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Spargo v North Essex District Health Authority [1997] EWCA Civ 1232 (13th March, 1997)
URL: http://www.bailii.org/ew/cases/EWCA/Civ/1997/1232.html
Cite as:
(1997) 37 BMLR 99,
[1997] EWCA Civ 1232,
[1997] 8 Med LR 125,
37 BMLR 99,
[1997] PIQR P235
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JOSE ANN SPARGO v. NORTH ESSEX DISTRICT HEALTH AUTHORITY [1997] EWCA Civ 1232 (13th March, 1997)
IN
THE SUPREME COURT OF JUDICATURE
QBENF
95/1674/C
COURT
OF APPEAL (CIVIL DIVISION)
ON
APPEAL FROM THE HIGH COURT OF JUSTICE
QUEEN'S
BENCH DIVISION
(Mr
Justice Collins)
Royal
Courts of Justice
Strand
London
WC2
Thursday,
13th March 1997
B
e f o r e :
LORD
JUSTICE NOURSE
LORD
JUSTICE BROOKE
and
LORD
JUSTICE WALLER
--------------
JOSE
ANN SPARGO
Plaintiff/Respondent
-v-
NORTH
ESSEX DISTRICT HEALTH AUTHORITY
Defendant/Appellant
----------------
Computer
Aided Transcript of the Palantype Notes of
Smith
Bernal Reporting Limited
180
Fleet Street London EC4A 2HD
Tel:
0171 831 3183 Fax: 0171 831 8838
(Official
Shorthand Writers to the Court)
---------------
MR.
T. COGHLAN QC
(instructed by Messrs Le Brasseur J Tickle, London WC2) appeared on behalf of
the Appellant Defendant.
MR.
S. MASKREY QC
and
MR.
A. BUCHAN
(instructed by Messrs Gadsby Wicks, Chelmsford) appeared on behalf of the
Respondent Plaintiff.
---------------
J
U D G M E N T
(As
Approved by the Court)
Crown
Copyright
Thursday,
13th March 1997
LORD
JUSTICE BROOKE:
This
is an appeal by the Defendants against a judgment of Collins J on 20th
September 1995 when he ordered on the trial of a preliminary issue that the
Plaintiff’s claim for damages for medical negligence was not
statute-barred by reason of the provisions of Sections 11 and 14 of the
Limitation Act 1980.
The
Plaintiff Jose Ann Spargo is now 67. Her complaint in this action is that a
negligent diagnosis made 22 years ago led to her being detained in a
psychiatric hospital for six years between 1975 and her release in 1981 for
much longer than was necessary and that this experience has had a catastrophic
effect on her life. In order to understand the central issue which the judge
had to decide it is first necessary to say something about the history.
The
Plaintiff was born on 4th March 1930. She had two brothers and one sister.
There was no clear history of psychiatric illness in the family. When she was
at Colchester County High School she attained A levels in History, French,
English and Art. In 1951 she embarked on a career as a journalist when she
because a reporter with the Essex County Standard. Five years later she became
the chief reporter for the Essex Chronicle and by 1961 she was the chief
sub-editor for that paper. In 1968 she was appointed editor of the Newsman
Herald while continuing to sub-edit the Essex Chronicle.
The
Plaintiff and her solicitor gave oral evidence, in addition to their affidavit
evidence, to the judge at the trial of the preliminary issue. His findings as
to what happened after 1970, when she was 40 years of age, were along the
following lines.
She
had started to take barbiturates in substantial quantities, and she was also
having difficulties with her marriage. The upshot of all this was that she
developed psychiatric problems and her behaviour became rather bizarre. She
became confused and began to abuse laxatives, and in 1973 she was diagnosed as
suffering from a drug-induced psychosis and admitted as a voluntary patient to
Severalls Hospital, Colchester. She was released soon afterwards, but was
readmitted towards the end of 1974. She was again behaving rather strangely
and had lost a lot of weight. The diagnosis now was possible organic
psychosis. She weighed only six and a half stone.
