JRM v King’s College Hospital Foundation Trust [2017] EWHC 1913 (QB) (01 August 2017)

JRM is now 8 years old. He was born at King’s College Hospital (“KCH”) on 28 February 2009, one of twins. His mother went into labour when the pregnancy had lasted 29 weeks. Sadly, his brother P died a fortnight later. JRM, who was delivered by forceps, suffered serious injury to his spinal cord around the time of his birth. (paragraph 1)

It is agreed that:

i) he suffered the acute spinal cord injury around the time of his birth;

ii) it consisted of vascular injury to the spinal cord due to occlusion of a branch of the anterior spinal artery. The two potential causes of that were


a) traumatic injury causing tearing of the lining of the artery (arterial dissection), and subsequent clot formation within the vessel;


b) occlusion due to a blood clot or placental emboli travelling from elsewhere and lodging in the arterial lumen.

iii) if the court accepted that there was excessive force and traction from instrumental delivery, it was agreed that the most likely mechanism of injury is the arterial dissection referred to above. If there was no significant trauma, then an embolic source was more likely. (paragraph 2)

It is further agreed that the injury could have been caused by the first mechanism if, when about to be born, JRM had been in the occipito-lateral (“OL”) position when the forceps were used. It could not have been caused had he been in the occipito-anterior (“OA”) position. There is no evidence of any other mechanism or events which could have caused traumatic injury otherwise. It is also the case that the second mechanism (i.e. occlusion as described at (b) above) is exceedingly rare. (paragraph 3)

The effect of JRM’s injury has been very substantial indeed. He has four limb paralysis, and only has reflex movements in his arms and legs. He has a tracheotomy and is ventilator dependent. (paragraph 4)

C alleges that there were two breaches of its duty of care by D:

i) the clinicians dealing with the mother’s care failed to have regard to an elevated CRP (C-Reactive Protein) blood test result, and to her being in pain and producing offensive liquor, and failed to advance the delivery by means of induction, which delay in delivery led to the use of forceps and the consequent injury;

ii) in any event, the obstetrician delivering JRM negligently used the forceps when JRM was in the OL position. (paragraph 5)

The second cause of action is not dependent on the first being established. (paragraph 6)

…it is an intrinsic part of C’s case to show that the injury to JRM occurred during the delivery, and that it did so through negligence. This is not a case in which C’s case was that the injury sustained was the inevitable result of a forceps delivery; it was that it was the result of this particular and negligently conducted forceps delivery. (paragraph 64)

C has failed to show that knowledge of the elevated CRP reading, taken on its own or together with the other clinical signs, should have caused the delivery to be induced (paragraph 69)

I find that had Dr Mahfouz examined the mother properly, he would have found that the baby was in the OL position. His subsequent application of the forceps to C in the OL position resulted in increased force being required. I find that JRM was delivered with excessive force, with the forceps being placed in the wrong position, and then pulled vigorously. The extensive bruising sustained, and the infliction of an injury consistent with excessive force being applied, support that finding. That finding is also consistent with the hospital’s internal records. I also find that the misuse of the forceps and the mode of delivery adopted by Dr Mahfouz caused the injury to C. The carrying out of the delivery thus by Dr Mahfouz fell far below the standard of care to be expected of him. It is accepted by the Defendant that if I made those findings, there must be judgement for C. (paragraph 82)