Medical staff often have to choose between different treatment options, which can lead to...
Early admissions of liability, based on an overall assessment of the likely outcome of a contested trial, are a common occurrence in personal injury cases. However, the weight of the evidence may subsequently shift and, in a guideline ruling, the High Court considered the circumstances in which such an admission may be withdrawn.
The case concerned a woman who underwent abdominal surgery to remove fibroids. She attended hospital twice in the week following the operation. On her second visit, she suffered a cardiac arrest and could not be resuscitated. A serious incident report subsequently identified numerous issues in respect of her post-operative care.
An independent gynaecologist, external to the hospital, also found that her care fell below an acceptable standard. In legal correspondence the trust later admitted liability in full for the woman's death. It did so before the administrator of her estate formally issued a clinical negligence claim on behalf of her loved ones.
The trust argued, however, that a new theory as to the mechanism of her death had emerged at a subsequent inquest. There was, it asserted, fresh evidence that she would not have survived even had she been appropriately treated and that any negligence on the part of clinicians had thus not caused her death. On that basis, it sought judicial permission to go back on its admission.
Ruling on the matter, the Court acknowledged that, were there a contested trial of liability issues, the trust would have a real prospect of successfully defending the claim. However, the theory, whilst representing a shift in one medical expert's opinion, did not amount to new evidence in that it had first been floated as a possibility some time before the admission was made.
The trust was open to criticism in that it had not taken its own independent legal and medical advice prior to making the admission. There was a significant delay between the inquest and the trust's application to resile from the admission. By the time the application was heard, the woman's death was almost five years in the past.
The admission had been a source of great relief to the woman's family and its withdrawal was bound to cause them distress. Money had subsequently been spent on investigating the value of the claim on the basis that liability was no longer in issue. The inquest was conducted on that assumption and opportunities to gather evidence at an early stage had been lost.
It remained open to the trust to argue that the woman's life expectancy was limited by underlying health problems and that the value of the claim should be reduced accordingly. Given the trust's conduct and the prejudice that the family would suffer if the admission were withdrawn, the Court concluded that the balance came down in favour of dismissing the application. The trust was, therefore, required to stand by the admission.