Negligence in Medical Endoscopic Procedures:

Comprehensive Analysis of Hamilton v Lanarkshire Health Board [2020] ScotCS 24

Introduction

In the landmark case of Derek Hamilton against Lanarkshire Health Board ([2020] ScotCS 24), the Scottish Court of Session addressed critical issues surrounding medical negligence within endoscopic procedures. The case revolves around Mr. Derek Hamilton, who sustained severe injuries after an alleged negligent endoscopic removal of a dental plate by Mr. Martin Downey, a consultant general surgeon with a sub-specialism in colorectal surgery employed by Lanarkshire Health Board.

Summary of the Judgment

The court found in favor of Mr. Hamilton, concluding that Mr. Downey had breached his duty of care, thereby causing the perforation of Mr. Hamilton's oesophagus. The judgment underscored that Mr. Downey's decision to persist with an endoscopic removal, despite the specialized nature of the procedure relative to his expertise, deviated from standard medical practices. Consequently, Mr. Hamilton was awarded damages amounting to £195,000, with further considerations regarding interest and expenses.

Analysis

Precedents Cited

The judgment extensively applied established legal principles concerning negligence, particularly drawing upon the Bolam Test, which assesses whether a medical professional has acted in accordance with a practice accepted as proper by a responsible body of medical opinion. The court also referenced key cases such as Hunter v Hanley (1955) and Sidaway v Bethlehem Royal Hospital Governors (1985), which clarify the standards for determining breach of duty and the applicability of sub-specialist expertise in medical negligence claims.

Legal Reasoning

The court's legal reasoning was grounded in the three-fold test for breach of duty: establishing a standard of care, demonstrating that the defendant failed to meet this standard, and proving causation linking the breach to the harm suffered. The evidence presented revealed that Mr. Downey, despite his colorectal specialization, lacked substantial experience in upper gastrointestinal (GI) endoscopic procedures. This deficiency was critical as the procedure in question involved removing a dental plate from the oesophagus—a task typically managed by upper GI specialists.

Expert testimonies from surgeons like Mr. Geoffrey Pye and Mr. Simon Galloway were pivotal. They highlighted that Mr. Downey's persistent endoscopic attempts, despite encountering resistance and the specialized nature of the procedure, did not align with the standard practices endorsed by experienced upper GI professionals. The court also considered the timing of Mr. Hamilton's deterioration and the corresponding lab results, which supported causation occurring during the second endoscopy.

Impact

This judgment has significant implications for medical practitioners, particularly general surgeons with sub-specializations. It reinforces the necessity for surgeons to recognize the boundaries of their expertise and to refer or involve specialists when handling procedures outside their primary field. The case underscores the judiciary's expectation that medical professionals adhere to established standards of care, especially in high-stakes and specialized procedures.

Furthermore, the judgment serves as a deterrent against overreaching in medical practice and highlights the importance of continuous professional development and specialization acknowledgment. Hospitals and medical boards may also take heed, reinforcing protocols that ensure appropriate expertise is matched with corresponding medical procedures.

Complex Concepts Simplified

Bolam Test

The Bolam Test originates from medical negligence law, establishing that a doctor is not negligent if they act in line with a practice accepted by a responsible body of medical professionals. It emphasizes peer acceptance as a benchmark for standard care.

Oesophageal Perforation

Oesophageal perforation refers to a hole or tear in the oesophagus, which can lead to severe complications like infection and sepsis. It is a medical emergency requiring immediate intervention to prevent life-threatening conditions.

Laparotomy

A laparotomy is a surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity. It is often performed to diagnose or treat various abdominal conditions.

Endoscopic Procedure

An endoscopic procedure involves using an endoscope—a flexible tube with a camera and light—to visualize internal organs. In this case, it was utilized to remove a swallowed dental plate from the oesophagus.

Conclusion