By
early March 1975 her weight had increased sufficiently for her doctors no
longer to fear for her condition, and she was discharged from hospital. Sadly
the improvement did not last, and on 16th April of that year she was found
wandering about in her nightdress in a confused and emaciated state. On this
occasion she was compulsorily admitted to hospital, and there she remained
until her release in November 1981. She made two or three unsuccessful
applications to the Mental Health Review Tribunal for her release during her
stay there, and towards the end of the period of her detention she was granted
periods of home leave in order to ease her re-introduction into ordinary life
outside hospital on her eventual release.
For
all this time she was under the care of Dr Marshall, a consultant psychiatrist
who died in March 1994. He caused various tests to be carried out to try and
ascertain the reasons for her strange behaviour. In January 1976 a clinical
psychologist reported to him that one of the tests she had conducted strongly
indicated some frontal lobe damage, which probably caused some disinhibition of
impulses. Shortly before this Dr Marshall had reported to the
Plaintiff’s mother that the present evidence was that she had suffered
brain damage, and that this was not something which was likely to improve.
Three and a half years later he wrote of the Plaintiff that it was assumed that
she suffered from selective brain damage resulting from excessive purging and
dieting: this damage was confined to those areas of her brain which are
associated with the finer qualities of moral judgment and insight. On 10th
November 1981 Dr Marshall noted in her discharge letter that the
Plaintiff’s troubles “had their origin in dieting and excessive
purging, later the focus of some considerable interest when it seemed likely
that the result had been fairly selective brain damage. Clinically the damage
had been frontal lobe, resulting in irresponsible behaviour and a lack of moral
judgment”.
It
is now common ground that the diagnosis of organic brain damage syndrome was
mistaken. It is not disputed that as things turned out her behaviour justified
her detention in hospital, but it is said that if she had been given the
treatment she should have been given, but for this faulty diagnosis, she would
have been released much earlier and would not have been left with the stigma of
suffering from organic brain damage.
The
writ in this action was issued on 14th December 1993, over 12 years after her
release from hospital. Parts of the Plaintiff’s medical history are
pleaded, and the central charge of professional negligence is based on the
thesis that the diagnosis of organic brain damage appeared to be based on the
psychological tests, and at that time it was not acceptable to make such a
diagnosis purely on a verbal-performance deficit. The results of the
psychological tests were open to alternative interpretations such as
attentional factors, the consequences of the medication she had been abusing,
electrolyte disturbance and the medications she had been prescribed as a
patient. If she had had organic brain damage, her IQ test performance would
radically have deteriorated: instead, it improved. It is suggested that once
the diagnosis was made she should have been referred to a neurologist to see if
he confirmed the diagnosis of dementia, and that further investigations would
have included a brain scan. Reasons are given, by reference to some
contemporary notes, for suggesting that dementia was contra-indicated. The
most appropriate diagnosis, it is said, was that of an obsessive compulsive
disorder with abnormal laxative abuse, but this was not considered. In the
original Statement of Claim the reader is referred to the attached medical
report for the Particulars of Injury. In a draft of a proposed amendment to
that pleading, if the case is allowed to proceed, appear the words “The
Plaintiff’s injury was the prolongation of her suffering from probable
obsessive compulsive disorder and being treated for organic brain damage”.
The
Defendants pleaded a very full defence in May 1994. Five pages of the Defence
are taken up with the limitation plea, to which I will return in due course.
Then after pleading to the medical history, and making it clear that they feel
that the Plaintiff’s advisers have dipped selectively into the voluminous
notes, the Defendants set out a positive case in response to the allegations of
professional negligence. In particular, they say that there was considerable
clinical and psychological evidence tending to support the diagnosis of organic
brain disease, which was not in any event a definitive diagnosis, and the test
results were not the sole basis for the diagnosis. They do not understand what
alternative interpretations are contended for the clinical and psychological
evidence and the observed behaviour deviations, and they deny that there was
any indication for a neurological opinion at any time. They do not understand
what other diagnostic tests are said to have been available in those days which
they did not perform, and they say that obsessional compulsive disorder could
not be considered seriously as part of the differential diagnosis in the
absence of any evidence to support such a diagnosis. They rely, finally, on
the decisions of the Mental Health Review Tribunal in 1976 and 1979 which
upheld their decision to detain the Plaintiff in her own best interests and to
protect her from self-harm.
