§ GUIDE · MEDICATION

The wrong drug, the wrong time,
or no drug at all

Medication claims are unusual because the evidence is often a drug chart. Three of the five judgments here succeeded, including one for £550,000. The two that failed show that a dose which causes side-effects is not automatically negligent.

Judgments read

5

Claimant succeeded

3 of 5

Largest sum stated

£550,000

Key evidence

The drug chart

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§ BEFORE YOU GO FURTHER

For a medication claim, these things usually need to be true

  • A drug was omitted that should have been given: a preventive dose, an anticoagulant, a vitamin, an antibiotic.
  • Or a drug was given at the wrong time or in a dose that no reasonable clinician would choose for your condition.
  • The omission or dose caused a specific injury: a clot, a bleed, a brain injury, organ damage.
  • It happened within the last three years, or you only recently found out.

Departing from a guideline is not itself negligence, as O'Brien shows. What matters is whether the decision was one a reasonable clinician could have made, and whether the drug would have made the difference.

§ 01

Drugs that were not given

Alexander v HCA International: the standard preventive diclofenac was not prescribed before a private ERCP and the patient developed necrotising pancreatitis; judgment for £550,000 against the doctor. Dickinson v Newcastle: thiamine omitted, brain damage, claim succeeded. Tuffin v University Hospitals Dorset: thromboprophylaxis omitted after surgery, leading to thrombosis and amputation.

§ 02

Drugs given at the wrong time

Lesforis v Tolias: a blood thinner given within about three hours of spinal fusion surgery caused a compressive haematoma and permanent impairment. The court found it negligent even though it was the surgeon's routine practice. Timing is a clinical judgement, but it has to sit within the range a responsible body of surgeons would accept.

§ 03

Doses that were defended

O'Brien v Guy's and St Thomas': a 70-year-old dialysis patient given 400mg of gentamicin in intensive care suffered permanent balance and hearing damage. The claim failed because the judge accepted a high dose was a reasonable choice for a worsening infection with sepsis risk, and that departing from the hospital guideline was not itself negligent.

§ 04

What a solicitor will want

The drug chart, the prescription record and any protocol the hospital says it followed. Where a drug was omitted, the chart usually shows it plainly. Where a dose is questioned, an expert in the relevant specialty advises on whether it was within the reasonable range.

§ THE JUDGMENTS BEHIND THIS GUIDE

The five judgments behind this guide.

Every one a published decision of the courts of England and Wales, linked to its source.

Claimant succeeded£550,000

Alexander v HCA International Limited & Anor

[2026] EWHC 1284 (KB)·2026·Liability decided at trial

A patient developed life-threatening pancreatitis after a gallstone-removal ERCP. The judge found the consultant never prescribed or instructed the standard preventive diclofenac suppository, so it was not given, and entered judgment for £550,000 against him.

Failing to give a recognised prophylactic drug before a procedure can be negligent even in private care. The prescribing doctor, not the hospital, carried the liability here.

Claimant succeeded

Dickinson v Newcastle upon Tyne Hospitals NHS Foundation Trust

[2026] EWHC 1574 (KB)·2026·Liability and damages decided at trial

A 37-year-old alcohol-dependent man admitted for a facial abscess was not given the prophylactic vitamin B1 (Pabrinex) that guidelines required during withdrawal, which the Trust admitted was a breach. The judge found this caused Wernicke's encephalopathy and a lasting functional disorder, and set the main heads of damages including a 24-hour care regime.

Breach was admitted, so the case turned on proving the brain injury was caused by the omission rather than by pre-existing conditions. It illustrates how catastrophic-injury awards are built from a care multiplicand, case management and accommodation rather than a single headline figure.

Mixed outcome

Jessica Tuffin v University Hospitals Coventry and Warwickshire NHS Trust

[2024] EWHC 3318 (KB)·2024·Liability decided at trial

After spinal surgery the hospital failed to give Ms Tuffin the prescribed anti-clotting injection, and she developed a deep vein thrombosis and post-thrombotic syndrome; three years later her leg was amputated above the knee. The judge held the trust liable for the DVT and its after-effects but found the amputation was caused by complex regional pain syndrome from the surgery itself, not the clot.

A missed dose of thromboprophylaxis that causes a DVT is negligent, but compensation covers only the harm the clot actually caused. Where a separate condition drives the worst outcome, the claimant must show the negligence at least materially contributed to it.

Claimant succeeded

Lesforis v Tolias

[2018] EWHC 1225 (QB)·2018·Liability decided at trial

Two days after spinal fusion surgery Mrs Lesforis suddenly lost movement in her feet; re-operation found a compressive blood clot. Martin Spencer J held it was negligent to give the blood-thinner Clexane routinely within about three hours of spinal surgery, which caused the haematoma, although the timing of the re-operation was not negligent.

Routine practices that fall outside the normal range at the time can be negligent even if the surgeon always did it that way. Post-operative anticoagulation after spinal surgery carries a recognised bleeding risk that must be weighed for each patient.

Claim failed

O'Brien v Guy's & St Thomas' NHS Trust

[2022] EWHC 2735 (KB)·2022·Liability decided at trial

A man with end-stage kidney failure was given a single 400mg gentamicin dose for a chest infection and suffered permanent balance and hearing damage. His sister's claim failed because the judge accepted that a high dose was a reasonable choice for a worsening infection with sepsis risk, despite his renal impairment.

A drug dose that causes known side-effects is not automatically negligent if it was a reasonable clinical judgement in the circumstances. Departing from a hospital guideline is not itself proof of negligence.

Browse the whole case library →

Contains information licensed under the Open Justice - Licence v2.0. Judgments from Find Case Law, The National Archives. Summaries are ours; amounts only where printed in the judgment.

§ QUESTIONS

Common questions

A preventive drug was skipped before my procedure.

That is Alexander, which succeeded for £550,000. Poor drug-chart record-keeping counted heavily against the clinician, and causation was proved with published trial data.

I was not given blood thinners after surgery and developed a clot.

Tuffin is the reference case. Thromboprophylaxis after surgery is standard, and an omission that leads to a clot is a strong claim.

A drug caused a known side-effect. Is that negligence?

Not automatically. O'Brien failed because the dose was a reasonable clinical judgement despite the risk. The question is whether a reasonable clinician could have chosen it.

The hospital departed from its own guideline.

That helps but does not decide it. In O'Brien the court held departing from a guideline was not itself proof of negligence.

How long do I have?

Three years from the injury, or from when you first realised the drug error may have caused it.

This guide is general information about the law in England and Wales, not legal advice about your case. ClaimGavel is run by Costart Projects Ltd on behalf of Tomlin & Partners, a specialist medical negligence firm regulated by the SRA. The free assessment on this page is an AI overview to show you roughly where you stand; a solicitor confirms the position in a free, no-obligation conversation.