Introduction

The case of SD against NHS Grampian Health Board ([2022] ScotCS CSOH_63) adjudicated by the Scottish Court of Session on 7th September 2022 addresses critical issues surrounding medical negligence in obstetric care. The plaintiff, SD, represented by Khurana QC, sought damages for her son, LD, who suffered severe disabilities due to alleged negligence during his birth. The defendants, represented by Stephenson QC and the NHS Scotland Central Legal Office, contested these claims, leading to an extensive examination of the care provided during labor and delivery at Aberdeen Maternity Hospital (AMH).

Central to the dispute were allegations of negligence by midwives and Dr. Sreebala Sripada, particularly concerning the administration of Prostin (a prostaglandin used to induce labor), interpretation of Cardiotocography (CTG) traces, and decisions related to performing emergency cesarean sections.

Summary of the Judgment

After a thorough examination of evidence over five weeks, the court concluded that there were no breaches of duty by the midwives involved in SD's care. The decision not to administer a second dose of Prostin was deemed cautious but within normal clinical practice. Furthermore, the allegation against Dr. Sripada for failing to act promptly was dismissed as the judgment recognized that her actions were reasonable given the circumstances and available information.

The court emphasized the importance of expert testimony in such cases, ultimately favoring the opinions of seasoned experts who upheld standard medical practices. Consequently, the decree of absolvitor was pronounced, absolving NHS Grampian Health Board and the associated medical staff of negligence.

Analysis

Precedents Cited

The judgment references several key cases that have shaped the legal framework for medical negligence:

• Hunter v Hanley (1955 SC 62): Established the foundational test for negligence in medical cases.
• Honisz v Lothian Health Board (2008 SC 235): Reinforced the principles from Hunter v Hanley, emphasizing the role of expert opinion in negligence claims.
• Bolitho v City and Hackney Health Authority (1998) AC 232: Introduced the concept that expert opinions must stand up to logical analysis.
• Meadows v Khan: Addressed the scope of duty and causation in wrongful birth claims.

These precedents were pivotal in guiding the court's approach to evaluating the evidence and determining the presence of negligence.

Legal Reasoning

The court employed a systematic approach to assess whether the defendants breached their duty of care. Key elements of the legal reasoning included:

• Duty of Care: Determining the extent of the medical staff's obligations towards the patient.
• Breach of Duty: Evaluating whether the defendants failed to meet the standard of care expected.
• Causation: Establishing a direct link between any alleged breach and the harm suffered by the plaintiff.

Expert testimonies played a crucial role, with the court weighing conflicting opinions to ascertain what constitutes standard practice. The judgment underscored that while medical professionals possess discretion in decision-making, their actions must align with accepted standards to avoid liability.

Impact

This judgment reinforces the importance of adhering to established medical guidelines and protocols in obstetric care. It highlights the necessity for:

• Clear Communication: Between midwives, doctors, and patients to ensure informed decision-making.
• Adherence to Protocols: While allowing professional discretion, deviations must be justified and within reasonable bounds.
• Expert Testimony: Continues to be essential in medical negligence cases, guiding courts in complex clinical scenarios.

Future cases will likely reference this judgment when assessing medical negligence claims, particularly concerning the administration of labor-inducing agents and the interpretation of fetal monitoring data.

Complex Concepts Simplified

Cardiotocography (CTG)

CTG is a technical tool used to monitor a fetus's heartbeat and the mother's uterine contractions during pregnancy and labor. It helps in assessing the well-being of the fetus and detecting any distress.

Prostin (Artificial Prostaglandin)

Prostin is a medication administered to induce labor by stimulating uterine contractions. It is typically given in doses to help ripen the cervix and initiate labor.

Bishop Score

The Bishop Score is a system used to evaluate the readiness of the cervix for labor. It assesses factors like dilation, effacement, and position to predict the success of labor induction.

Decelerations in CTG

Decelerations refer to temporary drops in the fetal heart rate. They are categorized based on their timing and characteristics:

• Early Decelerations: Occur in sync with uterine contractions, typically due to head compression.
• Late Decelerations: Occur after the peak of contractions, often indicating fetal hypoxia.
• Variable Decelerations: Irregular in timing and shape, usually caused by umbilical cord compression.

Conclusion

The judgment in SD against NHS Grampian Health Board serves as a reaffirmation of established standards in medical negligence, particularly within obstetric care. By meticulously analyzing the evidence and expert testimonies, the court underscored the importance of adhering to medical protocols while allowing for professional discretion. The decision avers the responsibilities healthcare professionals bear in ensuring patient safety and the critical nature of timely interventions based on monitored data.

This case reinforces the judiciary's reliance on expert opinions in medical negligence claims and sets a precedent for future deliberations on similar matters. It emphasizes that while medical professionals are granted discretion, their actions must consistently align with accepted practices to fulfill their duty of care and avoid liability.