November 2012

This case deals with the “Standard of Care” in Tort. It is a leading case. It is wrong, decided incorrectly by the Justices in the Appeal Court.

I’m going to try a precis the statement of facts to the bare essentials. There is a great deal of material in the case that really obscures the principal of the standard of care due.

On 11 January 1984 Patrick was admitted to St Bartholomew’s hospital, suffering from croup.

This is an important point that seemingly was ignored. Croup is a viral infection of the respiratory system: trachea, bronchioles, and lung bases. That there were “medical experts” testifying at this appeal, and that this point was ignored is disgraceful.

and was treated under the care of the senior paediatric registrar, Dr. Janet Horn and the senior house officer in paediatrics Dr. Keri Rodger. On 15 January hev was discharged home. No complaint is made about this episode of treatment.

This however was a virus. Viruses, due to difficulties in treatment, hang about, sometimes for the rest of your life. For example the “chickenpox” virus will represent 50yrs later in immuno-compromised patients as

On the evening of 16 January his parents became concerned about his condition. He had not slept well and had been restless.; further he seemed to be having increasing difficulty in breathing and was wheezier. As a result he was readmitted to St Bart’s. On the evening of the 16’th January, Dr Rodger examined him and was also concerned about his condition. At 8.30pm she arranged for him to be nursed by a special nurse on a one-to-one basis. On 17 January the medical notes indicated that he was much better but that there was still reduced air entry on the left side.

So one day after being discharged with “croup” the young lad is back with extreme respiratory distress. So much so, 1-t0-1 nursing was required. In the morning, left sided impairment of air-flow was noted. Sound normal?

Around 12.40pm on 17 January there occurred the first episode. The nurse who was observing Patrick summoned Sister Sallabank, a skilled and experienced nurse. Sister Sallabank described his respiratory sounds as ‘awful’ but reported that surprisingly he was still talking.

This is a clinical picture that even a novice doctor should express concern over. You have a senior nurse, expressing disbelief that under the symptoms and signs being displayed, that she is amazed that the lad can even talk. Clearly, things were not going well.

The sister was sufficiently concerned that about his condition to bleep Dr Horn rather than go through the usual chain of command by first contacting the senior house officer, Dr Rodger. She took this course because she felt something was acutely wrong.

Dr Horn being the senior paediatric registrar. So what did Dr. Horn do?

Dr Horn said that she would attend as soon as possible. In the event, neither she nor Dr Rodger came to see Patrick.

Right at that point, nothing much else factually, is required. Unbelievably, it happened a second time, again, no doctors attended, consulting the nurse by phone, who described the deteriorating conditions.

The third episode resulted in Patrick entering cardiac arrest. The crash team revived him briefly, Patrick suffering brain damage, later died. His parents sued for negligence.

The Judge had evidence from no less than eight experts, all of them distinguished. Five of them were called on behalf of Patrick and were all of the view that, at least after the second episode any competent doctor would have intubated.

On the other side, the defendants called three experts all of whom said that, on the symptoms presented by Patrick as recounted by Sister Sallabank and nurse Newbold, intubation would not have been appropriate.

The facts state that the doctors did not attend. That they did not attend the patient invalidates ANY opinion that they profess. They were not there, they did not examine the patient. When they did, upon admittance, examine the patient, they were so concerned that they assigned “one-to-one” nursing.

Now let us examine the law on this matter.

The lead case is “Bolam v Friern Hospital Management Committee [1957], which as its ratio states:

[A doctor] is not guilty of negligence if he has acted in accordance with a practice accepted as proper by a responsible body of medical men skilled in that particular art.

The question that the Judge asked was: whether intubation was correct in the circumstances? The question he should have asked was: should the doctors have attended the patient to ascertain a diagnosis, from which appropriate treatment would then have been prescribed.

The appeal was denied. The doctors found under the Judge’s test, not to be negligent. Clearly had the correct question been asked, the result would have been different and the doctors found negligent.

I’m working from the laptop, the desktop has blown another graphic card, or something.

Seems to be working ok.

Hayek’s most famous piece of political philosophy was, as we now know, completely wrong. In The Road to Serfdom, Hayek claimed that Keynesian-style macroeconomic management would lead to totalitarianism;

So I suppose a definition is in order just to clarify of what we speak:

Definition of totalitarian
relating to a system of government that is centralized and dictatorial and requires complete subservience to the state: a totalitarian regime

Our chappie claims that this is not the case. Western governments have become increasingly centralised and increasingly dictatorial. There would probably be some argument as to how one might measure this move to serfdom.

The ever increasing legislation that covers every area of life, with less and less input from individuals. For example juries can and should play a prominent role in lawmaking and comment on interpretation, but, increasingly they are marginalised.

The taking over by the State of the money supply. Once, when gold ruled the roost, government had to come cap-in-hand to the market to borrow money to wage war, increase spending on welfare and other subsidies. Now they simply create new money, taxing us without consent or redress.

in reality, nothing of the sort has ever happened. America, Europe, Japan, Korea, and others became solidly Keynesian after World War 2, and while macroeconomic management didn’t always work as advertised, it nowhere and never led to the advent of totalitarian regimes.

Really? You must be either an apologist, a liar, or a complete fool.

It’s also interesting that Hayek, despite hating the Nazis and totalitarianism in general, seems to have been somewhat influenced by many of the early 20th century Central European ideas that led to the rise of Nazism itself. For example, he repeatedly asserts that people are not created equal, making reference to “superior people,”

Clearly people are not equal in talents, abilities, physicality etc. To suggest that they are is simply incorrect. What the author really wants to say is that all should be equal under the “law”, which I agree with, but, again, is clearly incorrect.

and stating that he would prefer an economically libertarian dictator to a democratic government that restricted economic freedom.

Look at the abomination that we have currently. Democracy is a failure. It is an illusion, designed to lull the unwary to sleep. It has succeeded beyond the wildest dreams…government has arrogated to itself untold power with close to zero redress.

This foreshadowed the unfortunate libertarian support for dictators like Augusto Pinochet, as well as more recent libertarian flirtations with “scientific racist” ideas.

Did it? Any evidence to those assertions?

Are bearish.

We had a nice respite, courtesy of the Turkey Gods. But now it’s time to sit back and enjoy watching an illiterate America get pushed over “the fiscal cliff.” Dicks will be removed and accounts destroyed. Satan Claus is coming and there is nothing you or your stupid friends can do about it.

Pagan X-mas shopping is underway, so losses will be muted. But rest assured, as soon as 2013 arrives the market is going to be in catastrophe mode, leaving the lot of you– conversing about the markets on homosexual social networking sites– in a state of catatonic stupidity.

I will be selling this week.

Well no COT results ever eventuated. Therefore there has been no duCati Report this week either. Simply I’ll just add an issue to subscribers.

There does not seem to be any COT report this week. I’ll keep checking, but it may well be due to the Thanksgiving shortened week.

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