In this briefing we analyse the recent case of Sanderson v. Guys and St Thomas NHS Foundation Trust [2020] EWHC 20 (QB), in which the High Court grappled with an important issue around the application of NICE Guidelines, and re-emphasised the importance of clinical judgment.
What happened in Sanderson?
Sanderson was a birth injury case arising out of Ashley Sandersons birth on 26 February 2002. Unfortunately Ashley experienced a period of hypoxia before her birth causing cerebral palsy and severe associated disabilities.
It was alleged that the obstetric staff acted negligently in the second stage of labour by: (1) performing a fetal blood sample (rather than proceeding to immediate and urgent instrumental delivery) in the face of what were alleged to have been prolonged decelerations evident on the CTG; and (2) once it was recognised that the Claimant did in fact need to be delivered as soon as possible, taking too long to commence the Claimants delivery by ventouse.
It was claimed that but for the alleged breaches of duty, the damaging period of hypoxia would have been shortened or avoided altogether.
In finding for the Defendant Trust and dismissing the Claimants claim, the Judge, The Honourable Mrs Justice Lambert DBE, found that there had been no breaches of duty. Specifically, she found that there was no unreasonable delay in delivering the Claimant. However, it was her findings in respect of the first issue above, i.e. whether it was negligent to have performed fetal blood sampling rather than proceeding immediately to an instrumental delivery, that are the most interesting aspect of the Judgment.
In finding that it was reasonable for the obstetricians to adopt an expectant approach to the CTG and wait to see how the trace developed, the Judge highlighted the apparently contradictory nature of the relevant NICE Guidelines in place at that time, and made suggestions as to how clinicians should proceed in similar such circumstances.
The Guidelines in question were the 2001 NICE Guidelines concerning the use of electronic fetal monitoring. In determining the fetal blood sampling issue, Mrs Justice Lambert pointed out the inherent difficulties with the Guidelines themselves:
..the Guidelines on their face appear to advocate two contradictory management options in response to a single prolonged deceleration lasting longer than three minutes: conservative measures where possible or feasible (expressly including fetal blood sampling) and a few short paragraphs later urgent delivery (fetal blood sampling being contraindicated). On the critical question for my determination, the Guidelines point in two, entirely different, management directions.
The judge resolved this apparent difficulty by noting that it could not be said that the Guidelines were intended to provide practitioners with the complete description of appropriate management in the presence of a particular trace feature. Rather, she endorsed the conclusion of the Defendants expert obstetrician that the Guidelines do not provide a complete compendium of either definitions or clinical management options. The Guidelines are useful so far as they go, but they are limited. The Guidelines do not provide a substitute for clinical judgement but must be interpreted by the clinician and then applied in light of that judgement.
In concluding that there had been no breach of duty in respect of the fetal blood sampling issue, she concluded that: the Guidelines are a practical tool to be used in conjunction with clinical judgement.
The implications of Sanderson
That NICE guidance cannot simply be slavishly applied as if it was an instruction manual will be well known to practitioners, particularly those in primary care. Sanderson itself demonstrates that it is not always as simple as following the guidelines.
The Judgement in Sanderson should be welcomed for re-emphasising that NICE Guidelines are exactly that they are guidelines, not tramlines. Sanderson makes it clear that clinical judgement still has a critical role to play alongside any relevant NICE Guidelines when determining pathways of care, as, of course, NICE Guidelines always state on their face.
Read the original:
Guidelines, not tramlines! The interplay between NICE Guidelines and clinical judgement - Lexology
- Man With Cerebral Palsy Imitates Michael Phelps Rule Yourself Video - SwimSwam - March 24th, 2017 [March 24th, 2017]
- Baby Connor McCue diagnosed with cerebral palsy - months after successful liver transplant - Stoke Sentinel - March 24th, 2017 [March 24th, 2017]
- Fundraiser for local teacher with cerebral palsy takes off - Longview Daily News - March 24th, 2017 [March 24th, 2017]
