Medical Negligence in the Treatment of Pre-eclampsia

The current case involves determining the medical care and treatment that is required for Gilly suffering from pre-eclampsia, and whether or not there is an issue of negligence that Gilly can claim against the Fairgrreen Hospital

Issue 1 - Standard treatment procedure for pre-eclampsia

The only cure for pre-eclampsia is by delivering the baby. A person suffering from pre-eclampsia must be closely monitored until the time it is possible to deliver the baby. The person must stay in a hospital until the baby can be delivered. In this case, Gilly got admitted as she was suffering from pre-eclampsia and was discharged before delivering Fenella. Fairgrreen Hospital has breach the standard of care required in treating a person suffering from pre-eclampsia.

While at the hospital, the treatment requires that person must be monitored with regular blood pressure checks, urine checks to monitor protein level, blood tests to check kidney and liver health; and ultrasound scans to monitor blood flow through the placenta, growth of the baby, and baby's breathing and movements. The facts of the case do not show this level of monitoring the health of Gilly. Fairgrreen Hospital just took a scan. Fairgrreen Hospital has also breached this requirement too.

In cases of pre-eclampsia, delivering the baby at about the 37th to 38th week is recommended where artificial delivery is induced or a caesarean section is conducted as waiting for labour to start has no benefit. If the person is less than 37 weeks pregnant, pregnancy must be prolonged as long as it is safe so as to allow the baby to develop more. Delivery is subject to how high the blood pressure is, signs of kidney or liver problems, and the condition of the baby. In case the preeclampsia is mild, the person may be able to stay at home on bed rest, but requires frequent check-ups and tests. Complete bed rest is no longer recommended, but activity level is recommended. If the person is advised to self-care at home, they will be advised of dietary changes, and medicines to tackle

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1. NHS, ‘Treatment: -Pre-eclampsia’ accessed 24 July 2021 .
2. Ibid.
3. Ibid.
4. Ibid.
5. U.S. National Library of Medicine ‘Preeclampsia - self-care’ (2020) accessed 24 July 2021 .

blood pressure problems. Prenatal visits are important to care for the baby. If the condition is severe before the 37th week causing serious concerns for the person or the baby’s health, there must be an early delivery. The person must be informed about the risks of such early delivery and pre-eclampsia so the best decision regarding the treatment could be made.

The fact of the current case shows that Gilly has a severe pre-eclampsia because of the complication she developed from the accident. Her GP, as a result, advised her before her pregnancy that a caesarean operation would be the safest form of delivery given her injuries. Despite being aware of Gilly’s condition and knowing that the baby was small for its gestational age, the consultant did not consider Gilly’s pre-eclampsia to be serious and did not advise any urgent action. Gilly was 30 weeks pregnant at the time she was admitted. This is against the required treatment where the consultant should have had performed an early delivery as Gilly was suffering from a severe pre-eclampsia. There was no requirement for the doctor to prolong the pregnancy by considering that Gilly was well enough to go full term and that the baby would be better

as it was not safe by discharging Gilly and advising her rest and to refrain from work. This advise was otherwise suitable for mild preeclampsia. Moreover, the consultant advised Gilly of bed rest at home. As a practitioner, he should have known that complete bed rest is no longer recommended. The consultant did not guide Gilly of the necessary dietary changes and medicines to take and the activities that Gilly was required to take.

Issue 2 - Law of negligence

The failure to conduct the necessary treatment for Gilly has caused Fanella serious brain damage. The law of negligence will be applicable here to determine whether or not Gilly has a claim in negligence. Gilly must establish certain elements in order to succeed in her claim of negligence.

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6. U.S. National Library of Medicine ‘Preeclampsia - self-care’ (2020) accessed 24 July 2021 .
7. NHS, ‘Treatment: -Pre-eclampsia’ accessed 24 July 2021 .

Negligence arises due to a breach of the duty of care. Therefore, Gilly must established that the consultant owes a duty of care towards her and her baby and that he caused the breach of his duty harming Gilly and her baby. For such duty of care, the consultant and Gilly must have a sufficiently close relationship and that he must have reasonably foresaw the harm. If these elements are established by Gilly, Fairgrreen Hospital will be liable.

This current case involves a medical negligence on the part of Fairgrreen Hospital and as such the balance of probabilities will be applicable. Gilly must therefore establish that actions of the consultant are the most likely cause of the harm her baby suffered. The burden of proof falls of Gilly. She needs to establish a link between the consultant’s action and the harm the baby is suffering based on the balance of probabilities. For doing thus, the but for test can be applied to identify the cause of harm to the baby and assessing the negligence of the consultant. Thus, if Gilly proves that if not for the consultant’s actions, the baby would not have suffered the brain damage. In such case, Gilly would have a successful claim of negligence. To reiterate, there must be a causal link between the action of the consultant and the harm caused to the baby. Causation must be proved on the balance of probabilities.

