Contractual Obligations of Private Healthcare Providers in Medical Malpractice: Lessons from Bartolomucci v Circle Health Group Limited 2025

The recent English High Court decision in Bartolomucci v Circle Health Group Limited [2025] EWHC 529 (KB) clarified the contractual liability of private healthcare providers in medical malpractice cases. It focused on "all-inclusive" treatment models where patients receive care from both hospital-employed staff and self-employed consultants. The decision highlighted the need for clear differentiation of responsibilities between hospital staff and independent consultants.

Case Background

In 2015, the claimant underwent hip resurfacing surgery performed by a consultant orthopaedic surgeon and a consultant anaesthetist. During the operation, the claimant suffered a catastrophic brain injury due to prolonged hypotension under anaesthesia. The claimant sought a declaration on the scope of the defendant's contractual obligations, arguing that the "all-inclusive" nature of the treatment package implied that the hospital assumed responsibility for all aspects of the surgical procedure, including the services of the consultants.

Court's Decision

The Court was tasked with determining the intention of the parties by considering what a reasonable person would have understood the terms of the contract to mean. In addition to the claimant’s “all-inclusive” argument, he also argued that he had no direct contract with the consultants. The defendant, however, relied on express provisions within the terms and conditions of the contract which separated the consultants’ duties from those of the hospital.

The judge held that a reasonable person, upon reviewing the contract, would understand that the hospital's obligations did not include the provision of surgical services by the consultants. Despite the “all-inclusive” package, the contract included two clauses that explicitly stated that the hospital was not responsible for providing the consultants' services to the patient; these clauses specified that consultants are self-employed and that consultation fees are invoiced separately by the consultants themselves.

Key Takeaways

1. The judgment highlights the importance of clearly distinguishing between hospital and consultant responsibilities in the contract as this helps patients understand the extent of the hospital and surgeon's liability in the event a surgery has complications.
2. The two clauses specifying that consultants are self-employed and that consultation fees are billed separately proved crucial, showing the need for explicit terms in contracts to avoid ambiguity.
3. The case clarifies that “all-inclusive” packages are allowed, provided the contract clearly states which party is responsible for what.

Case Comment on Liability

The claimant also attempted to argue that the hospital was, at common law (case law developed through the courts) vicariously liable for the negligent acts of the consultants, but the judge held that this was not an appropriate argument, as the claimant was only seeking a declaration on the defendant’s contractual obligations and not on their liability at common law. However, had this case concerned common law liability, it would have been interesting to see whether the outcome would have differed as healthcare providers have a non-delegable duty to patients in their care.

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