Legal Case Summary
Bolitho v City and Hackney Health Authority [1998] AC 232
TORT – NEGLIGENCE – STANDARD OF CARE FOR MEDICAL PROFESSIONALS – CAUSATION
Facts
A child was brought to a hospital suffering from breathing abnormalities. The doctor summoned to deal with the matter never received the summons due to a low battery on her bleep. The child died as a result. The child’s mother sued for negligence, arguing that the child should have been seen and intubated.
Issues
Establishing the tort of negligence involves establishing that the defendant breached their duty of care to the claimant. The case of Bolam v Friern Hospital had established that professionals will not be in breach of their duty if they acted in accordance with practices accepted as proper by a responsible body of other medical professionals with relevant expertise. In addition, the claimant must show that but for the breach, the harm would not have arisen (causation).
The doctor testified that they would not have intubated the patient even if they had attended, and an expert witness agreed this was proper. The issue is whether this satisfied the Bolam test, and whether causation was established.
Decision/Outcome
No liability.
The House of Lords held that it is not possible for a defendant to argue that a breach did not cause the harm, because but for the breach, some other breach would have been committed. As such, it was necessary to assess whether the doctor would have been in breach if they had attended and not intubated the child.
The House of Lords clarified the Bolam test to include a proviso that the practice accepted as proper by a responsible body of professionals must be based on logical and defensible grounds.
In this case, refusing to intubate the child was not illogical, and so there was no breach.
Updated 19 March 2026
This case summary accurately reflects the decision in Bolitho v City and Hackney Health Authority [1998] AC 232 and the legal principles it established. The Bolam/Bolitho framework remains the governing standard for assessing breach of duty by medical professionals in English law. Subsequent cases, including Montgomery v Lanarkshire Health Board [2015] UKSC 11, have developed the law on informed consent and the disclosure of risks, moving that particular aspect away from the pure Bolam standard. However, this does not affect the core holdings described in this article, which concern the standard of care in treatment decisions and the causation analysis. The article remains accurate for its stated purposes, but students should be aware that Montgomery represents a significant development in the wider law of medical negligence, particularly regarding a doctor’s duty to warn patients of material risks.
