Bolam v Friern Hospital Management Committee [1957]

Introduction

The following case summary focuses on a particular area of law, specifically medical law. Bolam v Friern Hospital is a case where the standard of duty of care of a patient is questioned when the patient claims damages over sustained injuries as a result of treatment. This led to the establishment of the Bolam Test which still holds significant  relevance in law today, expanding from law to other fields.

Case Facts

• The plaintiff, John Hector Bolam, was a voluntary patient re-admitted at a mental hospital, Friern Hospital (the defendant hospital). He was suffering from depression.
• He was being treated for his condition with Electro-Convulsive Therapy (E.C.T) given by Dr. Allfrey and Dr. Bastarrechea, a chief consultant psychiatrist at the hospital.
• It was practice for the doctor to not warn their patients of the risks of treatment unless they asked, and if they asked, they replied by expressing that the treatment carried slight risks and were rare.
• Precautions were taken to support his chin, place a gag in his mouth and hold his shoulders in place while he was lying down on a couch. He had nurses present on either side of him to prevent him from falling off. He suffered fractures to his pelvis owing to convulsions caused by treatment.
• The patient was administered the treatment “unmodified” implying that he was given no relaxant drugs to ease convulsions and there was no proper manual restraint imposed in order to prevent any fractures or injuries of the patient.
• The plaintiff claimed damages citing the defendants to be negligent in his case, failing to administer any relaxant drugs or anesthetics as well as failing to allocate enough nurses to administer manual restraint in order to try to control his convulsions and avoid incident.
• He was not made aware of the risks of the treatment and was not informed that the treatment would be given without any relaxant drugs and manual restraint. Friern Hospital denied any liability for the injuries the plaintiff suffered as a result of treatment.
• The plaintiff was represented by N.R. Fox-Andrews Q.C. and Roger Ormrod and the defendants were represented by James Stirling Q.C. and E. Sutcliffe.

Legal Issues

• The main issue lies in regards to whether the doctors were negligent in using a method still in practice among respected medical professionals.
• Additionally, the issue deals with concerns regarding warning, risks as well as the failure to administer any relaxant drugs or supply enough nurses for efficient manual restraint to minimise the risk of fractures and other injuries.

Arguments Presented

Appellant’s Arguments

• Arguments and evidence stemmed from expert opinion by consultant psychiatrist Dr Randall.
• Randall was of the opinion that relaxant drugs and anesthetic should be given to any patient undergoing E.C.T treatment as to prevent convulsions and avoid fractures or any injuries.^[1]
• Mentioned in personal opinion, If relaxant drugs were not used, some form of manual restraint must be used, although he was aware of the different methods used to administer the treatment without anesthetics or restraints.
• He did state, however, that there was still a body of medical professionals who did not believe to use any anesthetics or restraints seeing that it would only increase the risk of injury to the patient and thus, he could not say that they fell below the standard of care required to treat the patient.
• The main concerns stem from the argument that the defendants doctors were negligent, failing to give any information about the risk of treatment, relaxant drugs, anesthetics or efficient manual restraint to protect the patient from injuring himself. The use of proper restraint was emphasized by N. R. Fox-Andrews Q.C.^[2]

Respondent’s Arguments

• Arguments and evidence were brought forward by chief consultant psychiatrist, Dr. Bastarrechea, who worked at the defendants hospital.
• In normal practice, he states that unmodified E.C.T is a more preferable treatment plan as with the use of relaxant drugs, comes the risk of the patient’s life in comparison to what he referred to as minimal risk of a fracture.^[3]
• He only used such drugs or anesthetics in special circumstances and where risk would be greater with unmodified E.C.T but did not use it for other cases and had no reason to believe that the plaintiff required the relaxant drug for treatment.
• In reference to warning the patients or informing them about the risks of treatment, Dr. Bastarreachea left the question up to the patient to inquire upon to which they would get an answer of minimal risk to life. It was considered a means to not drive the patients away from treatment and perhaps his only method of treatment.
• Expressing concern on manual restraint, until 1951, such restraints were not used as much and in their view coming from experience, there was a larger chance of injury (fractures) if more restraints were used.

Court’s Reasoning and Analysis

• Each issue concerning the plaintiff’s claims were carefully analysed by the court with High Court judge Sir William Lennox McNair (mentioned as McNair in reports) addressing the jury and defining what negligence means in law.
• He expresses that negligence in this case was best explained by Fox-Andrews who explained it as, “that in the case of a medical man, negligence means failure to act in accordance with the standards of reasonable competent medical men at the time.”^[4]
• It was understood by the court and through expert evidence that while the plaintiff should have been warned about the risk and given the recommended anesthetics, there was still a body of competent medical men who did not use such methods in routine.
• As mentioned, some used different methods including relaxant drugs, restraining sheets and manual control with a number of practitioners who considered that the less amount of restraint used, the less likely the risk of fracture.
• It was of important mention that the plaintiff’s injuries were a rare case where Dr. Page, the Deputy Superintendent of the Three Counties Hospital mentioned that within a quarter of a million treatment, he had only seen one acetabular fracture in 50,000 cases and the injuries caused to Mr. Bolam were particular and very rare in itself.^[5]
• Examination of Dr. Randall’s evidence, he re-iterates gaining full consent from the patient including warning him of the risks and explaining the full procedure and providing the patient with a consent form.^[6]
• Additionally upon questioning Dr. Bastarrechea, he told the court that he does not warn his patients and does not think it is desirable to inform a patient who is struggling mentally and may decide to refuse the only treatment method he may have available.
• He agreed that the patient should be aware of the procedure but does not agree that he should be aware of all the risks. However, that said, if the patient inquires into the matter themselves, they are told of the minimal risks of treatment.
• Furthermore, as said by Lord President Clyde in Hunter v Hanley (1955), no man is seen as being negligent because his method of treatment of conclusion differs from other professionals in the field.^[7] Negligence is understood as the failure of an act carried out by a medical professional that other competent professionals would not do.
• It implies that a person, specifically a medical professional, is not negligent if the act he carries out is still an accepted practice in accordance with a body of competent men in that particular field.
• The plaintiff, Mr. Bolam was a patient re-admitted to the hospital owing to suffering from depression and while he was aware of the treatment he was receiving, he was not aware of any risks or that he would receive no relaxant drugs or anesthetic. This argument was countered with Dr. Bastarrechea who explains that he would answer the questions of the patient, had he asked.
• He did not question the treatment and since he had not done so, there is no way of identifying whether the man would have refused treatment or not.
• The argument that with the use of relaxant drugs or efficient restraint, the risk of fractures would be excluded from the matter however, there is still a risk of injury being weighed against the risk of one’s mortality and as a result, the use of the drug is excluded altogether unless it is used in special circumstances where the treatment may prove to be difficult or challenging and is only administered with proper examination and judgement.^[8]
• Before leaving the jury to deliberate liability, Judge McNair referred the court to Roe v Minister of Health [1954].^[9] It established that medical professionals cannot be held liable for negligence if they could not foresee any harm at the time of the operation.