I
mention these matters only to show that this would be likely to be a formidably
difficult case to try, and to try fairly, after so many years, particularly as
the consultant psychiatrist against whom the charge of professional negligence
is principally aimed is now dead and cannot defend himself: he was, we were
told, already in a poor state of health when the writ was served shortly before
he died. Still, if the Plaintiff can show that by the operation of the 1980
Act she has a right to bring this action, notwithstanding the difficulties a
court would face in its efforts to do justice, she is entitled to do so, and
the court would have to try and do its best. That will be the effect of the
judge’s order, if it remains intact in this appeal.
The
judge found that the Plaintiff did not have the requisite knowledge for the
purposes of Section 11(4) of the 1980 Act until a date not more than 3 years
before she issued her writ in December 1993, so that her action is not statute
barred. What is meant by a person’s date of knowledge is explained by
Section 14 of the Act which provides, so far as is material:
“(1)
In sections 11 and 12 of this Act references to a person’s date of
knowledge are references to the date on which he first had knowledge of the
following facts - (a) that the injury in question was significant; and (b) that
the injury was attributable in whole or in part to the act or omission which is
alleged to constitute negligence, nuisance or breach of duty; and (c) the
identity of the defendant; ... and knowledge that any acts or omissions did or
did not, as a matter of law, involve negligence, nuisance or breach of duty is
irrelevant.
(2)
For the purpose of this section an injury is significant if the person whose
date of knowledge is in question would reasonably have considered it
sufficiently serious to justify his instituting proceedings for damages against
a defendant who did not dispute liability and was able to satisfy a judgment.
(3)
For the purposes of this section a person’s knowledge includes knowledge
which he might reasonably have been expected to acquire - (a) from facts
observable or ascertainable by him; or (b) from facts ascertainable by him with
the help of medical or other appropriate expert advice which it is reasonable
for him to seek; but a person shall not be fixed under this subsection with
knowledge of a fact ascertainable only with the help of expert advice so long
as he has taken all reasonable steps to obtain (and, where appropriate, to act
on) that advice.”
No
real issues arose about the Plaintiff’s knowledge of the facts referred
to in Section 14(1)(a) and (c): the controversy arose over Section 14(1)(b).
Before setting out the rival contentions it is necessary to return to the facts.
The
judge recorded what the Plaintiff told him, and except where it appears that
she shifted her evidence under cross-examination, he seems to have accepted
what she told him. When she was released from hospital in November 1981 she
felt out of touch with the world. She said she received precious little
assistance in putting her life together again and was given no support by her
husband. She was branded as someone suffering from organic brain damage, and
she described to the judge the reasons why she experienced enormous difficulty
in finding any employment and the frustrations she felt on that account.
By
1985 her marriage had deteriorated to such an extent that she instructed
solicitors to institute divorce proceedings. She then found that her husband
was taunting her with the brain damage, and she went back to Dr Marshall, who
arranged for her to have a further IQ test. The report on that test, dated
10th January 1986, indicated that she did not appear to be suffering from any
brain damage. She was found to be without any psychiatric impairment and
otherwise fit to be gainfully employed. This was, understandably a profound
relief to her. It appears that she had a word over the telephone with Dr
Marshall’s secretary, who told her that Dr Marshall accepted that a
mistake had been made in the diagnosis. This led to her writing to Dr Marshall
on 20th January 1986 to record her gratitude that it had been accepted that a
mistake had been made and that she could now go ahead in the knowledge that she
was not suffering from the brain damage that she feared she had.