- Rockford athlete with cerebral palsy trains for IRONMAN World ... - Fox17 - March 24th, 2017 [March 24th, 2017]
- Andrew Spencer: Norwood teen with cerebral palsy found safe after ... - WCPO - March 24th, 2017 [March 24th, 2017]
- I'm Celebrating Cerebral Palsy Awareness Month For the First Time ... - TeenVogue.com - March 24th, 2017 [March 24th, 2017]
- Cerebral palsy Overview - Mayo Clinic - March 24th, 2017 [March 24th, 2017]
- Local 22-year-old girl with Cerebral Palsy to get free chair lift - 13newsnow.com - March 25th, 2017 [March 25th, 2017]
- Missing 13-year-old with cerebral palsy found safe - WLWT.com - WLWT Cincinnati - March 26th, 2017 [March 26th, 2017]
- Cerebral Palsy | The Mighty - March 26th, 2017 [March 26th, 2017]
- Cerebral Palsy Overview - Cerebal Palsy Guidance - March 26th, 2017 [March 26th, 2017]
- Cerebral Palsy Group Support and Resources for Cerebral Palsy - March 26th, 2017 [March 26th, 2017]
- Teen with cerebral palsy earns spot in state finals for track and field - 7News - WSVN-TV - March 27th, 2017 [March 27th, 2017]
- Parma mother of child with Cerebral Palsy gets unexplainable water and sewer bills - newsnet5.com - March 27th, 2017 [March 27th, 2017]
- Living with cerebral palsy - TheChronicleHerald.ca - March 28th, 2017 [March 28th, 2017]
- Cerebral palsy couldn't stop Gillian from finishing eight remarkable races - Belfast Telegraph - March 28th, 2017 [March 28th, 2017]
- Life's Equation Book Signing for National Cerebral Palsy Month - FOX31 Denver - March 28th, 2017 [March 28th, 2017]
- Montrose cerebral palsy sufferer reaches impasse with Angus Council - Montrose Review - March 30th, 2017 [March 30th, 2017]
- Living with cerebral palsy, he's also become 'The Dude': a food critic - MyAJC - March 30th, 2017 [March 30th, 2017]
- uOttawa students engineer foot-controlled TV converter for man with ... - Ottawa Citizen - March 30th, 2017 [March 30th, 2017]
- Cerebral palsy children's home receives a face-lift - Rising Sun Overport - March 30th, 2017 [March 30th, 2017]
- Youngstown news, Taekwondo helps 13-year-old with cerebral palsy - Youngstown Vindicator - March 30th, 2017 [March 30th, 2017]
- Man born with Cerebral Palsy thanks Michael Phelps for teaching ... - WOTV4women.com - March 30th, 2017 [March 30th, 2017]
- Cavs ticket winner gives prize to 10-year-old with cerebral palsy - fox8.com - March 30th, 2017 [March 30th, 2017]
- 12-Year-Old with Cerebral Palsy Meets His 'Hero' John Cena: 'My Heart Melts,' Says Dad - PEOPLE.com - March 31st, 2017 [March 31st, 2017]
- Norfolk family's video of son with cerebral palsy goes viral - 13newsnow.com - March 31st, 2017 [March 31st, 2017]
- Milton Boxer With Cerebral Palsy Remains Undefeated - CBS Boston / WBZ - March 31st, 2017 [March 31st, 2017]
- Chase High hosts Cerebral Palsy Awareness Day | News ... - The Daily Courier - April 1st, 2017 [April 1st, 2017]
- 'That Stroller Is Peyton's Life,' Special Wheelchair Stolen From Girl With Cerebral Palsy - CBS New York - April 1st, 2017 [April 1st, 2017]
- John Cena meets 12-year-old fan with cerebral palsy - My Fox Boston - April 1st, 2017 [April 1st, 2017]
- Cerebral Palsy - Cerebral Palsy - April 1st, 2017 [April 1st, 2017]
- Blazing New Trails: Updates in the Care of Children with Cerebral Palsy - Wayne County Journal Banner - April 2nd, 2017 [April 2nd, 2017]
- Cerebal Palsy An Overview of Symptoms, Causes, and ... - April 2nd, 2017 [April 2nd, 2017]
- John Cena meets 12-year-old fan with cerebral palsy - WPXI Pittsburgh - April 3rd, 2017 [April 3rd, 2017]
- Tri-Cities 12-year-old with cerebral palsy meets his hero, John Cena - WJHL - April 3rd, 2017 [April 3rd, 2017]
- Cord blood stem cells offer promising treatments for Cerebral Palsy - April 4th, 2017 [April 4th, 2017]
- This 3-Year-Old With Cerebral Palsy Is Spreading Awareness In Style - Huffington Post - April 5th, 2017 [April 5th, 2017]
- Govt Urged to Make Special Provision for Children with Cerebral Palsy - THISDAY Newspapers - April 5th, 2017 [April 5th, 2017]
- Topsham student with cerebral palsy launches road race - The Forecaster - April 5th, 2017 [April 5th, 2017]
- Students design 'Chandler's Chariot' for boy with cerebral palsy - WBAL Baltimore - April 5th, 2017 [April 5th, 2017]
- WWE star John Cena surprises young fan with cerebral palsy in heartwarming video - Globalnews.ca - April 5th, 2017 [April 5th, 2017]
- Cerebral Palsy (Center for Cerebral Palsy) | Gillette ... - April 5th, 2017 [April 5th, 2017]
- 'Cerebral palsy will never stop me from being successful' - Evening Telegraph - April 7th, 2017 [April 7th, 2017]
