Introduction

The case of ALAN MCNAB AND OTHERS AGAINST GREATER GLASGOW HEALTH BOARD ([2020] CSOH 53) was adjudicated in the Outer House of the Court of Session on May 28, 2020. The plaintiffs, relatives of the deceased Alexandra McNab, alleged clinical negligence against Ms. Lizette Seaward, a consultant urological surgeon employed by the defendant health board. Central to the dispute were claims of inadequate informed consent and failure to properly assess and manage the risks associated with a ureteroscopy procedure, which the plaintiffs contend led to the deceased's death.

The plaintiffs argued that Ms. Seaward did not sufficiently inform Alexandra McNab of the heightened risk of urosepsis given her medical history and failed to confirm the presence of a kidney stone before proceeding with surgery. The defense maintained that informed consent was duly obtained and that the medical decisions were within acceptable professional standards.

Summary of the Judgment

Justice Lady Carmichael delivered the opinion of the court, concluding that the defendants, specifically Ms. Seaward, were not negligent. The court found that informed consent had been properly obtained, and the risks associated with the procedure had been adequately communicated. Moreover, the decision to proceed without a CT scan was deemed to be within the bounds of acceptable medical practice given the circumstances and the medical opinions presented.

The court held that the plaintiffs did not sufficiently prove that the standard of care was breached and that any potential failures did not causally link to the deceased's death. As such, the claims brought forth by the plaintiffs were dismissed, affirming the actions taken by the medical professionals involved.

Analysis

Precedents Cited

The judgment extensively referenced several key precedents that have shaped the legal landscape surrounding informed consent and clinical negligence:

• Montgomery v Lanarkshire Health Board (2015): Established that doctors must ensure patients are aware of any material risks involved in proposed treatments and of any reasonable alternatives.
• Bolitho v City and Hackney Health Authority (1998): Clarified that medical opinions must withstand logical analysis and rational scrutiny to be considered valid in negligence claims.
• Hunter v Hanley (1955): Emphasized that negligence claims require proof that a standard of practice was not met by a professional of ordinary skill.
• Keefe v Isle of Man Steam Packet Co Ltd (2010), Raggett v Kings College NHS Trust (2016), Gateway Assets v CV Panels (2018): These cases were cited to support the principle that adverse inferences can be drawn from defendants' failure to provide necessary evidence.

Legal Reasoning

The court's legal reasoning centered on assessing whether Ms. Seaward met her duty of care in obtaining informed consent and whether her clinical decisions were aligned with standard medical practices. Key points include:

• Informed Consent: The court examined whether the risks of ureteroscopy, including sepsis, were adequately communicated. It considered whether the absence of detailed documentation undermined the validity of the consent.
• Risk Assessment: The judgment delved into whether the previous episode of sepsis in 2011 significantly increased the risk in 2013 and whether this heightened risk was appropriately managed.
• Professional Standards: The court evaluated expert testimonies to determine if Ms. Seaward's actions were consistent with what a reasonable body of professional medical practitioners would do under similar circumstances.

Ultimately, the court found that Ms. Seaward did provide sufficient information for informed consent and that her decision to proceed without a CT scan was justifiable within the context of her medical judgment and the standards of her profession.

Impact

This judgment reinforces the standards set by Montgomery regarding informed consent, particularly in emphasizing that the absence of detailed documentation does not necessarily negate the validity of consent obtained verbally and in good faith by the medical practitioner. It underscores the necessity for medical professionals to engage in meaningful dialogues with patients, ensuring they understand the risks and benefits of proposed treatments.

Additionally, the case highlights the importance of balancing professional medical judgment with established protocols, especially in complex cases involving significant patient risk factors. Future clinical negligence cases will likely reference this judgment when assessing whether informed consent was adequately obtained and whether medical practitioners adhered to professional standards.

Complex Concepts Simplified

Informed Consent

Informed consent is a fundamental principle in medical ethics and law, requiring that patients are fully informed about the potential risks, benefits, and alternatives of a proposed treatment before agreeing to undergo it. This ensures that patients make autonomous and educated decisions regarding their healthcare.

Material Risks

A material risk is one that a reasonable person in the patient's position would likely consider significant when deciding whether to proceed with the treatment. It is not solely based on statistical probability but also on the impact that the risk may have on the patient's life and well-being.

Duty of Care

Duty of care refers to the legal obligation of professionals, including doctors, to adhere to a standard of reasonable care while performing acts that could foreseeably harm patients. Breaching this duty can lead to claims of negligence if harm results.

Bolitho Test

The Bolitho test determines whether an expert's opinion in negligence cases is both logically defensible and based on a reasonable body of professional judgment. If an expert's opinion cannot withstand logical scrutiny, it may be disregarded by the court.

Conclusion

The judgment in ALAN MCNAB AND OTHERS AGAINST GREATER GLASGOW HEALTH BOARD serves as a reaffirmation of the standards surrounding informed consent in clinical settings. It underscores that while thorough documentation is ideal, the absence of immediate records does not inherently equate to a failure in obtaining informed consent, provided that the practitioner can credibly demonstrate that comprehensive information was conveyed to the patient.

Moreover, the court’s analysis emphasizes the balance between adhering to professional guidelines and exercising individual medical judgment. By siding with Ms. Seaward, the court highlighted the importance of context-specific decision-making in medical practice, especially when dealing with patients who have complex medical histories.

For medical professionals, this judgment underscores the critical nature of effective communication with patients and the necessity of ensuring that consent processes are both thorough and patient-centered. For patients and their families, it reaffirms the legal protections in place to ensure that their autonomy and well-being are prioritized in medical decision-making.