The
judge describes how the Plaintiff’s attitude towards Dr Marshall began to
harden somewhat once she received this good news. She had previously thought
of him as rather a harsh person when she had thought about him at all, and she
had been disappointed that she had not received some help with housing or with
her efforts to find work on her release from hospital. She said she had the
consideration to wait till Dr Marshall retired on 20th June 1986 before taking
any steps to find out if it was possible to take proceedings against him. She
thought it was on the very next day that she went to see Mr Wicks. He was the
appropriate partner in the firm of solicitors she had instructed in her divorce
proceedings to handle a case like this. In fact Mr Wicks’s records show
that she first consulted him in October 1986.
In
an affidavit sworn in January 1995 the Plaintiff said that she felt a mistake
had been made because the psychological tests had been carried out on her while
she was under the influence of drugs like Largactil, and she had therefore been
branded as being brain damaged inappropriately. She had therefore decided to
consult her solicitors with a view to making a claim for compensation. She did
not know whether she had a case or not, and in particular she did not know if a
mistake in diagnosis had caused her to be detained in hospital when she would
not otherwise have been. However, she suspected that Dr Marshall had made a
mistake in her case and that he may have been negligent. When cross-examined,
she said that she knew that she had suffered in hospital for a long time and
that she firmly believed that that was because of the mis-diagnosis. In her
mind all her suffering was attributable to the mistaken diagnosis of organic
brain damage, and that was her clear view when she saw Mr Wicks in October 1986.
Why,
then, did a further period of seven years elapse before a writ was issued? A
chronology reveals the bare bones of the history of that seven year period:
30.1.87 Application
for Legal Aid.
23.3.87 Legal
Aid certificate issued.
15.7.88 Letter
before action. Request for medical records.
19.8.88 GP
records received.
26.8.88 Hospital
records received.
24.10.88 Hospital’s
solicitors advise that there are no further records.
21.2.89 Negative
report from expert (Dr Davies).
6.12.89 Counsel
advises against proceedings.
1.3.90 Legal
Aid sought for second opinion.
20.3.90 Legal
Aid for second opinion granted.
4.12.90 Instructions
sent to second expert (Mr Trimble)
22.7.91 Positive
report received from second expert.
14.12.93 Writ
issued.
The
judge’s main findings in relation to this later period were that Mr Wicks
was a thoroughly competent solicitor who had clearly had a great deal of
experience in dealing with medical negligence claims: in fact he is one of the
Law Society’s referees for judging the competence of other solicitors who
wish to be accredited as competent in handling such litigation. He had told
the judge he was aware of the potential limitation problems, and he was
concerned to issue proceedings by the summer of 1989.
It
was his practice, which he believed to be good practice, to take full
instructions from a client before obtaining medical notes. He found that it
was not easy to obtain coherent instructions from the Plaintiff. She was one
of the most difficult clients he had had to deal with, and this was one of his
most difficult cases. As a consequence, the sessions which were required to
prepare a proof of evidence lasted about a year: in July 1988 he was in a
position to ask for the hospital and GP records.
In
the event, he obtained the first independent psychiatric report on 21st
February 1989 from an expert he instructed the previous month, and if this had
been positive proceedings could have been issued soon afterwards. When he
received adverse advice from counsel in December 1989, he accepted that some
delay occurred during 1990, the details of which he explained to the judge,
before he sent instructions to a second expert. A further period of 7 months
passed before that expert reported.
For
the purposes of this appeal this court is not concerned about the details of
the history after 1986. The judge found Mr Wicks had not taken all reasonable
steps to obtain the necessary advice, and although a Respondent’s
Cross-Notice challenging that finding was filed and served, Mr Maskrey did not
in the event rely upon it. The reason he took this course was that the judge
did not make a finding of negligence against Mr Wicks. He had merely found
that he had not taken
all
reasonable steps, and the Respondent’s advisers ultimately took the view
that it was not realistic to challenge that finding in this court. Her primary
case under s 14(3) is, as it was before Collins J, that the slowness of her
solicitors cannot be properly attributed to her unless it was so excessively
slow that she ought reasonably to have taken steps on her own account to hurry
things along. On that aspect of the matter the judge made an express finding
that she did not act unreasonably and that she did not personally fail to take
all reasonable steps in that she instructed solicitors and co-operated with
those solicitors to obtain the necessary advice.
