Bell v Bedford Hospital NHS Trust [2019] EWHC 2704 (QB) (14 October 2019)

On 26 March 2012 C then aged 44 suffered a major stroke which has left her with significant permanent disabilities. It is now agreed that she had previously suffered transient ischaemic attacks (TIAs) in October 2009 and January 2010. She claims that there was a negligent diagnosis of a possible hypotensive episode in October 2009, and a failure to review her after the second episode in January 2010. Had a diagnosis of TIA been made on either of those occasions it is contended that the stroke would have been prevented. [1]

if C had been given a diagnosis of possible, probable or definite TIA, and advised of any necessary changes in her lifestyle in October 2009, on a balance of probabilities she would have been no more compliant with medication, stopping smoking, or losing weight for any more time than previously, nor in a way which would have made a difference… had she been diagnosed with a possible, probable or definite TIA in January 2010, it is unlikely that her ability to make changes in her lifestyle and compliance with taking medication would have improved. The history apparent from her notes shows numerous attempts to give up smoking, failures in compliance with advice given and failure to take medication prescribed. [60]

…there are two potential causes, atherosclerosis and dissection which each have substantial factors on the evidence which render them equally unlikely. There is a third potential cause cardio embolism which is even more unlikely. I am therefore unable to conclude that C has succeeded in proving on a balance of probabilities that atherosclerosis was the cause of the stroke she suffered, and that as a result adherence to medication and advice given after a diagnosis of TIA would have prevented the stroke occurring. [74]

C has succeeded in proving breach of duty in this case, she has failed to prove causation. The claim must be dismissed. [74]