In cases involving medical negligence such as the current case, causation must be established. Gilly must understand that the UK law of medical negligence recognises the independent standard of medical care set up by the medical profession. There are a few tests that are adopted in the law of medical negligence to prove negligence. Such tests are founded in case laws. For example, failure to communicate known risks in a medical treatment is negligence. Omission to provide medical advice is negligence. Misdiagnosis is negligence that caused the harm. However, it may not lead to the same outcome even where after diagnosis

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8. Donohue v Stevenson [1932] UKHL 100; James Plunkett, The Duty of Care in Negligence (Bloomsbury Publishing 2018).
9. Caparo plc v Dickman [1990] AC 605
10. Bolitho v City and Hackney Health Authority [1998] AC 232.
11. Palmer v Portsmouth Hospitals NHS Trust [2017] EWHC 2460 (QB.
12. Pickford v Imperial Chemical Industries (1998) 1 WLR 1189.
13. Hearne v Royal Marsden Hospital NHS Foundation Trust [2016] EWHC 117 (QB)
14. Kim Price, ‘Towards a history of medical negligence’ (2010) 375(9710) The Lancet 192.
15. Chester v Afshar [2004] UKHL 41
16. Montgomery v Lanarkshire Health Board (Scotland) [2015] UKSC 11.
17. Bolam v Friern Hospital Management Committee [1957] 1 WLR 582.

and treatment, the complications to the patient could not have been avoided. Failure to prescribe standard tests is negligence on the part of the doctor. Leaving the patient worse off than before is negligence.

For establishing a duty of care, a misdiagnosis or lack of medical care can be proven to demonstrate a breach of duty of care where there is proximity, which can be physical, circumstantial, or causal proximity, and where the doctor assumed charge of the patient. In this case, proximity between Gilly and the consultant cannot be disproved, and hence, the consultant has a duty to care towards Gilly and the baby. The consultant, being a doctor, has a standard of care towards their patients. The test of medical negligence is whether or not the actions of the consultant do not meet the actions expected out of a medical professional with similar skills and knowledge. As such, his actions will be compared with what a reasonable doctor possessing similar skill and experience as his would have done in the same case. If his action falls out of line from what is reasonably expected, the consultant will be liable for negligence.

Considering the tests, the consultant did not comply with the standard of care needed for Gilly. He owed a duty of care towards Gilly and the baby. He breached his duty causing harm to the baby when he failed to communicate known risks of not following the required treatment in case of a severe pre-eclampsia. He did not provide the necessary medical advice (dietary changes and relevant medicines) when he advise Gilly of rest at home. He misdiagnosed the severe pre-eclampsia as mild. If it was otherwise, the complications and harm could have been prevented. He prescribed only a scan but failed to prescribe other standard tests to check blood pressure, urine checks is negligence on the part of the doctor. The consultant should have advised for early delivery as it was as severe pre-eclampsia rather than discharging Gilly and prolonging the delivery. The consultant left Gilly worse off than before. As such, he will be liable for negligence.

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18. Hotson v East Berkshire Area Health Authority [1987] 2 All ER 909.
19. Bolam v Friern Hospital Management Committee [1957] 1 WLR 582.
20. Bolitho v City and Hackney Health Authority [1998] AC 232.
21. Colin Mitchell, et al, ‘Exploring the potential duty of care in clinical genomics under UK law’ (2017) 17 (3) Medical law international 158.
22. Sidway v Bethlem Hospital Royal Governors [1985] 1 All ER 643.

Courts may also assess negligence on the basis of the material contribution to harm. Fairgrreen Hospital can claim that Gilly did not rest and went for work against the advice of the consultant. Her action has also contributed to the harm caused. Further, it can also claim that despite the consultant’s advise to induce delivery, Gilly requested for delay in the inducement to wait for her husband to arrive. Fairgrreen Hospital can claim that the delay of 36 hours caused by Gilly had caused the harm. However, there is a link between causation with consent, and Gilly’s right to choose. If the consultant had advised Gilly of the risks of delaying the inducement, Gilly would have had the made an informed decisions of proceeding with the inducement on time.

To conclude, considering the facts and relevant legal principle, Fairgrreen Hospital would be liable for negligence.



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23. Dr Sido John v Central Manchester and Manchester Children's University Hospitals NHS Foundation Trust [2016] EWHC 407.
24. Chester v Afshar [2004] UKHL 41.
25. Turton G., ‘Informed consent to medical treatment post-Montgomery: causation and coincidence’ (2019) 27 Med Law Rev. 108–134.

Continue your exploration of Medical Assessment with our related content.

Bibliography

Cases

Bolam v Friern Hospital Management Committee [1957] 1 WLR 582

Bolitho v City and Hackney Health Authority [1998] AC 232

Caparo plc v Dickman [1990] AC 605

Chester v Afshar [2004] UKHL 41

Donohue v Stevenson [1932] UKHL 100

Dr Sido John v Central Manchester and Manchester Children's University Hospitals NHS Foundation Trust [2016] EWHC 407

Hearne v Royal Marsden Hospital NHS Foundation Trust [2016] EWHC 117 (QB)

Hotson v East Berkshire Area Health Authority [1987] 2 All ER 909

Montgomery v Lanarkshire Health Board (Scotland) [2015] UKSC 11

Palmer v Portsmouth Hospitals NHS Trust [2017] EWHC 2460 (QB)

Pickford v Imperial Chemical Industries (1998) 1 WLR 1189

Sidway v Bethlem Hospital Royal Governors [1985] 1 All ER 643

Books

Plunkett J, The Duty of Care in Negligence (Bloomsbury Publishing 2018)

Journals

Mitchell C, et al, ‘Exploring the potential duty of care in clinical genomics under UK law’ (2017) 17 (3) Medical law international 158

Price K, ‘Towards a history of medical negligence’ (2010) 375(9710) The Lancet 192.

Turton G., ‘Informed consent to medical treatment post-Montgomery: causation and coincidence’ (2019) 27 Med Law Rev. 108–134

Websites

NHS, ‘Treatment: -Pre-eclampsia’ accessed 24 July 2021