SD AS LEGAL REPRESENTATIVE OF LD AGAINST GRAMPIAN HEALTH BOARD

Factual and Procedural Background

The Plaintiff is the mother of a child born at The Hospital by caesarean section on 24 August 2008. The child suffers from quadriplegic dyskinetic cerebral palsy and requires continuous care. The Plaintiff initiated an action for damages alleging negligence by midwives and an obstetrician involved during her care on the induction and labour wards, which she claimed caused the child’s injuries. The initial trial found no breach of duty. The Plaintiff appealed, focusing on alleged negligence by the ward round doctors and one obstetrician, Dr Sripada, specifically regarding decisions during induction ward rounds, causation related to injuries after transfer to the labour ward, and the failure to arrange an emergency caesarean section at 0410 hours on 24 August.

The background facts detail the induction of labour beginning on 21 August 2008, with medical interventions including administration of Prostin and monitoring of contractions and foetal wellbeing. Concerns about meconium staining and foetal heart rate were noted. The Plaintiff was transferred to the labour ward around midnight on 24 August. Dr Sripada assessed the foetal heart trace as suspicious but not pathological at 0410 hours and decided against immediate caesarean section, planning a review in 30 minutes. Shortly thereafter, foetal bradycardia occurred, necessitating an emergency caesarean section. The child suffered severe acute asphyxia due to umbilical cord occlusion during rapid labour progression.

At proof, evidence was led from the Plaintiff, midwives, Dr Sripada, and multiple expert witnesses addressing the care decisions and interpretation of medical data. The Lord Ordinary found no breach of duty by the midwives and accepted that reasonable obstetricians could differ in interpreting the CTG trace at 0410 hours. The case against the ward round doctors was dismissed due to insufficient evidence, and Dr Sripada’s decisions were found to be reasonable. The appeal challenges these findings.

Legal Issues Presented

1. Whether the ward round doctors breached their duty of care in decisions during induction ward rounds, particularly regarding administration of Prostin and transfer to the labour ward.
2. Whether there was a sufficient causal connection between any negligent acts or omissions and the injuries suffered by the child after transfer to the labour ward.
3. Whether Dr Sripada negligently failed to arrange an emergency caesarean section at 0410 hours on 24 August.

Arguments of the Parties

Appellant's Arguments

• The ward round doctors should have prescribed or administered a second dose of Prostin and arranged earlier transfer to the labour ward, as failure to do so contributed to injury.
• Dr Sripada’s decision to delay caesarean section at 0410 hours was negligent because there was no reasonable or rational basis for waiting given all risk factors, including the absence of a realistic prospect of vaginal delivery and presence of meconium.
• The Lord Ordinary erred in relying on collateral notes and expert testimony that supported the reasonableness of Dr Sripada’s decision.
• The Lord Ordinary gave insufficient reasons for rejecting causation and failed to properly address the scope of duty of the ward round doctors.

Respondent's Arguments

• No breach of duty was established against the midwives or ward round doctors; the induction process was midwifery led and decisions were within professional standards.
• Dr Sripada’s interpretation of the CTG trace as suspicious rather than pathological was reasonable; reasonable obstetricians could differ in opinion.
• The risk factors did not justify immediate caesarean section; waiting 30 minutes for review was low risk and medically appropriate.
• The admission regarding delivery by 0450 hours related only to causation against Dr Sripada, not to negligence in the induction ward.
• The scope of duty principles as applied in Meadows v Khan support that the ward round doctors were not liable for the unforeseeable rapid labour complications causing injury.

Table of Precedents Cited

Court's Reasoning and Analysis

The court carefully reviewed the extensive factual and expert evidence. It acknowledged that induction of labour was midwifery led and that the decisions of midwives regarding administration of Prostin and membrane sweep were within acceptable professional judgment. The suspicion of meconium was never confirmed, and transfer timing was consistent with standard practice.

Regarding the ward round doctors, the court found no pleaded case of negligence and insufficient evidence to support holding them liable. The lack of medical direction was noted but did not amount to breach of duty given the midwives' accepted practice and absence of evidence of differing standards.

The critical issue was Dr Sripada’s interpretation of the CTG trace at 0410 hours. Expert evidence showed a genuine divergence of opinion whether the trace was suspicious or pathological. The court held that Dr Sripada’s view was reasonable and defensible, and thus not negligent. The decision to wait 30 minutes for review was medically justifiable and low risk. The rapid and unforeseeable progression of labour and cord occlusion causing injury could not have been predicted or prevented by earlier intervention.

On causation, the court found no sufficient evidence that earlier transfer or administration of Prostin would have altered the outcome. The injury was too remote from alleged midwifery failings, and the admission regarding delivery by 0450 hours did not relate to the induction ward negligence allegations. The scope of duty principles further supported that the induction ward doctors were not liable for the sudden labour complications.

The court declined to entertain a new argument that a caesarean section was inevitable at 0410 hours, as it was not supported by evidence or pleaded at trial. The court emphasized that a mere argument for a different course of action does not meet the legal test for negligence.

Holding and Implications

The court REFUSED THE RECLAIMING MOTION and upheld the decision of the Lord Ordinary. The findings of no breach of duty by the midwives, ward round doctors, and Dr Sripada were affirmed. The court concluded that the evidence did not establish negligence or causation sufficient to hold any party liable for the child’s injuries.

The decision results in dismissal of the Plaintiff’s appeal with no new precedent established. The judgment clarifies the application of professional judgment standards in obstetric care, the importance of scope of duty in medical negligence, and the necessity of evidential foundation for causation and breach of duty claims.