Summary of background

On 2nd July 2004 Mr Hoult, who had recently arrived in the country with a rattling chest, shortness of breath and feeling unwell, consulted the defendant hospital doctor after being urgently referred by his daughter's general practitioner. The referral had set out Mr Hoult's complex medical history and the drugs he was taking. Upon consulting Dr Shah, Mr Hoult was prescribed with antibiotics and was discharged from hospital. Dr Shah subsequently wrote to the referring GP, stating that Mr Hoult had signs of a chest infection and pulmonary oedema but no acute coronary syndrome.

Mr Hoult continued to suffer from a shortness of breath and so on 9th July 2004, he consulted Dr Shah again. Tests were carried out and Dr Shah noted that Mr Hoult was better and had no signs of fluid overload. On 16th July 2004, Mr Hoult felt unwell and so consulted Dr Shah again. Dr Shah informed Mr Hoult that he required urgent treatment for left ventricular failure, unstable diabetes and high blood pressure, although he did not record the blood pressure. Dr Shah prescribed Candesartan, an angiotensin-II receptor antagonist. On 18th July 2004, after taking two doses of the medication, Mr Hoult presented at another hospital with acute cilioretinal artery occlusion. On 23rd July 2004, Dr Shah reviewed Mr Hoult, undertook further tests and concluded that there was no need for coronary intervention. Dr Shah assured Mr Hoult that he would prescribe a different type of drug that would not affect Mr Hoult's eyesight but he prescribed Valsartan, another angiotensin-II receptor antagonist. Upon taking one tablet, Mr Hoult developed further acute loss of vision. On 5th August 2004, Mr Hoult was seen by a consultant neurologist who concluded that Candesartan and Valsartan had induced a hypotensive episode leading to hypoperfusion of the retina.

Claimant's case

Mr Hoult sustained injury and brought an action against Dr Shah alleging that he was negligent in (i) failing to manage the risk factors involved with his medical history; (ii) failing to record his blood pressure before prescribing Candesartan; (iii) failing to be necessarily cautious when prescribing antihypertensive medication and then prescribing a further drug of the same type. Mr Hoult alleged that the prescription of both drugs caused the significant loss of vision.

Mr Hoult had significant pre-existing health problems and had been receiving care and assistance before the accident. Mr Hoult was assessed as sustaining 85% loss of visual function equating to 85% of whole person impairment. His visual impairment compromised his ability to care for himself and perform household tasks, to read, to engage in social interaction and enjoy full physical mobility. He was unable to enjoy his previous pastime of watching cricket. Mr Hoult did however receive state funded care for some time prior to the accident and the level of care provided did not have to be increased.

Defendant's case

Liability was denied and a Defence filed denying that the Defendant was negligent or in breach of contract on the basis that the prescription of Candesartan on 16 July 2004 was reasonable and appropriate and the subsequent loss of vision experienced was a very rare complication not to be reasonably complicated by most treating practitioners. It was reasonable for the Defendant to consider that the visual loss was attributed to an embolic cause and therefore the subsequent prescription of Valsartan was also reasonable and appropriate.


The claim reached an out of court settlement for £68,000.
The case was settled on a global basis with no particular breakdown of damages. However, the following breakdown is an estimate of what Mr Hoult received:-

Breakdown of General Damages:- £30,000 for pain, suffering and loss of amenity.
Future travel and miscellaneous expenses:- £5,000;
Future aid and equipment costs:- £1,000;
Future care costs:- £2,000.

Breakdown of Special Damages:
Past travel expenses:- £16,000;
Past aid and equipment costs:- £10,000;
Past care costs:- £4,000.