Macaulay v Karim & Anor [2017] EWHC 1795 (QB) (14 July 2017)

C aged 53 was admitted as an emergency to hospital in the very early hours of the morning of 15 October 2011 in septic shock. He underwent extensive surgery later that day, probably commencing at about 10.00 or 11.00 or thereabouts. (paragraph 1)

The effect of surgery… was that it was necessary for his left leg to be amputated below the knee and for his right toes and his right fingers and thumb also to be amputated. (paragraph 2)

C had visited his GP D1 on 12 and 14 October and had presented himself at the emergency department D2 on 13 October, making various complaints about the way he felt, but none of these attendances resulted in a diagnosis and treatment of the condition that led ultimately to the surgery referred to above. (paragraph 3)

The essential issue in the case is whether D1 and/or D2 were negligent in not identifying the underlying problem or its general nature sooner and taking steps to bring forward treatment, including surgery, that would have prevented or reduced the serious consequences. (paragraph 4)

C had a medical history of Type II diabetes… He was regarded as “obese” with a Body Mass Index of 46.37 which was very high – “severe morbid obesity”… (paragraph 11)

[The case was factually complex with evidential uncertainty.]

C arrived at emergency department at about 10.30 and left at 16.30 with no blood tests having been administered and no intravenous antibiotics being commenced… it was C’s own decision to leave the hospital before the blood test had been carried… (paragraph 156)

Darnley considered and distinguished.

… there was a duty on the hospital to check that there was a good reason for him not being there to provide the specimen and then to warn him of the risk of not having done so. Only then could it truly be said that he had made an informed decision about ceasing to place reliance on the hospital that day for finding out what was wrong with him. (paragraph 186)

[The blood test result would have set in train the sequence of therapeutic measures leading to surgery.]

Conclusion on liability

…liability and causation to the extent indicated in paragraphs 198 above are established against D2. (paragraph 211)

Liability is not established against D1. (paragraph 212)