The
judge held that the Plaintiff did not have actual knowledge for the purposes of
Section 14(1) of the 1980 Act that her sufferings were attributable in whole or
in part to the misdiagnosis of organic brain damage till she first received Dr
Trimble’s report on 22nd July 1991. Although there was no question in
her own mind that her sufferings were attributable to the misdiagnosis, she
nevertheless did not have the requisite knowledge for the purposes of the Act
until she had been told this by an expert, and this did not happen until July
1991. He went on to hold that she could not be fixed with constructive
knowledge for the purposes of Section 14(3) because she, the Plaintiff, had
taken all reasonable steps to obtain (and, where appropriate, to act on) expert
advice, and that she should not be prejudiced because her solicitor had taken
such a long time to obtain the advice she needed.
What,
then, does the law require in order that actual knowledge is established?
This
branch of the law is already so grossly over-loaded with reported cases, a
great many of which have been shown to us or cited by counsel, that I see no
reason to add to the overload by citation from earlier decisions. I have
considered the judgments of this court in
Halford
v Brooks
[1991] 1 WLR 443;
Nash
v Eli Lilley & Co
[1993] 1 WLR 782;
Broadley
v Guy Clapham
[1993] 4 All ER 439;
Dobbie
v Medway Health Authority
[1994] 1 WLR 1234;
Smith
v Lancashire Health Authority
[1995] PIQR 514; and
Forbes
v Wandsworth Health Authority
[1996] 7 Med LR 175. From these decisions I draw the following principles:
(1) The
knowledge required to satisfy s 14(1)(b) is a broad knowledge of the essence of
the causally relevant act or omission to which the injury is attributable;
(2) “Attributable”
in this context means “capable of being attributed to”, in the
sense of being a real possibility;
(3) A
plaintiff has the requisite knowledge when she knows enough to make it
reasonable for her to begin to investigate whether or not she has a case
against the defendant. Another way of putting this is to say that she will
have such knowledge if she so firmly believes that her condition is capable of
being attributed to an act or omission which she can identify (in broad terms)
that she goes to a solicitor to seek advice about making a claim for
compensation;
(4) On
the other hand she will not have the requisite knowledge if she thinks she
knows the acts or omissions she should investigate but in fact is barking up
the wrong tree: or if her knowledge of what the defendant did or did not do is
so vague or general that she cannot fairly be expected to know what she should
investigate; or if her state of mind is such that she thinks her condition is
capable of being attributed to the act or omission alleged to constitute
negligence, but she is not sure about this, and would need to check with an
expert before she could be properly said to know that it was.
In
order to see whether Section 14(1)(b) is satisfied in the present case, it is
first necessary to identify the injury of which the plaintiff had actual
knowledge for the purpose of Section 14(1)(a). This was not a case of
traumatic injury or shock-induced psychiatric injury, such as would not give
rise to any particular problems of identification. Any possible claim in
trespass was statute-barred and as I have said the initial Statement of Claim
simply made a cross-reference to the attached medical report. That medical
report shows that the Plaintiff appeared to have been abusing laxatives, and
possibly psychiatric medications, in the early 1970s which led to loss of
weight and to an electrolyte disturbance which may have brought about temporary
alteration of her mental state. It then refers to her prolonged period of
hospitalisation, and the clear inference is that this prolonged hospitalisation
is being causally connected with, or attributed to, the misdiagnosis which is
pleaded in the Statement of Claim. The “injury” has now been more
precisely pleaded in the proposed amendment of the Statement of Claim.
The
judge was at a disadvantage in that he did not have this draft amendment before
him, and when he made his finding that the Plaintiff knew of the injury, and
that it was significant, he used less precise terms. He said at one point that
it was “quite plain that the Plaintiff did know that she was suffering
from a condition whilst she was at the hospital”. A little later he said
that “she knew that she had been suffering whilst she was under
detention, and there is no question as to that”. There was no appeal
against that finding.
