Author: Riya Pratibha Nayak , a Student of Symbiosis Law School, Hyderabad (2023-2028)

Factual backgrounds: 

This case centers around the plaintiff, Mr. Bolam, a salesman who was a voluntary patient at the Friern Hospital, a mental health institute, and, due to some previously present mental health issues, sought medical treatments under the professionals in the institution. 

The extent of his treatment revolved around the receipt of Electro-Convulsive Therapy (ECT), which includes the procedure of passing repetitive short and long shocks through the patient’s brain at decided intervals. The same was recommended to him by Dr. Bastarrechea when he was admitted due to the lapse of his depression. 

In the case of the Electro-Convulsive Therapy, Dr. Bastarrechea failed to intimidate Mr. Bolam about the risks or the potential health conditions, which included fits and fractures, that the patient undergoing the therapy could develop and directly undergo the treatment, only with the agreement of Dr. Allfrey, the senior registrar T the same institute.

When the procedure was started, Mr. Bolam was made to lie upright in a supine position, i.e., with his dorsar torso facing the celing of the room, and only a pillow was provided to him to support his back, while a male nurse gagged his lower jaw. no other means to restrain him were noted. When the initial shock was passed for one second with a 150 Voltage, it was subsequently followed by a longer shock that lasted four seconds. this method was repeated five times, untill they concluded the procedure.  

At the end of the procedure, the plaintiff incurred numerous bodily injuries from the procedure’s brutal seizures and jerking movements, which included the dislocation of both of his hip joints, and fractures on each side of his pelvis followed by the head of his femur, or thigh bone penetrating into his pelvic cup. the gravity of the above mentioned injuries, according to the plaintiff were caused because:

1) the doctors were negligent in not restraining him effectively (with only his lower jaw secured manually by a nurse)

2) the doctors’ negligence in not habituating Mr. Bolam with any kind of muscle relaxants before the beginning of the procedure. 

3) The plaintiff also stated that the hospital and the doctors were negligent in not informing him about any risks of body injuries before the procedure, thus bringing forth the alleged vicarious liability of the doctors and the hospital management committee. 


The following issues can be raised after a thorough examination of the facts and circumstances of the case: 

1) If the hospital or the doctors had previously provided the muscle relaxants, would they not have caused the injuries the plaintiff sustained or even reduced the gravity of his suffering? 

2)  If the hospital and the doctors had previously informed the plaintiff of the risks of injuries, would he have terminated the decision to undergo the procedure?

3) Had the doctors “effectively” restrained the plaintiff, would it have reduced the gravity of his injuries?


In medical procedures, in general, the hospital management and the doctor must provide the patient with a reasonable and adequate duty of care. While in the case of uncodified laws such as tort, under which the premise of the case falls, has no clear statement of the law, act, or rule that signifies the clear act that can be termed as reasonable care, This case did prove one point: an action is only punishable under the law if not reasonable;. In contrast, an act that is reasonable in nature is dismissed or excused. 

As seen in this case, the court ruled in favor of the defendant hospital, denying their liability for any negligent acts, as stated by the plaintiff. McNair J., the very judge under whose excellence the judgment was given, stated in his main reasoning that if any medical professional is doing the act that the standard medical body has approved, he cannot be held liable for the injuries that were sustained by the patient on whom the act was done. 

The case of the injuries sustained by the plaintiff was thoroughly examined by a bench of senior medical professionals, stating that the injuries sustained by the plaintiff, in this case, were extremely rare and unlikely, with or without any muscle relaxants or restraints. The court, however, contends that no matter how minimal or grave the risk of any injury or health condition is, the hospital is at fault for not specifying it to the plaintiff. 

The court stated the Bolam Test to avoid such a situation or overcome it altogether. 

The Bolam Test for standard and care was established by the courts to determine if the doctors and the hospital were, in fact, negligent in Mr. Bolam’s treatments. The same is now a standard practice in many health institutes to gauge negligence and such cases. The Bolam test states that merely ignoring or not following certain points of notice or practice does not amount to negligence if the methods from which the rest of the procedure was made are accepted by the concerned medical authority, in this case, the Friern Hospital management committee, therefore running the allegations of the doctors and hospital being liable for medical negligence. 

There have been significant criticisms of the Bolam test, as the critics argue that the Bolam test was conservative and potentially outdated in determining medical negligence in practice.  

determining The Bolam test also includes the essential requirement of assessing the patient’s anatomy and obtaining informed consent. In this instance, the plaintiff wasn’t adequately informed about the associated risks, underscoring the importance of ensuring patients receive the necessary information to make informed decisions regarding their medical treatment.

Medical practices and standards have significantly progressed since the Bolam case. Advancements in medical knowledge, technology, and ethical considerations have altered the administration of medical treatments. Critics contend that the Bolam test, originating from the standards of its time, might not adequately address cases involving contemporary medical practices and evolving patient expectations.

A significant criticism of the Bolam Test is the backlash it received for allegedly favoring doctors over patients in court. Patients may struggle to establish negligence on the part of medical professionals, potentially resulting in unjust outcomes when patients suffer harm due to medical negligence.

In conclusion, while the Bolam case has established a significant framework for determining medical negligence, it is not immune to criticism. The test’s reliance on the prevailing opinions of the medical community at the time of the incident can sometimes clash with current medical knowledge and patient-centered care. As medical practices and patient expectations continue to evolve, there’s ongoing debate regarding whether the Bolam test remains the most appropriate standard for medical negligence in the modern healthcare landscape.


Concluding with the statements about the Bolam Test, as stated by the courts and their verdic in favour of the defendant hospital, it can be said that

The doctors were not negligent in providing the muscle relaxants, However their lack of communicating the necessary information, regardless of the level of danger of saftey to the concerned patients was in fact their fault, However the courts haven’t perfectly addressed the adequacy of the warning, leaving the concept of informed concent open ended. 

The case of Bolam v. Friern Hospital Management Committee has not only been a landmark judgement in the English law, but has also significantly contributed to the aspect if medical negligence by having the Bolam Test as a body of reference.  While the same has faced quite a lot I’d criticism from critics, law makers and anyone aware of the case, it has also established some key requirements that specify what to do and what not to do to avoid such an incident to occur again, once and for all, but also suggests what to do if such an incident occurs and there is a need to establish liabilities of either of the parties. Thus, the Bolam Test is actually quite beneficial to make sure that any and all medical practices are carried on in complete saftey abr ethically to avoid any malpractice or damage to the concerned parties.

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