This was a key decision in medical negligence law for over 40 years, and hasn’t been completely superseded yet. I’m not a lawyer, but I believe it still applies in circumstances where it has not been overtaken by later legal decisions such as Montgomery vs Lanarkshire Health Board, 2015.
Mr Bolam was a voluntary patient at Friern Hospital, run by the Friern Hospital Management Committee. He agreed to undergo electro-convulsive therapy. He was not given any muscle relaxant, nor was he restrained, and as a consequence he suffered some serious injuries, including fractures of the acetabulae. He sued the Committee for compensation. He argued they were negligent for (1) not issuing relaxants (2) not restraining him (3) not warning him about the risks involved.
Judging the case, McNair J said:
“But where you get a situation which involves the use of some special skill or competence, then the test is not the test of the man on the top of the Clapham omnibus because he has not got this special skill. The test is the standard of the ordinary skilled man exercising and professing to have the skill. A man need not possess the highest expert skill at the risk of being found negligent…it is sufficient if he exercises the ordinary skill of an ordinary competent man exercising that particular art“……..
“I myself would prefer to put it this way, that he 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. I do not think there is much difference in sense. It is just a different way of expressing the same thought. Putting it the other way round, a man is not negligent, if he is acting in accordance with such a practice, merely because there is a body of opinion who would take a contrary view. At the same time, that does not mean that a medical man can obstinately and pig-headedly carry on with some old technique if it has been proved to be contrary to what is really substantially the whole of informed medical opinion. Otherwise you might get men today saying: “I do not believe in anaesthetics. I do not believe in antiseptics. I am going to continue to do my surgery in the way it was done in the eighteenth century.” That clearly would be wrong.” (McNair J)
The Court found against his case, because a responsible body of medical opinion would have done the same thing.
Thereafter, this meant that the scales of justice were heavily weighted in favour of the defence of medical negligence claims, as long as ‘a responsible body’ could be found to support the management that had been given.