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The issues to be decided in this trial
The issues to be decided in this trial
Liability
Has the claimant proved on the balance of probabilities, that the defendant negligently breached his duty of care owed to the claimant by:
Incorrectly grading her haemorrhoids as grade 2 / 3, when in fact they should have been graded as grade 1 / 2; and
Advising the claimant based on this incorrect grading to undergo a surgical haemorrhoidectomy when surgery was not an appropriate treatment option given that both parties agree that a surgical haemorrhoidectomy would not be indicated for grade 1 / 2 haemorrhoids and the claimant should therefore have been advised to undergo non-surgical treatment options which she probably would have opted for.
If the claimant has not proved on the balance of probabilities that the defendant’s grading of her haemorrhoids as grade 2 / 3 was incorrect, then I must decide whether the claimant has established on the balance of probabilities that the defendant negligently breached his duty of care owed to the claimant by:
Failing to advise the claimant of the risks and benefits of a surgical haemorrhoidectomy, including failing to advise her of the risk of anal stenosis; and / or
Failing to advise the claimant of alternative non-surgical treatment options and the risks and benefits of these options.
- Heading
- Ms Sarah Clarke KC Sitting as a Deputy Judge of the High Court
- Haemorrhoid grading system
- The issues to be decided in this trial
- Causation
- Burden and standard of proof
- Counsel
- The applicable law In Hunter v Hanley [1955] SC 200, at [204] (“ Hunter ”), Lord President Clyde held that: “…[a surgeon] is not negligent merely because his conclusion differs from that of other professional men, nor b
- In Bolam v Friern Hospital Management Committee [1957] 1 WLR 583, at [587] (“ Bolam ”), Mr Justice McNair summarised the test as follows: “…[a surgeon] is not guilty of negligence if he has acted in a
- The House of Lords subsequently qualified the Bolam test in Bolitho v Hackney HA [1998] AC 232 (“ Bolitho ”), at [241H]-[242A] (Lord Browne-Wilkinson) by explaining that, “The use of these adjectives
- Consenting a patient to a procedure In Montgomery v Lanarkshire Health Board [2015] UKSC 11 , at [86] to [87] (“ Montgomery ”) the Supreme Court held in relation to the issue of appropriate consenting of a patient to a procedure
- Where the advice given by the doctor for the purposes of consent is informed by clinical judgment, the approach described in Hunter and Bolam remains applicable to that exercise of clinical judgment (
- Causation In Chester v Afshar [2004] UKHL 41 (“Chester”), the majority of the House of Lords held that causation will be established not only in respect of a patient who would have declined the surgery if prope
- Section 16
- The approach to witness evidence generally
- The witnesses
- The claimant
- The defendant
- Expert evidence
- The claimant’s expert witness – Mr Michael Thompson (“Mr Thompson”)
- The defendant’s expert witness – Professor Robin Phillips (“Professor Phillips”)
- Relevant facts, evidence and findings
- The defendant
- The claimant’s history
- The claimant’s appointment with the Private GP
- The GP’s referral letter
- The first consultation with the defendant
- Flexible sigmoidoscopy procedure
- The second consultation with the defendant
- The process of grading the haemorrhoids
- Advice on treatment options and risks of surgery
- The operation
- The operation note and findings
- Letter of complaint
- Causation
- Submissions
- The defendant
- Discussion
- Issues 2 - If the claimant has not proved on the balance of probabilities that the defendant’s grading of her haemorrhoids as grade 2 / 3 was incorrect, then has the claimant established on the balanc
- Issues 3 - 4 – Causation
- Conclusions