Court rules that doctors do not have to tell parents the truth

BMJ 1997; 315 doi: (Published 12 July 1997) Cite this as: BMJ 1997;315:75
  1. Clare Dyer, legal correspondent
  1. BMJ

    Doctors have no duty to tell parents the truth about the death of their child, the Court of Appeal ruled last week. The court unanimously struck out a claim by the parents of a boy who died of Addison's disease for damages for psychological trauma caused by the discovery of an alleged cover up by doctors after the death.

    Robert Powell, who died aged 10 in 1990, had been treated at Morriston Hospital in Swansea four months before his death. The consultant paediatrician treating him considered the possibility of adrenal insufficiency but did not carry out a test to see if an injection of adrenocorticotrophic hormone would make the adrenal glands work.

    He was well for nearly four months after discharge, but over the last two weeks of his life he was seen by doctors in the group practice at Ystradgynlais Health Centre, first with a sore throat and pain in the jaw, then weakness, lethargy, and vomiting.

    On the afternoon of the day he died, one of the GPs was called but refused to refer him to hospital. When the parents called her again, she visited and agreed to write a hospital referral letter but not to call an ambulance. Robert's parents took him by car to hospital, where he died of cardiac arrest 2 hours and 45 minutes after arrival.

    Mr and Mrs Powell sued West Glamorgan Health Authority and the GPs for negligence over Robert's death. The health authority admitted liability for the consultant's failure to diagnose and treat his illness, and paid Mrs Powell £80000 ($134000) damages plus £20000 costs. The settlement included compensation for the panic disorder that she developed as a result of Robert's illness, treatment, and death.

    But Mr Powell became obsessed with the belief that there had been a conspiracy over his son's death, after first being shown his general practice file just after his death, and then seven months later while pursuing a complaint against the GPs. He developed post-traumatic stress disorder and was unable to work. The family's lawyers added claims for compensation for this, and for making Mrs Powell's panic disorder worse.

    The Powells alleged that the GPs had removed two documents from Robert's file, replacing them with different documents, and added to the file a letter of referral to hospital dated five days before his death but actually typed after he died. The letter did not appear in the hospital records.

    Lords Justices Stuart-Smith, Morritt, and Schiemann held that doctors had no “free standing duty of candour,” which, if breached, could lay them open to damages claims for personal injury by relatives of patients. That would involve “a startling expansion of the law of tort,” Lord Justice Stuart-Smith said.

    Doctors owed a duty of care to their patients, but not to relatives such as parents, said the judge. Explaining about a death did not put them into a doctor-patient relationship with relatives, even if the relatives were also the doctor's patients.

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