In a 2015 case, Mrs Montgomery, a type 1 diabetic of small stature, developed shoulder dystocia when going into labour. On these facts the judge found that the claimant had established a causal link between the breach and the injury she had sustained and held that the defendant was liable in damages (Parliament, 2003). The body of doctors Bolam test was subsequently lifted and adopted by the Court of Appeal and High Court in cases like Maynard v West Midlands RHA 1984 1 WLR 634 and Sidaway v Bethlem and Maudsley Hospitals 1985 AC 871 to become “the Bolam test”. There have been many trials and tribulations denting the Bolam principle, but its core still remains intact. A doctor is not guilty of negligence if he or she has acted in accordance with a practice accepted as proper and responsible by a responsible body of medical practitioners skilled in t… In other words, the Bolam test states that “If a doctor reaches the standard of a responsible body of medical opinion, he is not negligent”. Nothing in this briefing constitutes legal advice. Bolam (Bolam v Friern Hospital Management Committee [1957] 2 All ER 118) principle is not extended, they still have an innate reluctance to abandon it in resp Maidstone, Prospect Health Although many challenges and amendments have occurred, still the over-riding gold standard of defence in medical negligence is the Bolam test. Bolam sets out that a doctor is not negligent if they have acted in accordance with a responsible body of opinion. The case concerned a hypothetical situation that would have existed had the Claimant been referred for necessary investigations sooner. The voice for today's GP. Waterlooville, Hampshire, Fylde Private GP The Bolam test The Bolam test was first recognised in the case of Bolam vs Friern Hospital Management Committee. This was known as the Bolam test. For many years the accepted practice around informed consent to treatment, including medication, was based on  the “Bolam” test. The defence for the doctor argued that even if she had attended, she would not have intubated. She sued Dr Hanley alleging negligence. The jury returned the verdict in favour of the defendants in the court case, heard in 1957, in a verdict that has become a key test for breach of professional duty. Ipswich City, Menlo Park Recruitment Relevant themes: montgomery v lanarkshire health board, informed consent, bolam test. This was a case in which the issue of when to hold a discussion of options for management was a matter of medical judgment – and one therefore which would be governed by the Bolam test rather than by the principles in Montgomery. In accordance with the hospital’s usual practice of not administering a relaxant or applying manual restraint, the psychiatrist Dr Allfrey gave him electro convulsive therapy (ECT). Expert witnesses gave different views - some saying they would have intubated, others that they would not. Her baby developed hypoxia, leading to cerebral palsy. The Bolam principle, which is the keystone of the defence against medical negligence, is celebrating sixty years. Published by Royal College of Emergency Medicine, 25 January 2018. Although the original case was related to the alleged negligence of a doctor, the test has become the universal yardstick applicable to all health professionals. The court based its decision in part on GMC guidance on consent, which advises doctors to 'tailor your approach to discussion with patients according to (a) their needs, wishes and priorities, (b) their level of knowledge about and understanding of their condition, prognosis and treatment options, (c) the nature of condition, (d) the complexity of treatment and (e) the nature and level of risk associated with investigation/treatment'. Lord President Clyde directed the jury: 'The true test in establishing negligence in diagnosis or treatment on the part of the doctor is whether he has been proved to be guilty of such failure as no doctor of ordinary skill would be guilty of if acting with ordinary care.’ The jury returned verdict in favour of Dr Hanley, although a retrial was ordered on technical grounds. By referring to the importance of the accepted practice of other doctors, the Trust used the Bolam test. Castlebar, Mayo (IE), Faversham Medical Practice | The House of Lords ruled for the Health Authority in this case and within the ruling they applied a further element to the Bolam test: that of logic of a medical opinion. Case Five: David Spencer v Hillingdon Hospital NHS … Published by phg foundation (phgf), 31 March 2013. The NHS stands for National Health Service and provides its users with a quality standard of healthcare, irrespective of wealth. The information in this briefing is for general guidance on the principles of informed consent and the impact of recent case law. In the United Kingdom, the standard of care required successfully to defend a negligence claim derives from the case of Bolam v Friern Hospital Management Committee (1957): “The test is the standard of the ordinary skilled man exercising and professing to have that special skill.” While