In
his admirable submissions to this court Mr Maskrey has seized on passages here
and there in the judgment to paint a picture that the Plaintiff was so confused
in October 1986 that it was really not fair to attribute to her any
knowledge
that her suffering during her prolonged hospitalisation (or any part of it) was
capable of being attributed to the misdiagnosis. At one point he submitted
that the omission that was causally relevant was the failure to treat her
properly for her true condition, and that it was not necessary for him to
assert that that omission constituted negligence. He resiled from that
submission when the clear wording of Section 14(1)(b) was pointed out to him,
and in my judgment from a perusal of the Particulars of Negligence in the
Statement of Claim it is quite clear that it is the alleged negligence
surrounding the diagnosis of organic brain syndrome which constitutes the
omission or omissions relied upon as being the cause of the injuries complained
of. The failure to provide appropriate treatment was merely an inevitable
consequence of the negligence alleged.
One
passage on which Mr Maskrey relied is to be found at an early stage of the
judgment where the judge was referring to an attitude by the Plaintiff
“which is coloured by her lack of insight into her condition when she was
in the hospital”. Elsewhere, however, the judge found that “she
was clear in her mind that the connection was there between the misdiagnosis
and what she had suffered”. Notwithstanding this later finding, Mr
Maskrey argued that, looking at the judgment as a whole, we should draw a
conclusion from the judge’s findings to the effect that his client was so
confused when she first went to see Mr Wicks that it would be wrong to hold
that the clarity in her mind which the judge describes did not amount to the
requisite knowledge for the combined purposes of Section 14(1)(a) and (b).
Mr
Coghlan has, in my judgment, quite rightly riposted that in the absence of an
appeal on this point we cannot go behind the express finding the judge made.
Mr Coghlan referred us to the finding of the psychologist in January 1986 that
the Plaintiff was without any psychiatric impairment and otherwise fit to be
gainfully employed, and said that if the correctness of the judge’s
finding on this point had been appealed, he would have wanted to bring before
us all the contemporary hospital notes and a transcript of the
Plaintiff’s evidence at the hearing to demonstrate that the judge’s
finding that she was clear in her mind about the connection between the
misdiagnosis and her suffering could not be successfully challenged.
On
the face of it, therefore, the Plaintiff did know in October 1986 of her
“injury” and of the causally relevant “omission” said
to constitute negligence and of the possible connection between the two. Why,
then, did the judge find that she did not have the requisite knowledge for the
purposes of Section 14(1)(b)?
He
appears to have been influenced in his approach by a single passage in the
judgment of this court in N
ash
v Eli Lilly & Co
[1993] 1 WLR 782 at pp 795-6. In that passage Purchas LJ was endeavouring to
explain the state of mind that must be attributed to a plaintiff before he can
be fixed with knowledge for the purposes of Section 14(1). He contrasted the
person who thinks that his condition is capable of being attributed to the act
or omission alleged to constitute negligence, but realises that this belief
should be confirmed by an expert before he can be said that he knows that it
is, with the person whose firm belief is of sufficient certainty to justify
obtaining advice about making a claim for compensation: “then such belief
is knowledge and the limitation period would begin to run”. (See p 796G).
Mr
Coghlan submitted that the judge at first directed himself correctly when he
said:
“The
issue here is whether the Plaintiff did have knowledge that the injury was
possibly attributable as opposed to a belief which can, if you like, be given
the adjective ´firm belief’ that it was indeed attributable.”
But
he criticises the judge when, after quoting the relevant passages in the
judgment of Purchas LJ in
Nash,
he went on to say:
“It
does not seem to me that it is a fair or correct approach to say that because
an individual, for reasons which may be good or may be bad, has a certainty in
his own mind as to the connection, that in itself means that he has the
requisite knowledge if, looked at objectively, it is perfectly plain that no
layman would be able to know (as opposed to believe) that that connection
existed without the assistance of some expert advice.”
