Assessment

You act for the mother of Jessica Marshsea. Read the scenario and then answer the questions below in your presentation.

1. Advise Jessica's mother as to the potential claim in negligence against May Weston. You should only consider the liability of May Weston in relation to the initial injury, suffered when Jessica fell off the table.Do not discuss any potential defences.

2. Advise Jessica's mother whether the doctor, Raymond Bridgeworth, owes Jessica a duty of care in negligence and whether he has breached that duty.

Scenario

You have been consulted by the mother of Jessica Marshsea, a 5-year-old girl. Jessica was recently injured in an accident at school. She fell off a table and suffered a broken wrist. She was treated at the local hospital but following her treatment there she is likely to suffer from some permanent restrictions in the movement of her wrist and some continuing discomfort.

Acting on your advice, Jessica's parents have made a claim on her behalf against Jessica's teacher and alsoagainst the doctor who carried out the treatment. [There would also be claims against the school and the hospital, but we do not require you to consider these].

Extract statement of May Weston- Jessica's teacher

I am May Weston, primary school teacher at Westway primary school. Jessica Marshsea is a pupil in my class. There are 25 pupils in the class and during lesson times I am in sole charge of the class. I do not have a classroom assistant. On 6 July, I was teaching Jessica's class. Several pupils had completed some very good work so I told the class I would mount their work on the classroom wall. I told the class to sit at their tables and continue with their individual project work while I began work on the display. Jessica is a very lively 5-year-old and she wanted to help with the display. In fact, she is rather difficult to control at times. She does not always behave well, and she often does not do as I tell her. In order to keep Jessica occupied and stop her disrupting the class I said she could help with the display. I gave her the blu-tack and told her to put it on the back of the work to be displayed, ready to stick it on the wall. Jessica wanted to stick the work to the wall, but she could not reach high enough. She began to attempt to climb on a classroom table which was positioned against the wall. I told her firmly that she must not climb on the table. I asked her to continue putting blu-tack on the rest of the pictures.

I needed to use a step ladder to reach to the top of the display board. I knew it was kept in a storeroom just next to my classroom. I made sure that all the pupils were sitting down at tables working, and I checked that Jessica was occupied with the blu-tack. Then I slipped out of the classroom to get the step ladder. On leaving my classroom I met a colleague in the corridor to whom I spoke for a few minutes. Then I went into the storeroom to get the step ladder.

Just as I was locking the storeroom having collected the ladder, I heard a crash from inside my classroom. One of the pupils ran out and shouted to me that Jessica had fallen off a table. When I got back inside the classroom, I saw that Jessica was sitting on the floor just next to the table which was against the classroom wall. She was holding her wrist and crying. I knew that Jessica suffers from a medical condition which makes her bones brittle, so was worried she may have suffered a fracture. I immediately sent a pupil to fetch the head teacher. As soon as the head teacher arrived, she called an ambulance. It arrived very quickly, and Jessica was taken to hospital.

I am not to blame for the injury suffered by Jessica. She caused the accident herself by climbing on the table when I left the room for a few minutes. I had already told her not to climb on the table, but she was disobedient and did so anyway.

Extract from an independent medical report

I have examined Jessica Marshsea, aged 5, in connection with an injury to her right wrist on 6 July. This accident occurred 3 months ago and accordingly the fracture is now healed. During my examination, I took X-rays of Jessica's wrist to show the site of the fracture and its current condition. I have also been provided with her medical records. These include her previous medical history and the records of her treatment at Duxford Hospital on 6 July.

I understand that Jessica's injury was caused when she fell from a table onto the floor. It is clear that this did cause a fracture to her right wrist. The records of Jessica's previous medical history show that she suffers from a medical condition which makes her bones abnormally brittle and more prone to fracture. I can say that had it not been for this condition, it is very likely that the fall would only have caused bruising rather than resulting in a fracture.

The records of her treatment at Duxford Hospital on 6 July show that she was brought by ambulance to Accident and Emergency suffering from a suspected fracture of the right wrist. On examination by Dr Raymond Bridgeworth the fracture was confirmed, and a plaster cast was applied. Jessica was then discharged home and was later seen as an outpatient for removal of the cast some weeks later.

The X-rays which I took during my examination confirm that Jessica suffered a compound fracture of her right wrist. I can confirm that this would have caused Jessica to suffer considerable pain immediately after the accident and in the following weeks. I would have expected her to continue to suffer pain and discomfort over the next six to eight weeks.

Thereafter, she should have made a full recovery. However, my examination shows that she did not make a full recovery. The X-rays which I took show that the fracture has now healed but it is significantly out of alignment. From my professional experience, I can say that such misalignment of the wrist bones is likely to result in a permanent restriction on movement of the wrist. This was confirmed by my examination of Jessica. She was unable to achieve a full range of bending and twisting movements in the wrist. Her mother reports that she often complains of the wrist aching. In my view, this aching and the restrictions on movement are likely to be permanent. They are likely to have a significant effect on Jessica's abilities as she grows up and reaches adulthood.

I have been asked to comment on the cause of the misalignment of the fractured wrist bones. In my view, the only explanation is that the fracture was not properly aligned before the plaster cast was applied.

Statement of Dr Raymond Bridgeworth - doctor who treated Jessica.

I am Dr Raymond Bridgeworth. On 6 July, I was on duty in the Accident and Emergency department at Duxford Hospital when Jessica Marshsea was brought in for treatment. I was told that she had fallen from a table at school. I was also informed that she suffered from a medical condition causing brittle bones.

I began to carry out an examination of Jessica's wrist. However, she was suffering considerable pain and she would not stay still. I confirmed that her wrist was fractured but I was experiencing great difficulty in setting the bones in the correct position before applying the plaster cast. To be effective, this needs the patient to remain still, but Jessica kept pulling away and trying to climb off the hospital bed. I do accept that as a result ofthese difficulties I was not able to set the bones of Jessica's wrist as carefully as I would normally have liked. I accept that X-rays taken subsequently do show some misalignment of the bones.

I had only just begun work in the Accident and Emergency department. This was my first job as a newly qualified doctor. I had never worked in an Accident and Emergency department before, and I had no experience of examining very young children in this kind of situation. I have since found out that Duxford hospital has a dedicated children's casualty nurse. Standard practice would have been for me to call her to help assist in calming an injured child such as Jessica. I also understand that a child as young as Jessica would normally be sedated before application of a plaster cast. Had I done this, with the help of an experienced nurse, I could probably have set the bones in Jessica's wrist more accurately. However, I am satisfied that I did my best in a difficult situation.