[Music]
welcome to this lecture on medical law
today we'll be reviewing medical
negligence and the baalam test as with
all things nowadays we must include a
legal disclaimer the information I am
providing here is intended for education
purposes only and with all information
provided being well documented in the
public domain under no circumstances
shall we accept any liability for any
loss or damage incurred as a result of
improper use of this lecture
if you require independent legal advice
please seek a professional legal opinion
I am a medical doctor I am NOT your
lawyer clinical negligence is defined as
the failure by a health care
professional to excise a reasonable
standard of care in addition to this a
doctor should only be considered as
negligent where the following can be
proven one the doctor has a duty of care
to the claimant to the doctor breached
his duty by falling below the reasonable
standard of care and three foreseeable
harm has occurred to the claimant as I'm
sure you're aware the main question here
is how do we determine whether the
doctor has fallen below the reasonable
standard of care this is where the Bolam
test comes in let's review the bolan
test in some detail Bolam test has
become a legal method for determining
whether a doctor acted negligently ie
did the doctor
act to a reasonable standard of care the
test is based upon the case of mr. Bolen
who was a voluntary psychiatric patient
at fryin Hospital back in the 1950s mr.
Boehm suffered from recurrent depression
which
was treated with electro convulsive
therapy at the time a number of methods
existed including a modified ECT method
which included the use of muscle
relaxants and restraints and an
unmodified ECT method which was the
original technique first used in the
1930s when ole axons are used in Bolin's
case his doctor used an unmodified
technique when no muscle licensed nor
restraints were used during ECT the
patient suffered hip fractures resulting
from violent muscle contraction whilst
mr. Boland symptoms of depression had
improved he was not happy with his
resulting injuries so he sued the
committee for compensation he made the
argument that they were negligent this
was based on the grounds that they had
not issued him with muscle relaxants
they had not restrained him during the
procedure and he claimed he had not been
warned about the risks involved the
judge residing over the case of mr.
Boland sought the expert opinions of a
number of other doctors he found around
an equal distribution of doctors would
in fact perform either the modified
technique where they argued that the
muscle relaxants should mitigate the
risk of muscle spasm and therefore
reduce the risk of injury the remaining
half of the experts agreed that an
unmodified technique was appropriate
given the potential side effects of the
anesthetic agents that were available at
that time judge McNear made a landmark
ruling which established the basis for
the Boland test he stated a doctor who
was acted in accordance with a practice
accepted at the time as proper by a
reasonable body of medical opinion
skilled in that particular form of
treatment in question was not guilty of
negligence merely because there was a
body of competent medical professional
opinion which might adopt a different
technique
therefore a defendant doctor would have
upheld a reasonable standard of care
even if other expert witnesses state
that the procedure should not be
performed in this way providing that
another reasonable body of medical
opinion agree with the defending doctor
george mcneir wisely added the caveat
stating whilst a man is not negligent
merely because there is a body of
opinion who would take a contrary view
this does not mean that a medical man
can carry on with the same old technique
if it has been proven to be country -
what is really substantially the whole
of informed medical opinion essentially
it's not acceptable for any doctor to
continue providing outdated clinical
practice where evidence-based medicine
has proven it to be substandard to a
novel technique therefore the doctor who
provided the care to mr. bholaram cannot
be considered negligent on the grounds
that he didn't use an appropriate
technique however mr. bholaram had
further argue that he was not fully
informed regarding the risks of the
procedure it was estimated that the
likelihood of the complications that
occurred in mr. Bhalla case were around
1 in 10,000 cases therefore the question
was raised should a doctor be criticized
for not stressing the minimal risks
involved in a treatment where the risk
of refusal of treatment exists in
response to this the deputy
superintendent representing fryin
Hospital declared every patient must be
considered as an individual if they're
unduly nervous I do not say too much if
they ask me questions I tell them the
truth the risk is small but a serious
thing when it happens and it could be a
great mistake if they refused to benefit
from the treatment because of
in the case of a patient who is very
depressed and suicidal it is difficult
to tell him of things you know would
make him worse during the case it was
determined that during the 1950s
treatments for depression were very
limited ect
was considered the mainstay treatment
mr. Bhalla case was complicated as
without treatment his condition could
have deteriorated this would result in a
worsened mental state given that there
was an albeit small risk that he would
have refused treatment it was determined
that under these circumstances doctors
could display a therapeutic privilege
not to disclose the risks this is a very
paternalistic stance taken in the case
of mr. Bolen essentially it is
considered doctor knows best
okay so let's recap and summarize what
we've learned clinical negligence is the
failure by a healthcare professional to
excise a reasonable standard of care in
addition to this you can only consider a
doctor to be negligent where the doctor
has a duty of care to the claimant the
doctor is breached his duty by falling
below the reasonable standard of care as
determined by the Bonhams test and
foreseeable harm has occurred to the
claimant regarding the Bolam test it's
aimed to determine the key question of
whether a doctor has acted in accordance
with a reasonable standard of care the
test defines that a doctor may not be
considered negligent where his or her
actions are supported by a body of other
medical experts therefore a doctor may
be considered negligent where this
support cannot be provided importantly
the bolan test is essentially a
peer-review system your colleagues
within the same field will therefore
determine
whether your actions as a doctor are
reasonable thank you everyone for
watching this lecture in subsequent
lectures we'll be looking at the Buffalo
test and the case of Montgomery versus
Lana Keisha healthcare board both of
these topics set about changes within
the law regarding the standard of care
from medical professionals if you
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time if you found this lecture helpful
why not consider reviewing our a medical
ethics series of lectures some links are
included here