Tort Law

Bolam v. Friern Hospital Management Committee

[1957] 1 WLR 582

Facts

• Mr Bolam was a voluntary patient at Friern Hospital.
• He suffered from mental illness.
• He agreed to undergo electroconvulsive therapy, commonly called ECT.
• During ECT, an electrical current induces a seizure.
• At that time, medical practitioners differed over the safest method of administering the treatment.
• Some doctors used muscle-relaxant drugs and physical restraints to reduce the risk of fractures.
• Other responsible practitioners believed that muscle relaxants created separate medical risks and that strong restraint could itself increase the possibility of injury.
• Bolam was not given a muscle-relaxant drug.
• He was not restrained in the manner later alleged to be necessary.
• During the treatment, he suffered fractures to his pelvis.
• He also alleged that he had not been warned of the risk of fracture.
• Bolam sued the hospital for medical negligence.
• Medical experts testified that a responsible body of psychiatrists supported the method used by the hospital.

• What standard of care applies to doctors and other skilled professionals.
• Whether failure to use muscle relaxants or stronger restraints amounted to negligence.
• Whether the hospital negligently failed to warn Bolam of the fracture risk.
• Whether a doctor is liable merely because another responsible professional would have followed a different practice.

• A professional is not judged by the standard of an ordinary unskilled person.
• The professional must exercise the ordinary skill of a reasonably competent practitioner in that field.
• Under the Bolam test, a doctor is not negligent if acting in accordance with a practice accepted as proper by a responsible body of medical professionals skilled in the relevant area.
• The existence of another responsible body supporting a different treatment does not automatically establish negligence.
• A doctor does not guarantee successful treatment or freedom from complications.
• The professional practice relied upon must be genuinely responsible.
• Bolitho later clarified that professional opinion may be rejected if it cannot withstand logical analysis.
• Montgomery later held that disclosure of material risks is governed by patient autonomy rather than solely by Bolam.

• ECT involved recognised competing medical approaches.
• The hospital’s method was supported by competent expert evidence.
• Some responsible psychiatrists avoided muscle relaxants because of risks associated with those drugs.
• Some also believed that excessive manual restraint might increase the possibility of fractures during the seizure.
• The hospital therefore had not adopted an irrational or professionally unsupported method.
• Bolam’s injury was serious, but a harmful outcome did not itself prove negligence.
• The correct inquiry was whether the treatment fell outside every responsible body of medical practice.
• The evidence permitted the jury to find that it did not.
• On the warning issue, professional practice at the time did not require disclosure of every small treatment risk.
• The jury could therefore accept that failure to mention the fracture risk did not fall below the professional standard then recognised.
• The case did not declare that doctors have unlimited freedom to define their own duties.
• It established that courts should respect responsible professional judgment where genuine medical disagreement exists.

• The jury found for Friern Hospital Management Committee.
• McNair J formulated the Bolam test.
• The hospital was not negligent because the method of treatment was supported by a responsible body of medical opinion.
• A doctor was not liable merely because another competent body would have acted differently.