A
little earlier the judge had spoken of the solicitor’s perception that he
needed confirmation that there
was
the relevant causal connection, and a little later he added that the question
will, in certain circumstances, be whether a particular injury
was
caused by an operation or
was
caused by something else. In my judgment, in all these passages the judge is
substituting the much tougher test of proof of causation for the much less
rigorous statutory test of attributability, in the sense that the identified
injury was capable of being attributed to the identified omission. The test is
a subjective one: what did the Plaintiff herself know? It is not an objective
one: what would have been the reasonable layman’s state of mind in the
absence of expert confirmation? After all, the policy of Parliament, in these
cases which would otherwise be statute-barred, is to give a plaintiff who has
the requisite low level of knowledge three years in which to establish by
inquiry whether the identified injury was indeed probably caused by the
identified omission and whether the omission (identified initially in broad
terms) amounted to actionable negligence. The judge’s approach would be
to stop the three years from even starting to run until a much more advanced
stage of the investigation had been completed.
In
Nash
the Court of Appeal was concerned with 18 Plaintiffs who claimed that there was
a causal connection between their having taken Opren and their experiencing the
unpleasant symptoms effects from which they suffered. The facts of the
individual cases are much more fully described in the judgments of Hidden J and
the Court of Appeal in the Medical Law Reports (see [1991] 2 Med LR 169: [1992]
3 Med LR 233 and [1992] 3 Med LR 353). It is not surprising that in proposing
a test to enable the court to identify the relevant state of mind of Plaintiffs
in a case like that - they knew the unpleasant symptoms they were suffering but
were gradually picking up, from different sources, including television
programmes, various pieces of information which helped to inform their minds
about a possible connection between their sufferings and the drugs they had
taken - this court was at pains to say that the person who thought that her
condition was capable of being attributed to the drugs she had taken but
realised that her belief should be confirmed by a doctor did not have the
requisite knowledge. But that is a long way from the present case where the
judge found that the Plaintiff was clear in her mind that the connection was
there between the misdiagnosis and what she had suffered when she came to her
solicitor for advice on whether and if so how she could claim compensation for
what she had suffered. In such a case it is not necessary, nor required by the
statute, for a court to embark on a further inquiry whether a rational lay
person would have been willing to say that she knew that there was a possible
casual connection between her suffering and the omission she had identified
without first going to a doctor to seek confirmation.
Mr
Maskrey advanced to us a number of sophisticated submissions which tended to
show that the pragmatic tests designed by this court in recent years to make it
easier for lower courts to identify the relatively low level of knowledge
required by the statute may not be appropriate in every possible case. However
that may be, they are in my judgment both appropriate for use in this case and
binding on this court and the judge was wrong to be lured into a more
sophisticated inquiry which in the end postponed the date of knowledge for a
further four and a half years. I would therefore allow this appeal.
In
the circumstances there is no need to express a view on the issue of
constructive knowledge. It raised very difficult questions of statutory
construction which are much better left, so far as this court is concerned, to
a case in which they have to be decided. The Law Commission has now embarked
on a major review of all aspects of the law of limitation, and the parties
would do well if they acquainted the Commission with the problems of statutory
interpretation which arose in this case, and which are very evident from the
report of the judgment at first instance (see (1996) Med LR 219 at pp 226-229).
This will enable the Commission to consult widely as to the policy they should
recommend to Parliament in cases where a blameless plaintiff has a painstaking
solicitor who does not seek quick expert advice on the question “Is my
client’s injury capable of being attributed to the omission which she or
I have identified?” - but takes a very long time before asking an expert
an infinitely more complicated list of questions which in turn take a very long
time to answer. Once the recommended policy is identified it would be helpful
if the Commission found ways of expressing it in statutory language less opaque
than that contained in s 14(3) of the present Act.
LORD
JUSTICE WALLER:
I
agree.
LORD
JUSTICE NOURSE:
I
also agree.
Order: preliminary
issue decided in favour of the defendant and action dismissed; appeal allowed
with costs - the plaintiff's contribution being assessed at nil, order nisi
made against the Legal Aid Fund under
section 18 of the
Legal Aid Act 1988 and
adjourned to the Registrar; costs below to be paid by the plaintiff, not to
be enforced without the leave of the court; legal aid taxation of the
plaintiff's costs; leave to appeal to the House of Lords refused.
© 1997 Crown Copyright