Meiklejohn v St George's Healthcare NHS Trust & Anor
2014
COURT OF APPEAL (CRIMINAL DIVISION)
United Kingdom
CORAM
- LORD JUSTICE LAWS
- LORD JUSTICE TOMLINSON
- LADY JUSTICE RAFFERTY DBE
Areas of Law
- Tort Law
- Health Law
- Evidence Law
- Civil Procedure
2014
COURT OF APPEAL (CRIMINAL DIVISION)
United Kingdom
CORAM
AI Generated Summary
The case centers on whether Prof Judith Marsh breached her duty in treating Richard Meiklejohn for aplastic anaemia in 2003. The Claimant argued that proper informed consent was not obtained and that Prof Marsh was negligent in her diagnosis and treatment decisions. The court held that Prof Marsh did obtain verbal consent, was not negligent in her diagnosis, and that the Claimant would have accepted the recommended treatment of ALG with Prednisolone even if other treatments had been discussed. Key legal principles include standards for informed consent, negligence, and risk communication causation.
Judgment
Lady Justice Rafferty:
Richard Meiklejohn (“the Claimant”) was born on 20 January 1972. Sadly, he died after the hearing of this appeal. The doctor whose professional standards he criticizes is Professor Judith Marsh (“Prof Marsh”) one of the UK’s leading experts in aplastic anaemia (“AA”) a life-threatening failure of formation of blood cellular components. In March 2003 she was Reader in Haematology at St George’s Hospital Medical School a national tertiary referral centre for AA whose Director was Professor Gordon-Smith, himself a leading authority in AA. In November 2003 she was appointed to the Chair in Clinical Haematology at St George’s.
In 1993, at 21, the Claimant was diagnosed with thrombocytopenia, macrocytic anaemia and hypocellular bone marrow with an overall diagnosis of AA. A watch and wait policy was adopted. Characteristic signs are reduced red and white blood cells and platelets and an hypocellular bone marrow. Most cases of AA are acquired, the majority idiopathic. Mercifully rare, in the UK about 150 new cases of AA are seen annually, about 50 by Professor Marsh. In 2003 some, thought inherited, were known as inherited bone marrow failure syndromes (“IBMFS”) and included Fanconi’s anaemia (“Fanconi’s”), and Dyskeratosis Congenita (“DC”).
Telomerase (“ TERC” or “hTR”) mutations were in 2001 discovered in the relevant gene. Its inherited form is autosomal dominant, requiring only a single copy inherited from either parent.
The clinical signs of DC were for some time described as the classic triad (“the triad”): abnormal nails, reticular skin pigmentation and oral leucoplakia (white thickened patches).
After 2003, research revealed that the TERC mutation might not always be inherited, and November 2005 tests on the Claimant suggested his was not inherited. Consequent on the emerging science DC as a form of inherited AA is described as constitutional (not acquired) AA.
This case turns upon events on 25 March 2003 and thereafter. Dr Amos had referred the Claimant to Prof Marsh who on 25 th examined him and took a history whose nature and extent are in issue. She diagnosed and explained non-severe acquired AA. Following her advice the Claimant as an in patient on 7 May 2003 began a 5 day course of standard treatment, Anti Lymphocyte Globulin (“ALG”). A side effect, serum sickness, was treated with the corticosteroid Prednisolone of which a rare side effect is avascular necrosis (“AVN”), of which he was not warned. He developed