust were not legally liable for the human error of one of its doctors.
Michael Shiers is a Solicitor at Nash & Co Solicitors in Plymouth. He has been a member of the Law Society’s Personal Injury Specialist panel since 1996 and is an accredited Senior Litigator of the Association of Personal Injury Lawyers.
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