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18/02/2026
BREACH OF DUTY & CAUSATION
The court in Hodgson found that the failure of the Defendant GPs to conduct a pelvic examination or to investigate the Claimant’s abdominal pain, vaginal discharge and irregular bleeding in their respective consultations, constituted breaches of duty. She had the warning signs of Pelvic Inflammatory Disease which remained untreated from the index consultation, causing her to suffer complications including development of a tubo-ovarian abscess necessitating removal of her left fallopian tube.
The judge found the Defendants to be negligent on both the Bolam and Bolitho tests because their omissions lacked a logical basis, even if there may be a body of clinicians that would also have exercised their clinical judgement by electing not to conduct a pelvic examination, having already performed an abdominal investigation.
Background
On 30 August 2016 the Claimant attended an in-person appointment with Dr Hammond, the First Defendant GP, who recorded ongoing abdominal pain, vaginal discharge and irregular bleeding in her history. He noted that she had a “resolving pelvic infection”, most likely Pelvic Inflammatory Disease (“PID”) on the basis of a soft and non-tender abdomen, an improvement in her symptoms and co-amoxiclav management of her condition. Dr Hammond performed an examination of the Claimant’s abdomen, but not her pelvis. He advised that the only further investigations necessary at that stage were blood tests for infection and told the Claimant to phone again if she experienced recurrence of severe abdominal pain, fever and/or vomiting.
On 5 September, the Claimant discussed her bloods with the Second Defendant GP, Dr Dieleman, on the telephone. He did not refer her for urgent pelvic examination. Whilst he did not recollect this consultation at trial, he maintained that pyelonephritis was his suspected diagnosis.
Whilst it was agreed at trial that the Claimant had PID as early as 30 August, by the time a definitive diagnosis of PID was later made on or around 25 April 2018, the Claimant’s condition had significantly deteriorated. As a result of her condition remaining untreated for a prolonged period, she had to undergo avoidable surgery and suffered permanent pain and reduced fertility.
Critical Issues
The critical question was whether, applying the Bolam (Bolam v Friern Hospital Management Committee [1957] 1 WLR 582) test, a responsible body of general practitioners would have supported the omissions to:
1. Perform a pelvic assessment of the Claimant at the index consultation or arrange an ultrasound thereafter by the First Defendant.
2. Urgently refer her for pelvic examination by the Second Defendant. If either answer was ‘yes’, then even if supported by a body of experts, the second issue was whether the omissions were negligent for being illogical (the Bolitho (Bolitho v City and Hackney Health Authority [1998] AC 232) test).
The Claimant and First Defendant’s expert GP witnesses, Dr Hicks and Dr Hampton respectively, agreed on the following: ([77-78])
1) GPs should adopt a “low threshold for consideration of a diagnosis of PID” because “untreated or inadequately treated PID can result in severe long-term complications”.
2) Classic symptoms for PID included abdominal pain, vaginal discharge and bleeding.
3) PID was a condition which could wax and wane in terms of presentation of symptoms.
On this basis, Dr Hicks did not consider any responsible body of general practitioners would support the failure to make a pelvic assessment of the Claimant on 30 August, given she reported warning signs of PID at this consultation.
Dr Hampton, on the other hand, advised that it was a matter for the First Defendant’s clinical judgement as to whether a pelvic examination was indicated, and a responsible body of GPs would also elect not to conduct an examination, believing that her PID was resolving.
The Legal Tests
The Court relied upon Bolam to assess whether the standard of care met that of a responsible body of medical opinion, which was “respectable and reasonable” (Maynard v West Midlands Regional Health Authority [1984] WLR 634 [38])).
Bolitho then enables a judge to make an independent finding of negligence because a doctor’s act or omission lacked a logical basis, even if there may be a body of clinicians that would have done the same thing.
Judgment
Whilst the Court acknowledged that negligence must be assessed based on contemporaneous knowledge without the benefit of hindsight that the Claimant was indeed suffering from PID on both 30 August and 5 September 2016 (following Duchess of Argyll v Beuselinck [1972] Lloyd’s Law Reports Vol.2 172 ([43])), it concluded that the oversights of the Defendants constituted ‘Bolam’ breaches of duty. The Claimant presented with symptoms and a history consistent with PID; PID was suspected and indeed the First Defendant’s ‘working diagnosis’ ([23]); and the First Defendant’s own expert agreed a pelvic examination was mandatory when PID is suspected. No responsible body of GPs, therefore, would support failing to at least consider a pelvic examination ([80]); given the First Defendant’s notes were comprehensive, it was unlikely that he considered it, but neglected to record that consideration ([85]).