- Otte student proposes cerebral palsy awareness event | Local News ... - Blair Enterprise Publishing - April 7th, 2017 [April 7th, 2017]
- Cobb trampoline park adds events for those with autism, cerebral ... - Atlanta Journal Constitution - April 7th, 2017 [April 7th, 2017]
- The Heart of a Champion: Riverside student battling cerebral palsy gets surprise of a lifetime - San Benito News - April 8th, 2017 [April 8th, 2017]
- Princeton Ethics Professor Defends Woman Convicted of Raping ... - Christian News Network - April 8th, 2017 [April 8th, 2017]
- Nine-year-old cerebral palsy patient is guest of honour at unveiling of Co-op revamp - Nottingham Post - April 8th, 2017 [April 8th, 2017]
- Perth woman with cerebral palsy faces losing driver's licence after 36 years - ABC Online - April 8th, 2017 [April 8th, 2017]
- Cerebral palsy may be linked to birth weight - Independent Online - April 8th, 2017 [April 8th, 2017]
- Cerebral Palsy's Kate Laver tennis invitational - The Desert Sun - April 8th, 2017 [April 8th, 2017]
- Gurgaon: Doctors come together to treat Cerebral Palsy in children ... - Hindustan Times - April 11th, 2017 [April 11th, 2017]
- Teen takes best friend with Cerebral Palsy to prom - Story | WNYW - Fox5NY - April 11th, 2017 [April 11th, 2017]
- No compensation for girl left with cerebral palsy in 'tragic' home birth ... - Echo - April 11th, 2017 [April 11th, 2017]
- No compensation for girl left with cerebral palsy in 'tragic' home birth as top judge rules midwives 'could not have ... - Echo - April 11th, 2017 [April 11th, 2017]
- Man with cerebral palsy is memorable in more ways than 1 ... - Washington Times - April 12th, 2017 [April 12th, 2017]
- White Sox announcer gives play-by-play on finding success with ... - CNN - April 15th, 2017 [April 15th, 2017]
- Grandmother takes on epic Everest trek for grandson with cerebral palsy - Taranaki Daily News - April 15th, 2017 [April 15th, 2017]
- Rare surgery helps kids with cerebral palsy walk - KHOU - April 15th, 2017 [April 15th, 2017]
- Princeton Ethics Professor Defends Woman Convicted of Raping Man With Cerebral Palsy - GOPUSA - April 16th, 2017 [April 16th, 2017]
- Parents promote partial OHIP funded life changing cerebral palsy U.S. surgery - insideTORONTO.com - April 16th, 2017 [April 16th, 2017]
- Cerebral palsy girl Molly Grace helped in Facebook appeal - BBC ... - BBC News - April 16th, 2017 [April 16th, 2017]
- Students create cerebral palsy toothbrush - Bangalore Mirror - April 18th, 2017 [April 18th, 2017]
- Dad's Facebook Appeal To Find Feeding Tube For Daughter With Cerebral Palsy Is Huge Success - Huffington Post UK - April 18th, 2017 [April 18th, 2017]
- Cerebral Palsy can't stop me from surfing - News24 - April 18th, 2017 [April 18th, 2017]
- Heartland man with cerebral palsy inspires others in his quest to walk - WOWT - April 19th, 2017 [April 19th, 2017]
- Derby-themed party races to help cure cerebral palsy - MDJOnline.com - April 19th, 2017 [April 19th, 2017]
- Five-year-old with cerebral palsy making strides thanks to surgery in Ohio - WKEF ABC 22 - April 20th, 2017 [April 20th, 2017]
- Greek Week Raises Over $50,000 for Cerebral Palsy Awareness - University of Miami - April 21st, 2017 [April 21st, 2017]
- 5-year-old girl with cerebral palsy takes her first steps thanks to miracle surgery - AOL - April 21st, 2017 [April 21st, 2017]
- Wellington Rotary Club to post Outrun Cerebral Palsy 5K - Palm Beach Post (blog) - April 21st, 2017 [April 21st, 2017]
- Surgical Procedure Can Reduce Pain, Improve Mobility For Children With Cerebral Palsy - CBS New York - April 21st, 2017 [April 21st, 2017]
- Amazing Women Series: Mother in 'constant awe' of triplets - Canadian Jewish News (blog) - April 24th, 2017 [April 24th, 2017]
- 1st annual Madoc walk for cerebral palsy - www.insidebelleville.com/ - April 24th, 2017 [April 24th, 2017]
- Willard senior with cerebral palsy to compete in national speech tournament - Springfield News-Leader - April 26th, 2017 [April 26th, 2017]
- Meet Dr Amitabh Mehrotra, who defeated cerebral palsy to start a school for children with disabilities in Lucknow - YourStory.com - April 26th, 2017 [April 26th, 2017]
- Watch Marijuana Help This Girl With Cerebral Palsy And Autism - The Fresh Toast - April 26th, 2017 [April 26th, 2017]
- Young N. Idaho inventors adapt car for child with cerebral palsy ... - KTVB - April 27th, 2017 [April 27th, 2017]
- Patrick Barden set to complete London marathon with cerebral palsy - Metro - April 27th, 2017 [April 27th, 2017]
- Cerebral Palsy sufferer, Patrick Barden, from Shorne, completes London Marathon - Kent Online - April 30th, 2017 [April 30th, 2017]