Breach of Duty & Causation

May 26, 2022
by Hannah Farrell

All of our expert witnesses are fully trained in opining on breach of duty, causation, current condition, prognosis, and life expectancy.

What is Breach of Duty?

A breach of duty is where a person has failed to meet a certain standard of care.

In UK medico-legal cases, a breach of duty is governed by the General Medical Council (GMC), who publish these standards in guidance titled Good Medical Practice. The GMC set the standard that doctors should follow with regards to professional values, knowledge, skills, and behaviour.

In a breach of duty report, our expert witnesses will examine the records provided to them and assess whether the care provided has met the minimum standards expected within the UK.


Guidance states that all doctors must clearly, accurately, and legibly record any drugs prescribed to a patient. Dr X gives insulin to Patient A, who has diabetes, whilst an inpatient on the ward. Dr X does not record this on the drug chart. This constitutes a breach of duty.

What is the Bolam Test?

The Bolam Test is a method of deciding whether clinical negligence occurred. The Bolam Test defines the minimum standard of care that a clinician must deliver so as to not be found guilty of negligence.

The Bolam Test is based on the following statement:

If a doctor acts in accordance with a responsible body of medical opinion, he or she will not be negligent”.

The above statement simply means that, a doctor must show that at least one other doctor (with a standard level of skill) would have acted in the same way in delivering a standard level of care.


Dr X did not record a dose of insulin on Patient A’s drug chart. Upon review of this, it was decided that no other doctor, with a standard level of skill, would have failed to record the dose of insulin on the drug chart. Therefore, Dr X fails the Bolam Test.

What is Causation?

In the medicolegal world, causation refers to how one event/action has led to another result i.e., cause and effect. A doctor can act negligently without causing an effect. Equally, a claimant’s injuries must have been caused by negligence.


Because Dr X did not record the dose of insulin on Patient A’s drug chart, a colleague returns an hour later, notices the seemingly missed dose, and gives a further dose of insulin to Patient A. Subsequently, Patient A goes into a hypoglycaemic coma. It can be proven that Dr X acted negligently when not recording the dose of insulin given, which led to a double dose being given and Patient A going into a coma. Causation is proven; Dr X’s failure to record the dose of insulin was a breach of duty and caused Patient A to go into a coma.