4 June, 2020

Alan McNab and others v Greater Glasgow Health Board [2020] CSOH 53

The pursuers were relatives of the late Ms McNab. They alleged clinical negligence on the part of a consultant urological surgeon employed by the defenders. Quantum was agreed between the parties. A proof proceeded in relation to negligence and some disputed aspects of causation. The proof was heard over five days. On 28 May 2020, Lady Carmichael granted decree of absolvitor.

The issues
The deceased died as a result of multi-organ failure secondary to sepsis. The sepsis was caused by a right rigid ureteroscopy procedure carried out by the defenders’ consultant urological surgeon, Ms Seaward. No ureteric stone was found, during the ureteroscopy. There is a small risk of sepsis with ureteroscopies.

The pursuers claimed that there had been a failure by Ms Seaward to obtain the deceased’s informed consent to the procedure, and that the deceased would not have given consent if fully informed. They also claimed that Ms Seaward failed to confirm the continued presence of a ureteric stone by further imaging prior to performing the procedure, and that in the absence of such imaging she should have cancelled the procedure. They claimed that she had a duty to check the deceased’s urine cultures before proceeding.

Lady Carmichael found on the evidence that the deceased’s previous episode of postoperative urosepsis did not mean that she was at an increased risk of sepsis. She found on the evidence that the deceased’s informed consent to the procedure was obtained, despite the lack of a full contemporaneous record.

In relation to the alleged failures to confirm the presence of the stone by imaging and to cancel the procedure, Lady Carmichael heard competing evidence from the pursuers’ expert Mr Baird and from the defenders’ expert Professor McClinton. She accepted Professor McClinton’s evidence that a reasonable body of clinicians would have acted as Ms Seaward did in the circumstances, and that there was a logical basis to proceed to a ureteroscopy. That procedure would demonstrate conclusively whether there was a stone present, in the context of a patient still complaining of pain which she described as the same she had experienced previously from a stone.

The final case based on a failure to obtain urine cultures also failed. There was no case on causation as to what the outcome would have been, had such urine cultures been obtained. Further, Lady Carmichael accepted Professor McClinton’s evidence that there was a practice at the material time of carrying out a dipstick test of urine on the morning of the procedure, as occurred in the deceased’s case.

Una Doherty Q.C. appeared for the defenders. Geoff Clarke Q.C. and Ranald Macpherson, Advocate, appeared for the pursuers.

Opinion of Lady Carmichael can be viewed here.

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