In Keith Williams v CWM Taf University Hospital Board, the Claimant appealed against the decision that the multidisciplinary medical team who had treated him for critical limb ischemia were not negligent.

The Appellant had Type 2 Diabetes and was admitted for foot pain after an earlier, incorrect diagnosis of gout. The medical team decided that, of the three options available to treat the Appellant’s dense calcification and critical ischemia, the performance of a Sympathectomy was the best choice. The alternative options were angioplasty or amputation of the leg. The advice of the Radiology department was that an angioplasty was unlikely to be successful. After a short-term improvement in his condition following the Sympathectomy, the Appellant’s condition deteriorated further. An angiogram, and then an angioplasty, was performed. This treatment proved successful and amputation of the leg was avoided.

However, the Appellant suffered from complications arising from the Sympathectomy. The Appellant claimed these complications could have been avoided if the medical team had done an angiogram and then an angioplasty, in the first instance. This was supported by the Appellant’s expert.

The Judge at first instance dismissed the claim of negligence. The Claimant accepted that the medical team’s decision to choose a Sympathectomy was supported by a reasonable body of medical opinion, fulfilling the Bolam test. However, the Appellant appealed on the grounds that there was no logical basis for that standard body of medical opinion, such that the test in Bolitho was not met.

The Court of Appeal upheld the Judge’s decision that there was no negligence. It held that only if there was sufficient expert evidence to undermine the standard body of medical opinion would a Judge find that the burden had shifted. There was no such expert evidence in this case to support the Appeal. It could not be said that the medical team had been negligent. Its actions were supported by a body of medical opinion and based on logical reasoning. In this case, Bolam applied and Bolitho followed.

Giles Colin was instructed by Shared Services Partnership Legal & Risk for the respondent.

Read more about the case on Lawtel here.