Synclair v East Lancashire Hospitals NHS Trust [2015] EWCA Civ 1283 (16 December 2015)

“This appeal in a clinical negligence action raises a short point concerning the trial judge’s evaluation of the evidence before him, and in particular whether it was open to him to regard as incorrect observations recorded in an apparently contemporaneous clinical note of a ward round conducted by a surgical registrar…

The judge… found the notes to be inaccurate and found in favour of the Claimant.” (paragraphs 1 and 2)

“…that simply because a document is apparently contemporary does not absolve the court of deciding whether it is a reliable record and what weight can be given to it. Some documents are by their nature likely to be reliable, and medical records ordinarily fall into that category…” (paragraph 12)

“…the inherent reliability of the clinical notes…” (paragraph 15)

“…the Claimant’s account and the clinical note cannot both be an accurate record, the judge had ample material upon the basis of which he could prefer the former to the latter.” (paragraph 27)

Appeal dismissed