The Bolam test The Bolam test was first recognised in the case of Bolam vs Friern Hospital Management Committee. It also considered DH guidance on consent for examination or treatment, which warns healthcare practitioners to 'remember their duty to keep themselves informed of legal developments that may have a bearing on their practice', highlighting human rights cases that have set out doctors' duty to involve patients in decisions relating to their treatment. 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. Register now to enjoy more articles and free email bulletins. After 60 years, and almost since the NHS began, this case continues to play an important role in the lives of doctors and patients. The Montgomery decision redefined the standard for informed consent and disclosure. St Annes, Lytham St Annes, Lancashire, Castle Medical Centre In 1954, John Bolam was admitted to Friern Hospital with relapse of depression. Does the Chief Medical Officer’s report into clinical negligence in the NHS signal the end of the Bolam test? The voice for today's GP. Sort by Date. Published by Royal College of Emergency Medicine, 01 November 2017, Published by Society of Radiographers (SCoR), 17 January 2018. Bolam was rejected in the 2015 Supreme Court decision of Montgomery v Lanarkshire Health Board. 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). View options for downloading these results. This is a constant problem within quasi-judicial bodies that often take every opportunity to accept unchallenged the lowest standards of expert opinion. • Having established a breach of duty, there must be proof of causation of damages. 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. Nurses were present on either side to prevent him from falling off the couch, but Bolam suffered acetabular fracture of both hips. In a 2015 case, Mrs Montgomery, a type 1 diabetic of small stature, developed shoulder dystocia when going into labour. Published by Social Services Research Group (SSRG), 01 March 2016. It ultimately required surgical drainage and multiple surgical interventions; following which, microbiology evidence confirmed actinomyces. Faversham, Kent, Only 15% of legal claims against doctors succeed, Government review not bold enough to reverse rising indemnity costs, say MDOs. The information in this briefing is for general guidance on the principles of informed consent and the impact of recent case law. Free online information about Clinical Negligence at patient.co.uk, Published by Royal College of Surgeons of England (RCS), 01 November 2016. The Hunter v Hanley case, in Scotland, preceded the Bolam case by two years, but illustrated the same principle. Castlebar, Mayo (IE), Faversham Medical Practice Bolam holds that the law imposes a duty of care between a doctor and his patient, but the standard of that care is a matter of medical judgement. The court accepted that if Mrs Montgomery been told about the risk of dystocia, she would have chosen to have a caesarean. 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). The Supreme Court ruled in favour of Mrs Montgomery despite attempts to defend her treatment based on the Bolam test. Previously, the Bolam test 14 in England and the Hunter v Hanley test 15 in Scotland were used to determine what should be disclosed. 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. This discussion concerns breach of duty and the Bolamdefence. by Dr Thomas Abraham There have been many trials and tribulations denting the Bolam principle, but its core still remains intact. 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 doctor’s judgment is not to be questioned. While treating Mrs Hunter for bronchitis, Dr Hanley gave a course of penicillin injections. During the treatment, he sustained violent muscle spasms causing him to fracture both hips. High Court judge McNair J directed the jury: ‘A doctor is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art…putting it the other way round, a doctor is not negligent, if he is acting in accordance with such a practice, merely because there is a body of opinion that takes a contrary view.’. It does not matter that other medics would have delivered a different treatment. Duri… This was recognised in the classic direction of McNair J. to a jury in Bolam vs Friern Hospital Management Committee. 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. 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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. The Bolam test is then described and how it has come to play such a prominent role in assisting the courts to assess if an appropriate standard has been achieved in medical negligence litigation. Sorted by For many years the accepted practice around informed consent to treatment, including medication, was based on  the “Bolam” test. Two decades ago, two-year-old Patrick Bolitho - while in hospital - developed obstruction of the airway and suffered cardiac arrest, which resulted in brain damage and subsequently death. 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”. The new NHS Redress Act, which returns an element of beneficence to the compensation equation, appears to be a natural and logical response, but it is a gamble as yet untested. Although a doctor was called upon to attend, she failed to do so. During the 12th injection, the needle broke and part of it was left embedded in her buttocks. Maidstone, Prospect Health Ensuring quality and consistency of expert witnesses available to civil and criminal courts is in the interests of both the public and the medical profession. 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. Instead, doctors must provide infor… Bolam v Friern Hospital Management Committee (Queen's Bench Division) Facts : During the course of electro-convulsive therapy administered to him at the defendants' mental hospital, the plaintiff, a voluntary patient, sustained bilateral "stove- in" fractures of the acetabula. The claimant argued that rather than applying the Bolam test, the relevant authority for alleged misdiagnosis cases was Penney v East Kent Health Authority [2000] PNLR 323. Quick Reference Where clinical negligence is claimed, a test used to determine the standard of care owed by professionals to those whom they serve, e.g. The Bolam principle, which is the keystone of the defence against medical negligence, is celebrating sixty years. 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. 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). Nicholas Wilkes discusses the merits of the old method as against new plans On 30 June 2003, Chief Medical Officer Sir Liam Donaldson (main picture) published his long-awaited consultation paper, entitled ’Making Amends’. The NHS stands for National Health Service and provides its users with a quality standard of healthcare, irrespective of wealth. The Bolam test: on borrowed time?, Mayur Lakhani. 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. Every healthcare professional and doctor should carefully read a report in The Times of 9 October 2002.1 This is a powerful and moving account of a mishap in the NHS that led to the death of a Ž veyear- old girl. Some experts felt that more restraint meant more likelihood of fracture. . Prospect Health The Bolam Test. He agreed to undergo electro-convulsive therapy. Blacktown, Prospect Health The guideline is mainly written for clinicians working in England and... Clinical negligence was formerly known as medical negligence. A short history of the Bolam test - a keystone of medical negligence law for 60 years Hull GP Dr Thomas Abraham looks back at the 60-year history of the Bolam test, which has underpinned doctors' defence against medical negligence claims almost since the NHS began. Although many challenges and amendments have occurred, still the over-riding gold standard of defence in medical negligence is the Bolam test. Case Five: David Spencer v Hillingdon Hospital NHS … Why do patients decide to sue their doctor? Conversely the “but for” test does not provide a complete or exclusive test of causation in the law of tort (Stapleton, 2015). Relevant themes: montgomery v lanarkshire health board, informed consent, bolam test. For treatment the Bolam test applies. Published by Scottish Parliament, 10 January 2019. In England alone, the NHS deals with over a million patients every 36 hours. The case concerned a hypothetical situation that would have existed had the Claimant been referred for necessary investigations sooner. Waterlooville, Hampshire, Fylde Private GP In Penney , three claimants had undergone cervical smear tests which health screeners had determined to be negative. Given the complexities of modern medicine it is possible, and even likely, that a dissenting g… 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. These tests ask whether a doctor’s conduct would be supported by a responsible body of clinicians. 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'. News, insights and clinical education. Relevance Dr McLellan, the obstetrician had failed to warn her of the risks and did not offer caesarean section, which might have prevented this. 08 October 2020 For many years the accepted practice around informed consent to treatment, including medication, was based on the “Bolam” test. Published by Royal College of Emergency Medicine, 25 January 2018. This site is intended for healthcare professionals, By Dr Thomas Abraham on the The test to be applied was set out by Lord Browne-Wilkinson… 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. 1. The Bolam test was established in 1957 following the decision of the court in Bolam v Frierm Barnet HMC in which the court concluded that a doctor might be able to avoid a claim for negligence if he can prove that other medical professionals would have acted in the same way. 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. 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