The Judge explained that the First Defendant was also ‘Bolitho’-negligent because his actions were illogical. There was no basis for his judgement that the Claimant’s PID would resolve, in light of the expert consensus that symptoms of PID fluctuate in severity (especially after antibiotics). There were numerous and powerful reasons to examine the Claimant’s pelvis given the risks of undiagnosed PID versus few and limited justifications against examination ([88]-[99]).
The Court found that the evidence of the Second Defendant was a retrospective reconstruction and failing to arrange a pelvic examination was unreasonable ([103]). This was especially since Dr Dieleman and his expert GP witness, Dr Hall, conceded this at trial, agreeing to the tenor of the Claimant’s counsel’s cross[1]examination ([59]-[60])). Whilst not deliberately dishonest or self-serving, he was a “genuine witness who simply made mistakes in his evidence by not limiting it, in the absence of any recollection, to what he could read or properly infer from his contemporaneous notes and to evidence of his usual practices.” ([62]).
Since the Claimant had received input from multiple clinicians, the delay in the Claimant’s diagnosis was also an indication of system-level negligence i.e., the absence of a co-ordinated, escalation-based approach.
The five-day trial concerned breach of duty only. There was no dispute that had an appropriate pelvic examination been conducted on 30 August 2016, signs of PID would have been detectable. Antibiotic therapy could have commenced within 48 hours, preventing the development of a tubo-ovarian abscess, the removal of a fallopian tube, and the cascade of chronic pain, miscarriage and fertility impairment that ensued ([5]).
Expert Evidence
This judgment also contained criticism of the First Defendant’s expert who appeared to be attempting to explain away Dr Hammond’s actions, had therefore lost independence and was seeking to advocate for him.
Equally, the Second Defendant’s expert was criticised for taking as fact the Second Defendant’s purported recollection of the events of the telephone call and as fact that pyelonephritis was his diagnosis ([74]-[75]). Dr Hall had “very concerningly” failed to address the Claimant’s recollection of what transpired during that appointment. In doing so, she had sought to resolve a factual dispute, “trespassing on the judicial function”. This not only constituted a failure of the expert’s duty to provide their opinion on each potential factual scenario but rendered her evidence redundant when it became apparent during trial that her factual assumptions were incorrect and unsupported evidentially ([76]). She was unable to provide a considered opinion on the accepted version of facts, being the Claimant’s case. So one-sided was Dr Hall’s opinion that she was compelled to abandon her original opinion during cross-examination.
Key Takeaways
Hodgson does not establish new law but it applies existing principles to cases of suspected PID, as well as any case involving the omission to investigate further; to record the considerations taken; to heed high-stake risks; and to any case of co-ordinated care involving multiple clinicians, face-to-face and telephone consultations.
For both clinicians and practitioners, this case clarifies that in cases in which a clinician has omitted to conduct a clinical investigation where the risks are high (and the downsides are minimal), well-reasoned expert evidence must be gathered to justify such an omission.
The case also serves as a further reminder of the significant judicial weight attached to clinical documentation/medical records (Synclair v East Lancashire Hospitals NHS Trust [2015] EWCA Civ 1283 ([42])). The Court praised the First Defendant GP’s clear notes which allowed the Court accurately to infer the thought process behind his decision not to escalate the Claimant’s care, whereas the Second Defendant’s failure to keep contemporaneous records and therefore his vague or reconstructive testimony undermined his credibility. Hodgson thus serves as both a cautionary tale and a professional benchmark.
Further, this case underscores, especially in women’s health or nursing negligence claims, that telephone consultations should not be treated as mere administrative follow-ups. Physical assessment is essential where symptoms are ongoing or ambiguous. Defendants should note that Hodgson represents an increasing trend of cases pleaded on the basis of cumulative, system-level oversight, especially where handover, triage or inter-practitioner communication is in issue.
Given that professional overreach is commonly encountered in this field, both practitioners and experts are reminded that it is for the court to decide facts, not the expert. Where facts are disputed, experts should give alternative opinions depending on which account is preferred by the court. They will then avoid the ‘trap’ of appearing to advocate for their instructing party.
