Submitting medico-legal intra-partum CTG (I-P CTG) monitoring to the Bolam and Bolitho principles

The Medico-legal Journal
George G Buttigieg

Abstract

The article analyses some of the seeming weaknesses of the Bolam and Bolitho tests as applied to electronic foetal monitoring in labour, in the form of intra-partum CTG monitoring. Homing on to such aspects as confirmation of foetal hypoxia/acidosis, it evaluates the Bolam and Bolitho tests in the context of evidence-based medicine versus traditionally held views, which still hold their own in medical jurisprudence. Case law examples are quoted to illustrate various points. The discussion is of practical relevance both to the individual obstetrician as well as to national budgetary implications, bearing in mind, that, for example, in 2011, 'birth asphyxia' comprised 50% of the UK NHS litigation costs, and in the 2000-2010 decade, the same NHS forked out £3.1 billion for maternity medico-legal claims (the highest of any speciality), mostly involving cerebral palsy and CTG misinterpretation. The article concludes with suggestions to help level the potential extant equivocity between legal principle and medical practice. It also looks at the ruling in Montgomery v Lanarkshire Health Board, UK Supreme Court, and its challenge to Bolam. The implications pose a serious and overdue challenge to a test, born in 1957 and lacking the nec...Continue Reading

References

Mar 15, 1985·American Journal of Obstetrics and Gynecology·M HelfandK Ueland
Mar 4, 2003·Journal of the Royal Society of Medicine·Ash SamantaMichael Gunn
Mar 14, 2003·American Journal of Obstetrics and Gynecology·Steven L Clark, Gary D V Hankins
Jun 29, 2014·BMJ : British Medical Journal·Daghni Rajasingam, Kate Harding

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