The scope of the duty of care of a junior doctor

George Andrews v Greater Glasgow Health Board [2019] CSOH 31

The Scottish Court of Session judgment in Andrews v Greater Glasgow Health Board addresses the scope of the duty of care of a junior doctor; and whether a case will fail on causation, if a precise point in time when an event would have occurred could not be determined. The focus of this article is on the former issue.

Background

This case concerned the death of an elderly lady caused by an ischaemic bowel. She had attended hospital by ambulance with symptoms of chest and upper epigastric pain, vomiting and diarrhoea. Investigations were mostly normal, and she was discharged home by the junior doctor with a diagnosis of viral gastroenteritis. Prior to her discharge, the junior doctor discussed the deceased’s case with the on call consultant who approved the decision. Her symptoms developed and following a return to hospital, ischemic bowel secondary to superior mesenteric artery thrombosis was noted. A laparotomy confirmed significant necrosis and resection was unfortunately not possible.

Decision

With regard to breach of duty, the pursuer argued, inter alia, that the junior doctor should have recognised that the deceased might be suffering from a serious medical condition; and that he therefore failed to advise her that she should be admitted to hospital.

In finding for the pursuer, Lord Pentland held that the junior doctor was negligent in having failed to give that advice, which the deceased would have accepted. Furthermore, the junior doctor had provided the consultant with inaccurate information about the deceased and her circumstances, which he had to be held responsible for.

The defenders had sought to rely on a passage in Jones on Medical Negligence (5th ed paragraph 3.115) which stated that:-

“Inexperienced doctors will discharge their duties of care by seeking the assistance of their superiors to check their work, even though they may themselves have made a mistake”.

While it was accepted that much will depend on the particular facts and circumstances of the case, Lord Pentland rejected this position. He stated that it would be “going too far to say that there [was] any clear principle to this effect”, and added that:-

“In general, the principle is that a junior and inexperienced doctor must achieve the same standard of care as a more experienced colleague would be expected to bring to the task in hand.”

Lord Pentland also considered the English decision of FB v Rana [2017] in which the Court of Appeal held that in taking a case history, a junior doctor did not hold a lesser duty than a more experienced colleague. While the Trial judge in that case considered that the junior doctor could not be expected to elicit the relevant history, the Court of Appeal held that a doctor is to be judged by the standard of skill and care appropriate to the post which he or she was fulfilling, and not their experience.

In applying this principle, Lord Pentland found that the junior doctor in the present case did not carry out a sufficient assessment of the deceased to exclude the possibility that she was suffering from a serious condition.

Comment

It is clear from this decision that inexperience is not an effective defence to an action for professional negligence. The junior doctor owed the deceased a stand-alone duty of reasonable care. The fact that he discussed the deceased’s case with the on call consultant did not have the effect of exonerating him from his failure to exercise reasonable care.

This decision, together with the developing common law of clinical negligence, reinforces the importance of full and accurate patient information being obtained, recorded, and discussed with senior colleagues.