“ Emmanuel E …G1 P0 36+6 poly AFI 28.5 generalised abdo pain obs (N) SROMº, PU BO OGTT 7-8 ↑ TORCH screen (N) obs (N) CTG – Tightening 3:10 B – 140 A – Present D – Nil O – (N) (see diagram) tender generally VE – Cervix, posterior 1cm dilated, soft 2cm long station -3 △ TPTL Plan – keep in - Analgesia. Bedside…scan – Ceph - Poly…”
“please turn to page 56” added. 1645 Drugs chart “cocodamol Ekanem TPTL 30/500g PO” 1650 Internal page 56 A further note was made by Dr E. “GIP 36+1 …Poly AFI 28 Generalised abdominal pain. pain is sharp, SROMº LUTSº, Nil bowel symptoms obs (N) Urine not yet done TORCH screen (N) SGTT 7.8 CTG – Tightening 3:10 B – 140 V - >5 Bedside scan A – Present cephalic D – Nil O – (N) O/E (see diagram) Tender – generalized Tensed VE – Consent + Chaperone Cervix – Posterior, 1cm dilated Soft, 3cm long station -3 △ TPTL Plan: 1. keep in. Inform SCBU; NNU 2. FBC + CRP 3. Urine dip + MCS 4. Analgesia 5. BM monitoring 6. Diabetic team review 7. Re-Speculum if pain worsens “ Miss “Miss Sivarajan informed Plan: Plan: Transfer to LW.”
“Transfer to ward pain has increased 3-4:10 D/W SPR Emmanuel for Transfer to D/S. LWC informed awaiting a room on D/S”
“Transfer to D/S care handed to RM Sam Bond”
“Miss Nicks WR 37 yr CiPo 36+1 Rh- Post TlL Polyhydramnious Admitted TPTL SGTT GDM Booked”
“I write this statement from memory and having reviewed the maternal records of”
“I write this statement from memory and having reviewed the maternity records of”
“1650” and then wrote a substantially similar but also partly different set of notes in the antenatal clinical records. In particular he noted the mother's “pain was sharp”
“re speculum if pain worsens”
“Before I turn to that, I must tell you what in law we mean by “negligence.”
“In the Bolam case itself, McNair J. [1957] 1 W.L.R. 583, 587 stated that the defendant had to have acted in accordance with the practice accepted as proper by a ‘responsible body of medical men.’ Later, at p. 588, he referred to ‘a standard of practice recognised as proper by a competent reasonable body of opinion.’ Again, in the passage which I have cited from Maynard’s case [1984] 1 W.L.R. 634 , 639, Lord Scarman refers to a ‘respectable’ body of professional opinion.The use of these adjectives - responsible, reasonable and respectable - all show that the court has to be satisfied that the exponents of the body of opinion relied upon can demonstrate that such opinion has a logical basis.In particular in cases involving, as they so often do, the weighing of risks against benefits, the judge before accepting a body of opinion as being responsible, reasonable or respectable, will need to be satisfied that, in forming their views, the experts have directed their minds to the question of comparative risks and benefits and have reached a defensible conclusion on the matter.”
“In Wilsher v Essex AHA[1987] 1 QB 730 the Court of Appeal for the first time gave detailed consideration to the standard of care required of a junior doctor. (This issue did not arise in the subsequent appeal to the House of Lords). The majority of the court held that a hospital doctor should be judged by the standard of skill and care appropriate to the post which he or she was fulfilling, for example the post of junior houseman in a specialised unit. That involves leaving out of account the particular experience of the doctor or their length of service. This analysis works in the context of a hospital, where there is a clear hierarchy with consultants at the top, then registrars and below them various levels of junior doctors. Whether doctors are performing their normal role or ‘acting up’, they are judged by reference to the post which they are fulfilling at the material time. The health authority or health trust is liable if the doctor whom it puts into a particular position does not possess (and therefore does not exercise) the requisite degree of skill for the task in hand.”
“Where, as in the present case, a breach of a duty of care is proved or admitted, the burden still lies on the plaintiff to prove that such breach caused the injury suffered: Bonnington Castings Ltd. v. Wardlaw [1956] A.C. 613; Wilsher v. Essex Area Health Authority [1988] A.C. 1074. In all cases the primary question is one of fact: did the wrongful act cause the injury? But in cases where the breach of duty consists of an omission to do an act which ought to be done (e.g. the failure by a doctor to attend) that factual inquiry is, by definition, in the realms of hypothesis. The question is what would have happened if an event which by definition did not occur had occurred. In a case of non-attendance by a doctor, there may be cases in which there is a doubt as to which doctor would have attended if the duty had been fulfilled. But in this case there was no doubt: if the duty had been carried out it would have either been Dr. Horn or Dr. Rodger, the only two doctors at St. Bartholomew’s who had responsibility for Patrick and were on duty. Therefore in the present case, the first relevant question is ‘What would Dr. Horn or Dr. Rodger have done if they had attended?”
“19 If it is a defendant's duty to measure noise levels in places where his employees work and he does not do so, it hardly lies in his mouth to assert that the noise levels were not, in fact, excessive. In such circumstances the court should judge a Claimant's evidence benevolently and the defendant's evidence critically. If a defendant fails to call witnesses at his disposal who could have evidence relevant to an issue in the case, that defendant runs the risk of relevant adverse findings see British Railways Board v Herrington[1972] AC 877 , 930G. Similarly a defendant who has, in breach of duty, made it difficult or impossible for a Claimant to adduce relevant evidence must run the risk of adverse factual findings.”
“From this line of authority I derive the following principles in the context of the present case: (1) In certain circumstances a court may be entitled to draw adverse inferences from the absence or silence of a witness who might be expected to have material evidence to give on an issue in an action. (2) If a court is willing to draw such inferences, they may go to strengthen the evidence adduced on that issue by the other party or to weaken the evidence, if any, adduced by the party who might reasonably have been expected to call the witness. (3) There must, however, have been some evidence, however weak, adduced by the former on the matter in question before the court is entitled to draw the desired inference: in other words, there must be a case to answer on that issue. (4) If the reason for the witness’s absence or silence satisfies the court, then no such adverse inference may be drawn. If, on the other hand, there is some credible explanation given, even if it is not wholly satisfactory, the potentially detrimental effect of his/her absence or silence may be reduced or nullified.”