RP v United Great Western Hospitals NHS Foundation Trust (2026)

The Claimant (R) in this matter was a 25-year-old young man.  The case concerned failures that occurred during R’s birth, whilst he and his mother were under the care of the Great Western Hospitals NHS Foundation Trust.

R’s delivery was complicated by shoulder dystocia (his uppermost shoulder got stuck, thus preventing delivery of his body). R was a big baby who weighed around 4kg at birth.  R had an older sibling whose birth at the same hospital had also been complicated by shoulder dystocia.

At R’s birth there was a failure to perform the necessary manoeuvres required for shoulder dystocia to an acceptable standard.   It was not clear whether the emergency bell had been sounded following the diagnosis of shoulder dystocia and it looked as though only one member of staff was present at this point: you need at least 3 and preferably 4 staff members to perform shoulder dystocia release manoeuvres.  The hospital notes were extremely poor, which did not assist and it took time to work out what had happened.  It emerged that R’s weight had been estimated at the start of labour as 4kg by a midwife, who palpated his mother’s abdomen in order to make that estimate.  It was not clear whether this midwife was aware of the previous history of shoulder dystocia, or made the relevant enquiries.  Whatever the reason, caesarean section was not offered, despite the fact that (a) R was a big baby and (b) there was a previous history of shoulder dystocia.

We argued that there was no reasonable explanation for R’s lasting Erb’s palsy other than non-diagnostic traction (thus, it was highly likely that the midwife who was present panicked and yanked – this is absolutely not the right way to treat shoulder dystocia as it is very likely to cause permanent damage to the brachial plexus – a nerve superhighway that runs along the shoulder behind the clavicle and innervates the arm).

We argued that R had suffered a permanent injury to his right brachial plexus in consequence of the poor management of his birth.   It was the Defendant’s case initially that there was no breach of duty of care, and that there had been sufficient staff present to perform the requisite manoeuvres for resolution of shoulder dystocia.   They also argued that even if only one midwife was present, then she could have performed the McRoberts release manoeuvre unaided by pushing one of R’s mother’s legs towards her chest with one hand, pushing her other leg back with one of her own legs, whilst standing on her remaining leg and manipulating the head with her remaining hand.  Our midwifery expert commented acerbically that this was not a recommended technique, even for a contortionist.

As above, liability was ferociously contested and therefore Court proceedings were issued on 29^th March 2022 and a split Trial was ordered.  Despite the weaknesses in its own case, the Defendant did not offer any form of negotiations.  It then emerged at Joint Expert Meetings that their own liability experts did not support their case.  Liability was then conceded in full, after we wrote to the Defendant’s legal representatives to enquire whether they now disagreed with their own experts as well as ours.    Judgement was entered for the Claimant with no percentiles reduction to account for litigation risk.   This is fairly unusual in Erb’s palsy cases.    In this instance, the Defendant’s own refusal to enter into any sort of dialogue before Joint Expert Meetings denied it the opportunity to argue for such a reduction.

The Defendant then contested all issues relating to the claim’s value, and initially refused to countenance the retention of any experts other than those in the fields of Orthopaedic Surgery, Physiotherapy and Care/Occupational Therapy.  Following an application to the Court further permission was granted to instruct experts in the fields of Assistive Technology and Psychiatry.  Following an application from the Claimant, permission was also granted for experts in the fields of psychiatry and assistive technology to be called.  Interestingly, having reviewed R, the Defendant’s expert assessed him as having a Group 3 Narakas injury – a more serious injury than the one we had previously believed was present.

There was a round table settlement meeting in early 2026, but this was unsuccessful.  Instead, the Defendant let Joint Expert Meetings take place … and their experts once again indicated that they didn’t support their own case.  Specifically, after serving an extraordinary report from a care expert, which opined (amongst other things) that fathers don’t do much caring for their children in the first year of life (which was news to us) and that people in their eighth and ninth decades of life are in their eighties and nineties (which was a departure from arithmetic as we understand it), this expert made multiple concessions at her meeting.   Settlement was reached in exactly the sum we had offered to the Defendant earlier in the year.

The case demonstrates how determined defendants can be to limit their own liability.  In this instance, the Defendant’s uncompromising approach serially backfired.

It was our privilege to represent R, who conducted himself with dignity throughout the proceedings, and in the face of a very difficult approach by the Defendant.  We all wish him well for the future and hope that he can now move on with his life.