Khan v Meadows [2019] EWCA Civ 152

A GP negligently failed to refer a patient for genetic testing for haemophilia carrier status and gave incorrect advice. The patient later gave birth to a child with both haemophilia and autism. The Court of Appeal held the GP liable only for losses related to haemophilia, not autism, as autism fell outside the scope of duty.

Facts

The respondent consulted the appellant GP in 2006 to establish whether she was a carrier of the haemophilia gene, following her nephew’s diagnosis with the condition. Blood tests were arranged but these could only detect whether the patient had haemophilia, not carrier status. The appellant negligently advised that results were normal, leading the respondent to believe any child would not have haemophilia. In 2010, the respondent became pregnant and gave birth to a son who was diagnosed with severe haemophilia shortly after birth. In 2015, the child was also diagnosed with autism. Had proper genetic testing been conducted, the respondent would have known she was a carrier, undergone foetal testing, and terminated the pregnancy.

Key Background

The haemophilia and autism conditions were unrelated – the autism was not caused by haemophilia nor made more likely by it. Autism was a risk inherent in any pregnancy. The parties agreed quantum at £1,400,000 if liability was limited to haemophilia-related losses, or £9,000,000 if both conditions were recoverable.

Issues

Whether the appellant’s liability extended to all losses associated with both the child’s haemophilia and autism, or was limited to losses associated with haemophilia alone. The court had to determine the scope of the duty of care owed by the GP.

Judgment

The Court of Appeal unanimously allowed the appeal, holding that the appellant was liable only for losses related to haemophilia.

Application of SAAMCO Principles

The court applied the scope of duty test from South Australian Asset Management Corporation v York Montague Ltd (SAAMCO). Lady Justice Nicola Davies identified three relevant questions: (1) the purpose of the advice/information; (2) the appropriate apportionment of risk; and (3) what losses would have occurred if the advice had been correct.

The court found that the purpose of the consultation was limited to establishing haemophilia carrier status. The GP had no duty to advise on wider pregnancy risks, and was not asked about nor given information concerning the respondent’s general wishes about future pregnancies.

Distinction from Previous Cases

The court distinguished this case from Parkinson v St James and Seacroft University Hospital NHS Trust and Groom v Selby, where doctors had undertaken to prevent conception entirely or knew patients wanted no further children. In those cases, doctors assumed responsibility for all problems of pregnancy.

Rejection of Trial Judge’s Approach

The Court of Appeal held that Yip J had erred by reverting to the ‘but for’ causation test rather than applying the SAAMCO scope of duty test. The link must be between the scope of duty and the damage sustained, not merely between the breach and a stage in the chain of causation.

The court also rejected the analogy with Chester v Afshar, noting that in Chester the misfortune was the very misfortune the defendant had a duty to warn against. The development of autism was a coincidental injury, not one within the scope of the appellant’s duty.

Implications

This decision clarifies that in medical negligence cases involving advice or information, liability is limited to consequences within the scope of the specific duty undertaken. Where a patient seeks advice on a particular condition, the doctor is not liable for unrelated conditions that may affect a child born as a result of the negligent advice. The scope of duty test from SAAMCO applies to determine recoverable losses, and courts must identify the adequate link between the breach of duty and the particular type of loss claimed, rather than holding defendants liable for all foreseeable consequences of a pregnancy they failed to prevent.

Verdict: Appeal allowed. The appellant GP's liability was limited to the additional losses associated with the child's haemophilia only, not those associated with autism. Damages assessed at £1,400,000 rather than £9,000,000.

Source: Khan v Meadows [2019] EWCA Civ 152