Successful claim 26 years after negligent mismanagement of twin birth
The High Court recently allowed a claim by a woman with cerebral palsy resulting from brain injury during her birth 26 years ago. The Court's lengthy judgment in the case of CNZ v Royal Bath Hospitals NHS Foundation Trust [2023] EWHC 19 (KB) clarified important legal principles for obstetric medical negligence claims.
The Claimant was one of twins. Her mother underwent induction of labour at a weekend managed by an obstetric registrar. There was no obstetric consultant at the Royal Bath Hospital. The Claimant’s sister was born first by vaginal delivery. Following this, progress in labour slowed. The Court found that the Claimants’ parents requested a caesarean section to deliver the second twin but the obstetric registrar’s preference was to perform an artificial rupture of membranes to stimulate vaginal birth. This procedure would have been more challenging because attempts to give a spinal anaesthetic had failed and the Claimant's mother was reluctant to undergo it.
The Court found that the registrar was aware of this but did not explain the parents’ preference for a caesarean when discussing the plan with her consultant by phone. There followed further discussions and phone calls before a decision was ultimately made to perform a caesarean section. The decision had been delayed because of the registrar’s initial failure to take into account the parents’ views. There were then further delays in performing the caesarean.
Prior to delivery, the Claimant suffered a lack of oxygen to the brain due to pressure on the umbilical cord. The Court found that, if she had been born without delay, this lack of oxygen and the consequent brain injury would have been avoided.
On the basis of medical expert evidence, the Court determined that a caesarean section was a reasonable option in the circumstances. Therefore, the pros and cons should have been discussed with the parents and their views taken into account when making a plan with the Consultant.
Although the Court found that the negligent delays caused the entirety of the Claimant’s brain injury in this case, it also considered an alternative scenario in which brain injury occurred partly during the period before the delay started and partly during the delay. It asked whether the Defendant would be liable to pay all or only part of the compensation in relation to the Claimant’s disabilities in that scenario?
When it is possible to show that a particular part of a Claimant’s disabilities were caused by negligence, the Defendant is only liable to pay compensation for that part. However, in this case, the Court decided that scientific evidence could not sufficiently link specific elements of the Claimant’s functional disabilities to particular points in time during which she was experiencing lack of oxygen. Therefore, even if her brain injury had occurred only partly during the negligent delay, the Defendant would still have been liable for the full amount of damages for her disabilities.
This is not always the case. Medical negligence claims are decided on their individual facts and often involve complicated issues about the causation of disabilities. It is vital to carefully investigate a claim, taking into account the relevant scientific knowledge about a disability, to maximise the chance of succeeding.
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