Bolitho v City & Hackney HA – Case Summary

Bolitho v City and Hackney Health Authority

House of Lords

Citations: [1998] AC 232; [1997] 3 WLR 1151; [1997] 4 All ER 771; [1998] PIQR P10; [1998] Lloyd’s Rep Med 26; (1998) 39 BMLR 1.


The claimant was the estate of a child who suffered respiratory failure and was taken to the hospital. The doctor did not to attend to him. The respiratory failure developed into cardiac arrest. The child suffered brain damage and ultimately died. The claimant argued that this could have been avoided if the child had been intubated.

The doctor argued that even if she had attended to the child, she would not have intubated him. This meant that the child would have died in any event. The defendant (the doctor’s employer) presented expert evidence that other doctors might have done the same. The claimant presented counter-evidence from an expert who considered not intubating to be negligent.

  1. Was the doctor in breach of her duty of care to the patient by failing to attend to him?
  2. Would the doctor have been in breach of his duty of care if she had attended but not intubated?
  3. Did the doctor’s failure to attend to the patient cause their death?

The House of Lords held in favour of the defendant. There was no reason to challenge the expert evidence indicating that not intubating the child was reasonable. As such, even though the defendant was in breach by failing to attend to the child, that breach did not cause death: the child would have died in any event.

This Case is Authority For…

When applying the Bolam test, the court must be satisfied that the expert body of professional opinion the defendant is relying on has a logical and defensible basis for approving of the defendant’s practice.

This means that the court must be satisfied that the experts directed their minds to the risks and benefits of the practice and reached a defensible conclusion. The House of Lords noted that the courts are only likely to find that a practice is not logical or defensible in rare cases.


The House of Lords explained that a defendant cannot argue that their breach of duty did not cause the harm because they would also have committed some other breach. So, if failure to intubate had been negligent, the defendant could not have claimed that their failure to attend did not cause the child’s death because they would have negligently allowed the child to die even if they had attended. However, on the facts, it was not negligent to fail to intubate the child.