treating Mrs Hunter for bronchitis, Dr Hanley gave a course of penicillin injections. He pursue… Published by Scottish Parliament, 10 January 2019. Prescribing and Technical Information (1), Faculty of Dental Surgery, Royal College of Surgeons (1), National Institute for Health Research - NIHR (1), Public Health Institute, Liverpool John Moores University (1), Royal College of Emergency Medicine - RCEM (2), Royal College of Paediatrics and Child Health - RCPCH (1), Royal College of Physicians of London - RCP (1), View options for downloading these results, Publications - Medicines related conversations: changes to informed consent, The surgeon as an expert witness: a guide to good practice, Consent in Adults, Adolescents and Children in Emergency Departments, Consent: Supported Decision-Making: a guide to good practice, Consent, capacity and restraint of adults, adolescents and children in emergency departments, Obtaining consent: a clinical guideline for the diagnostic imaging and radiotherapy workforce, Factors that influence decision making by 8-12 year olds in child and adolescent mental health services (CAMHS): a systematic review, Managing incidental and pertinent findings from WGS in the 100,000 Genomes Project, SPICe briefing : informed consent in healthcare settings. Before Montgomery, a doctor's duty to warn patients of risks was based on whether they had acted in line with a responsible body of medical opinion. To satisfy the Bolam test, a medical professional must show that he acted in a way that a responsible body of medical professionals in the same field would regard as acceptable. The ruling. News, insights and clinical education. . These tests ask whether a doctor’s conduct would be supported by a responsible body of clinicians. Relevance This was recognised in the classic direction of McNair J. to a jury in Bolam vs Friern Hospital Management Committee. The test to be applied was set out by Lord Browne-Wilkinson… The Bolam test: on borrowed time?, Mayur Lakhani. The test is essentially a peer review of the doctor's behaviour - if others would have acted in a similar way, then the doctor is unlikely to have breached his duty of care. Treatment is not negligent if there is a responsible body of specialists practising that discipline who would have done the same, provided the view of that responsible body is capable of logical analysis (the Bolitho qualification). ECT was delivered without any muscle relaxant drugs and the patient was unrestrained apart from the presence of nursing staff to prevent him from falling off the bed. Previously, the Bolam test 14 in England and the Hunter v Hanley test 15 in Scotland were used to determine what should be disclosed. 08 October 2020 For many years the accepted practice around informed consent to treatment, including medication, was based on the “Bolam” test. Nurses were present on either side to prevent him from falling off the couch, but Bolam suffered acetabular fracture of both hips. Bolam was rejected in the 2015 Supreme Court decision of Montgomery v Lanarkshire Health Board. The Bolam test also defaults to a standard that can be supported by those with special skills (and of course interests) which may fall short of what is reasonably acceptable. This rule is known as the Bolam test, and states that if a doctor reaches the standard of a responsible body of medical opinion, they are not negligent. It states that if a doctor has acted according to proper and accepted practice, he is not guilty of medical negligence. Instead, doctors must provide infor… In 1954, John Bolam was admitted to Friern Hospital with relapse of depression. The Bolam Test is a means of assessing clinical negligence in Court. Conversely the “but for” test does not provide a complete or exclusive test of causation in the law of tort (Stapleton, 2015). The Hunter v Hanley case, in Scotland, preceded the Bolam case by two years, but illustrated the same principle. At the trial, the expert witnesses said that a large body of medical opinion was not in favour of using relaxant drugs. McNair J set out the test for determining the standard of care owed by medical professionals to their patients (sometimes referred to as the ‘Bolam test’). The case was dismissed because the court found that the doctor's only failure was not to attend - and that because she could reasonably have made the decision not to intubate she was not responsible for the boy's death. During the treatment, he sustained violent muscle spasms causing him to fracture both hips. Prospect Health View options for downloading these results. Bolitho narrowed the scope of the test, stating that the court must be satisfied that the body of opinion relied upon has a logical basis. 18 August 2017. The court accepted that if Mrs Montgomery been told about the risk of dystocia, she would have chosen to have a caesarean. Her appeal was successful and the judgment held that the assessment of whether consent was adequate in a clinical negligence claim would not be assessed by the Bolam test. 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