Automated Summary
Key Facts
A woman consulted a general medical practitioner to determine if she was a carrier of the haemophilia gene. Inadequate testing and failure to recommend genetic testing led her to believe she was not a carrier. She later gave birth to a child with severe haemophilia and autism, unrelated to the haemophilia. The parties agreed autism was a reasonably foreseeable risk of pregnancy, but the defendant denied liability for autism-related costs, admitting only responsibility for haemophilia-related damages.
Issues
- A secondary issue is whether the economic costs of an unrelated disability (autism) incurred due to the continuation of a pregnancy (caused by the doctor's negligence regarding haemophilia) fall within the scope of the doctor's duty of care. The court considers if the autism-related costs are recoverable under principles of foreseeability and duty nexus.
- The primary legal issue is whether the SAAMCO principle (limiting liability to the scope of a defendant's duty of care) applies to clinical negligence claims, particularly where a doctor's negligence leads to the birth of a child with unrelated disabilities. The court also examines how SAAMCO's approach to duty scope interacts with claims for 'wrongful birth' and whether unrelated disabilities (e.g., autism) are recoverable when the negligence relates to a specific risk (e.g., haemophilia).
Holdings
The Supreme Court dismissed the appeal, holding that the medical practitioner's duty of care was limited to preventing the birth of a child with haemophilia. The court applied the SAAMCO principle, determining that the costs associated with the child's autism, an unrelated condition, fell outside the scope of the defendant's duty. Thus, the practitioner was not liable for autism-related expenses, only those linked to haemophilia.
Remedies
The Supreme Court upheld the Court of Appeal's decision to limit Dr Khan's liability to £1.4m in damages for the additional costs of caring for the child associated with his haemophilia. The agreed amount for haemophilia-related costs was £1.4m, while the £7.6m related to autism (a separate, unrelated condition) was excluded from recoverable damages as it fell outside the scope of the defendant's duty of care.
Monetary Damages
1400000.00
Legal Principles
- The court found factual causation (but-for test) as the child would not have been born without the negligence. However, legal causation was restricted to haemophilia-related costs. Autism was not causally connected to the breach of duty as it was an unrelated condition that would have occurred regardless of the negligence.
- The court analyzed the scope of the defendant's duty of care, concluding that Dr Khan's duty was limited to providing information about haemophilia carrier status. Autism-related costs were outside this scope as they were unrelated to the specific risk addressed in the consultation. The SAAMCO principle was applied to limit liability to consequences directly arising from the breach of duty.
- The court applied remoteness principles to determine that autism-related costs were too remote. While autism was a foreseeable general risk of pregnancy, it fell outside the specific scope of Dr Khan's duty as established by the purpose of the consultation. The SAAMCO counterfactual confirmed this by showing the loss would have occurred even with correct advice.
Precedent Name
- Caparo Industries plc v Dickman
- Chester v Ashfar
- Groom v Selby
- McFarlane v Tayside Health Board
- Rothwell v Chemical & Insulating Co Ltd
- Rees v Darlington Memorial Hospital NHS Trust
- Parkinson v St James and Seacroft University Hospital NHS Trust
- Platform Home Loans Ltd v Oyston Shipways Ltd
- South Australia Asset Management Corpn v York Montague Ltd
- Kuwait Airways Corpn v Iraqi Airways Co
- Nykredit Mortgage Bank plc v Edward Erdman Group Ltd
- Hughes-Holland v BPE Solicitors
Judge Name
- Lord Reed
- Lady Black
- Lord Hodge
- Lord Leggatt
- Lord Burrows
- Lord Kitchin
- Lord Sales
Passage Text
- 98. The subject matter of Dr Khan's advice was limited to whether Ms Meadows was carrying a haemophilia gene and accordingly only losses causally connected to that subject matter are within the scope of the defendant's duty. On the agreed facts, the losses caused by the haemophilia gene are those associated with the haemophilia from which her child suffers and do not include costs associated only with his autism, which is causally unrelated.
- 77(iii) Applying the SAAMCO counterfactual test as a cross-check, it supports a decision that the autism losses were outside the scope of the doctor's duty of care. If we ask the question, would the claimant have suffered the same loss had the information/advice been true, the answer is 'yes' as regards the autism losses (so that the scope of the duty of care does not extend to the recovery of the autism losses) but 'no' as regards the haemophiliac losses.
- 68. Thirdly, Dr Khan was in breach of her duty of reasonable care, as she readily admitted. Fourthly, as a matter of factual causation, Ms Meadows lost the opportunity to terminate the pregnancy in which the child had both haemophilia and autism. There was thus a causal link between Dr Khan's mistake and the birth of A. But that is not relevant to the scope of Dr Khan's duty. In this case, fifthly, the answer to the scope of duty question points to a straightforward answer to the duty nexus question: the law did not impose on Dr Khan any duty in relation to unrelated risks which might arise in any pregnancy. It follows that Dr Khan is liable only for the costs associated with the care of A insofar as they are caused by his haemophilia.