Consulting A Consultant: A Doctor's Standalone Duty Of Care

A patient is admitted to the acute assessment unit (AAU) by ambulance following numerous bouts of diarrhoea and vomiting. The junior doctor on duty examines the patient and, after a few hours of observations, sends her home. Before doing so, he speaks with the consultant on call and obtains the necessary authorisation to discharge her.

Does the consultant's authorisation absolve the junior doctor of responsibility?

This was the situation in George Andrews v Greater Glasgow Health Board [2019] CSOH 31. The patient was admitted to hospital by ambulance on 6 January 2013. This followed a visit to hospital on the evening of the previous day. She had presented with reports of vomiting, diarrhoea, and the inability to eat. Dr Izzath conducted his examination and she was placed on observations.

After a number of hours' observations her symptoms had improved. Dr Izzath recorded a clinical impression of likely gastroenteritis. Dr Izzath did not have the authority to discharge a patient. He reported the patient's symptoms and the results of the laboratory tests to the consultant on call. In evidence, the consultant confirmed this would have been a detailed discussion as it was his responsibility to approve the discharge.

The patient was discharged on the evening of 6 January 2013. She had further episodes of diarrhoea and vomiting before being re-admitted to hospital on the evening of 7 January 2013. She underwent a midline laparotomy on 8 January 2013 but died the following day. The deceased's executor brought a claim against the NHS health board as a result of the alleged negligence of Dr Izzath.

The question for the court was whether Dr Izzath was at fault because he neglected to advise the deceased that she should be admitted when he assessed her on 6 January 2013. The expert evidence was that Dr Izzath should have offered the deceased admission to hospital and not to do so would be a departure from normal practice that no ordinarily competent clinician would have made.

Lord Pentland held that Dr Izzath did not offer to admit the deceased and so Dr Izzath was negligent. Lord Pentland concluded that there was a causal link between this negligence and the deceased's death. Appropriate...