Judgement and Ratio Decidendi

• After carefully hearing and analysing both sides, the High Court judge allowed the jury to deliberate and in 40 minutes returned favouring the defendants hospital.^[10] In other words, Friern Hospital was not found not liable for negligence.
• This case established the ‘Bolam Test’ which states that a medical professional is not liable for negligence if their actions are accepted as proper by a responsible body of professionals working in that particular field, even if not all professionals agree.^[11]
• The Bolam Test is used across the court system for medical negligence cases establishing whether a doctor has breached their duty of care.

Critical Analysis

• The Bolam Test recognised that medical professionals are not liable for negligence if their practices are seen to be proper by a responsible board of competent medical professionals and has been used in many cases since its establishment.
• It opens research to many concepts like medical ethics, particularly Non-Malifience. It means to do no harm to the patient or avoid any unnecessary harm to the patient.^[12]
• In the present, the test applies not only to medical professionals but has expanded to other fields as well and evaluates whether these skilled specialists weighed all their options, risks and benefits before making an informed decision. It ensures they acted fairly.
• In the case, the court weighed both expert testimonies before making an informed decision in regards to whether the hospital was negligent in their standard of care towards the plaintiff, Mr. Bolam leading to his injuries. However, it was found that the practice itself was still widely regarded as proper across a number of competent medical men and thus, they were not held liable for the plaintiff’s injuries.

Conclusion

• Bolam was a voluntary patient re-admitted into Friern Hospital for treatment for his depression, later claiming damages for injuries sustained during his treatment using Electro-Convulsive Therapy or E.C.T. The hospital denied any liability citing that they did not desire to warn the patient of the risks so that they may not feel compelled to deny treatment or administer effective restraint in order to not risk any fractures or other injuries. Moreover, they opposed the use of relaxant drugs expressing concern over the risk of mortality of the patient.
• This landmark judgement has led to the establishment of the Bolam Test which states that the act of a professional, skilled in their art or field should not be held liable for negligence if their act is regarded as proper by a board of competent responsible professionals in that field. It evaluates whether the specialist in their field acted with the standard duty of care and ensured to have acted fairly.

Bibliography

Primary Sources

Cases

• Bolam v Friern Hospital Management Committee [1957] 1 WLR 582
• Hunter v Hanley (1955) S.L.T 213
• Roe v Minister of Health [1954] 2 Q.B 66

Secondary Sources

• Future Doc, ‘How to Tackle ANY Medical Ethics Case’ (November 21 2021) <youtube.com/watch?v=k37sIHnMAmc> accessed 4 June 2026.
• Maria Adams, ‘The Bolam Test Revisited: The Legal Standard for Medical Negligence Claims’ (Lacey Solicitors, 30 2025) <https://laceysolicitors.com/the-bolam-test-revisited-the-legal-standard-for-medical-negligence-claims/> accessed 4 June 2026

^[1] Bolam v Friern Hospital Management Committee [1957] 1 WLR 582, 584.

^[2] Bolam v Friern Hospital Management Committee [1957] 1 WLR 582, 588.

^[3] Bolam v Friern Hospital Management Committee [1957] WLR 582, 584.

^[4] Bolam v Friern Hospital Management Committee [1957] 1 WLR 582, 586.

^[5] Bolam v Friern Hospital Management Committee [1957] 1 WLR 582, 585.

^[6] Bolam v Friern Hospital Management Committee [1957] 1 WLR 582, 588-589.

^[7] Hunter v Hanley (1955) S.L.T 213.

^[8] Bolam v Friern Management Committee [1957] 1 WLR 582, 591.

^[9] Roe v Minister of Health [1954] 2 Q.B 66.

^[10] Bolam v Friern Management Committee [1957] 1 WLR 582, 594.

^[11] Maria Adams, ‘The Bolam Test Revisited: The Legal Standard for Medical Negligence Claims’ (Lacey Solicitors, June 30 2025) https://laceysolicitors.com/the-bolam-test-revisited-the-legal-standard-for-medical-negligence-claims/ accessed 4 June 2026.

^[12] Future Doc, ‘How to Tackle ANY Medical Ethics Scenario’ (YouTube, November 21 2021)     03:06-03:26 www.youtube.com/watch?v=k37sIHnMAmc accessed 4 June 2026.