Medical negligence cases most commonly involve claims against doctors in their many guises and nursing staff. In circumstances involving an emergency situation, however, it is worth bearing in mind that another set of clinicians is frequently involved: ambulance crew. Two recent cases, both brought under the Fatal Accidents Act 1976, are a reminder of this.

Taaffe (Personal Representative of the Estate of Eleanor Taafe) v East England Ambulance Service [20120] EWHC 1335 (QB)

In May 2012 Sir Robert Nelson heard Taaffe (Personal Representative of the Estate of Eleanor Taaffe, deceased) v East of England Ambulance Service [2012] EWCH 1335 (QB). The claimant (C) sought damages from the defendant on the basis that its paramedics had been negligent in their treatment and management of his wife, E.

On 25th February 2007 E, who was 50, developed severe chest pains and an ambulance was called. She had a history of hypertension and family history of cardiac disease. She did not have a history of significant indigestion, which was the nature of the pain she described. The paramedics found that the pain had subsided by the time of their arrival, that E appeared stressed, was cold but was a normal colour. On questioning, E said that she had no nausea or vomiting and no constriction of her chest. They did two ECGs. They took the view that the results were normal although the computer print-out from one of them said: “Abnormal…T – wave abnormality, consider inferior ischaemia”. The paramedics did not consider that they needed to advise E to attend hospital and they did not do so. Instead they asked her whether she wanted to go. She preferred not to. She had an appointment with her GP the next day and the paramedics thought that would suffice. E attended her GP and was prescribed pills for depression and indigestion.

Five days later E suffered an acute myocardial infarction and died.  

C’s case was that the paramedics were negligent in that they failed to advise E to attend hospital on 27th February in order to have her condition properly investigated. This was the central issue on liability (it was not disputed by the defendant that, had E attended hospital on that day, she would have been admitted, her condition would have been diagnosed and she would have avoided the fatal cardiac arrest).

The defendant maintained that the paramedics had acted properly in light of the fact that the pain had subsided by the time they arrived, E appeared essentially healthy and, as far as they were concerned the ECGs were normal. In the circumstances this was a classic Bolam scenario i.e. whilst some competent and reasonable paramedics in the same situation might have taken E to hospital, other similarly competent and reasonable paramedics would not.

It was held that the paramedics (a) had failed to take a proper history (b) had failed to make a proper assessment of the signs and symptoms they did find (c) had insufficient knowledge or training in respect of the potential consequences of E’s history of high blood pressure and (d) placed too much reliance to the ECGs and, in any event, failed to appreciate the significance of an abnormal reading on one of them. In the circumstances, their care fell below the standard expected of a reasonably competent paramedic and the defendant was liable.  

Post script

Another interesting element to this case was the question of damages. On the evidence, there was a substantial risk that C and E’s marriage would not have survived for a significant number of years beyond February 2007 in any event. Damages had to be assessed in light of that and the consequences it had for C’s true financial situation. Ultimately, the court took the view that a 40% discount should be applied to reflect the risk that relationship breakdown would have terminated the dependency. The discount was applied to the past dependency, past loss of service, future loss of dependency and pension.

Moied (Personal Representative of the Estates of (1) Addebe Moied and (2) Fatima Moied v South Central Ambulance Service [2012] EWHC 1335

Also in May 2012, the High Court heard the case of Moied (As personal Representative of the Estates of (1) Addeba Moied, deceased and (2) Fatima Moied deceased v South Central Ambulance Service [2012] EWHC 1335. As in Taaffe, the claimant (C) sought damages from the Ambulance Service on the basis that its technician (not paramedic) had been negligent in his treatment of C’s wife (AM) and unborn child (FM). Unlike Taaffe, however, the claim failed.

AM was 33 weeks pregnant with her 5th child. She had a history of hypertension. She was at home when she became unwell, vomited and collapsed. C called an ambulance. The first crew arrived. The technician found AM on her back at the bottom of a flight of stairs. He was told by C that she had fallen after she had collapsed. On examination, her breathing was shallow and irregular, there was fluid and vomit in her airway and her jaw was clamped shut. The technician feared that she might have a cervical spine or head injury, which fear was compounded by the fact that her jaw was clamped. Accordingly, he did not move her on to her side as he would otherwise have done but left her on her back and called for assistance. Sadly, AM went into cardiac arrest as the 2nd ambulance arrived. She and FM died a few days later.

It was agreed between the parties that, once AM had suffered the cardiac arrest, neither she nor the baby had any realistic prospect of surviving so the issue on breach was whether the first ambulance crew had provided reasonable care. It was alleged that they had not. The principal basis for this assertion appears to have been that AM should have been tilted on her side (rather than left on her back) and her airway secured. The question in respect of causation concerned the cause of the initial collapse. If it was eclampsia, as the defendant maintained, then even if AM had been put on her side, it would have been very difficult to clear her airway and ventilate her (because of the clamped jaw) in any event.

The judgment is a long one but ultimately the court held (a) the technician’s concern about the cervical spine injury was reasonable (b) he was therefore faced with a balancing exercise between clearing her airway and protecting her spine (c) in the end he had followed a course which would have been considered proper by a responsible body of ambulance technicians and had not been negligent (d) as to causation, a form of eclampsia caused AM’s collapse and caused her jaw to clamp. There was a substantial risk that her airway would have remained obstructed by fluid / vomit in any event.