healthcare update - issue five
Off the record?
The High Court decision in Loraine v Wirral University
Teaching Hospital NHS Foundation Trust came out in May 2008
and was dismissed by many as a first instance decision which did
not sit happily with other similar cases. However, it was clear to
us when attending a recent obstetric conference that the case is
causing widespread concern.
In Loraine, the Judge challenged the safety of the system, often
depended upon in Obstetrics and Gynaecology, of relying on the
history supplied by a patient’s GP, and the patient herself, when
booking her in for the management of pregnancy.
The Judge decided that when Mrs Loraine was booked in for what
was her fifth pregnancy, all of the records from her four previous
pregnancies should have been to hand and reviewed, so that a
complete history could be obtained.
Mrs Loraine had given birth to all four of her previous children
at Arrowe Park Hospital and she was there again for the management
and birth of her fifth child. The records of all of her previous
pregnancies could therefore be retrieved from archive.
The Judge decided that it was not enough, when Mrs Loraine was
booked in, for the midwife to retrieve the records from archive
only if something of significance came to light. Nor was it enough
to be reassured by the fact that Mrs Loraine’s third and fourth
deliveries had been uncomplicated.
Had the records been to hand, the Judge accepted Mrs Loraine’s
case that a fibroid, which had been detected in her third
pregnancy, would have been investigated further, particularly as
baby Loraine’s presentation was oblique through to week 37. The
Judge also accepted Mrs Loraine’s case that she would therefore
have been an in-patient when she went on to suffer placental
abruption. Delivery would then have been brought about in a timely
fashion, and baby Loraine would have avoided the hypoxic brain
injury that befell him, causing cerebral palsy.
The stakes were high, and it seems that the Judge had every
sympathy for Mrs Loraine. She could not be relied upon to draw the
fibroid to the attention of the midwives and doctors whom she saw
and understand that it might present an obstacle to normal
delivery. The Judge concluded that the system in place at the Trust
of not reviewing previous records was unsafe and so found the Trust
liable.
Clearly, this case raises as many questions as it answers in
terms of the systems that can and should be put in place,
particularly when booking a patient in for the management of
pregnancy. Should all of the patient’s hospital records be
retrieved and reviewed, to include, say, her orthopaedic records?
What if she had given birth previously at a different hospital, why
should such a patient be exposed to a potentially unsafe system?
How far can anyone rely on the information a patient gives? Even if
Loraine can be regarded as a one-off first instance decision it is
a salutary lesson as to how vulnerable Trusts can be when anything
but the most stringent systems are in place, and an indication that
the courts can take a “safe systems” approach, rather than being
influenced purely by Bolam.
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aspects of the subject matter and does not provide comprehensive
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