01/05/2019

The issue of medical causation can be complex. The complexities of legal causation in a medical context can be even more difficult to grapple with. This case provides welcome clarity for those practitioners involved in inquests as to how coronial causation should be approached.

Background

The case of R (on the application of Chidlow) v HM Senior Coroner for Blackpool and Fylde Divisional Court [2019] EWCH 581 (Admin) 12 March 2019 concerned an inquest that was heard in relation to the death of Carl Bibby, who died on 28th July 2009 at the age of 38.

On the evening of the 27th July 2009, Police were called to Mr Bibby’s residence due to his neighbours being alarmed about noises coming from the property. The Police attended and, following concerns about Mr Bibby’s health, made numerous calls to the ambulance service requesting an ambulance to attend. This call was not correctly categorised and, as a result, it took longer than it should have done for the ambulance to arrive. By the time the paramedics arrived on scene, Mr Bibby had suffered a cardiac arrest and could not be resuscitated. The ambulance service admitted to a delay in attending the scene.

At post-mortem examination, a medical cause of death could not be ascertained. However, a Consultant in Critical Care and Emergency Medicine gave evidence at the inquest that, had paramedics arrived before Mr Bibby’s cardiac arrest he would, on the balance of probabilities, have survived. In giving this opinion, the expert Consultant relied, to a certain extent, on statistical evidence of survivability in circumstances such as those of the deceased.

The Coroner ruled that, despite the evidence heard, it was not safe to leave the issue of whether there was a causal link between the delay and Mr Bibby’s death to the jury. This was on the basis that there was no clear cause of death and it would therefore be inappropriate and speculative to make any findings about causation.

Mr Bibby’s brother, Mr Chidlow, brought judicial review proceedings seeking a declaration that, in making this ruling and not allowing the jury to consider the causation issue, the Coroner acted unlawfully. He asked that the record of inquest be quashed and a new inquest be listed in front of a different Coroner.

Summary of Judgment

Mr Justice Pepperall concluded that the Coroner had erred in law and that the issue of the causal link between the admitted delay and Mr Bibby’s death should have been left to the jury. While they may well not in fact have agreed with the Consultant’s evidence, it was still an issue that should have been left to them to consider.

In coming to this conclusion he made a number of important findings, including:

  1. In providing evidence in relation to causation the doctor had not only been relying on statistics. He had instead based his opinion on a number of factors: his own experience; his reading of the other medical evidence available in the case; his understanding of the deceased’s condition at the time the Police were in attendance, and subsequently, during the ambulance attendance; as well as available statistics; and
  2. There was sufficient evidence heard to enable the likely effect of a delay in treatment being received and its implications for survivability to be considered.

Lord Justice Hickinbottom agreed.

As a result of this, the record of inquest was quashed and the case was remitted for a fresh inquest.

Practical Implications

This case has helped provide some clarity in relation to how causation should be considered at inquests. This clarity is provided in two key areas:

  1. The presence of statistical evidence is not on its own enough to establish causation. Instead, specific consideration needs to be made as to the individual circumstances of the deceased and thus where he or she was likely to fall in relation to the statistical categories; and
  2. There is a difference between being able to establish the exact cause of death and being able to say whether or not their life could have been saved with earlier medical attention/treatment. The absence of a clear cause of death therefore does not prevent a causal analysis of any delay in treatment.

The above is likely to be of considerable help when seeking to make submissions as to how much weight to attach to any statistical evidence presented and whether or not the causal impact of any act or omission can be assessed when the cause of death is unclear.