HAMED v. MILLS, TOTTENHAM HOTSPUR & COWIE (2015)

This was a clinical negligence action brought by a catastrophically brain-injured young footballer against those responsible for his medical care, including a Premier League football club, when he was a teenager. William Featherby Q.C. was instructed for the Claimant.

The risk of sudden cardiac death in young footballers – as with all young athletes – has been recognised for decades. Sudden cardiac death among fit, young people has been called the silent killer.

Diagnostic and early-warning protocols are – or should be – in place to screen for potentially lift-threatening heart disease among young athletes. The protocols are there, of course, to codify and supplement the duties of care doctors owe to their patients and employers owe their employees.

Radwan Hamed was a highly talented youth player. He emerged from a football academy and signed as a professional for Spurs as a seventeen year old.

Tottenham Hotspur, who were one of the defendants to this claim, are a very wealthy club.
Dr Peter Mills is a consultant cardiologist who accepted instructions from football clubs to screen dozens of young players for incipient cardiac disease.

Dr Charlotte Cowie was the doctor in charge of Spurs medical arrangements at the time.
In an athlete in his teens or twenties exerting himself, HCM can cause the heart to fibrillate, depriving the body’s organs, especially the brain, of enough oxygen-infused blood to function properly. Common outcomes are death or severe brain damage, the latter in Radwan’s case.

A comprehensive cardiological check should involve a host of investigations depending on the suspicion of disease the cardiologist has, including: taking a history of symptoms and a personal history; taking a family history; family screening; arranging an echocardiogram, an electrocardiogram, an MRI scan and a 24 hour ‘Holter’ monitor; exercise testing; and arranging a period of detraining to see if the heart changes physiology.

In Radwan’s case the only clinical tests Dr Mills carried out were an echocardiogram and an electrocardiogram. They raised suspicions but were never followed through. Radwan and his parents were given no information about them.

The upshot was that Radwan and his parents (he was seventeen at the time) never had an opportunity to consider whether Radwan should give up football rather than accept the admittedly small risk that he might suffer a cardiac arrest. The defendants all contended that Radwan would have accepted the risk and played on, but they abandoned that defence after they heard Radwan’s parents say movingly in evidence (as they had maintained in their witness statements) that they would never have permitted their son to gamble his life and health if they knew he had a latent heart condition.

As it was, Radwan continued to play football for Spurs’s youth team for a year after he had been seen by Dr Mills. A year after Dr Mills saw him, he collapsed during a youth match he was playing for Spurs in Belgium. His heart went into fibrillation and he suffered irreversible brain damage.

Radwan Hamed’s case concerned his cardiac collapse and subsequent brain damage. His case was that the consultant cardiologist charged with diagnosing him – Dr Mills – and his employers – Spurs, who had signed him on as a young professional footballer – disastrously let him down. Spurs, in turn, sued their own in-house doctors as third parties.

The essence of Radwan’s case was that Dr Mills, to whom Spurs had sent Radwan for a routine cardiological check-up, failed to diagnose or warn about a latent and potentially fatal heart condition known as hypertrophic cardiomyopathy (HCM), a congenital weakness in the heart. He asserted that Dr Cowie failed to recognise or react to the signals Dr Mills was sending her.

All the defendants denied liability. They sought to palm off responsibility for Radwan’s disastrous injury on each other. Indeed, the cardiologist – strikingly – denied that he owed Radwan any duty of care at all. Radwan Hamed’s case was that, between them, these the defendants could and should have acted in such a way that his grave injury would never have happened.

Dr Mills contended that he had done enough to alert Spurs’s doctors to the possibility that Radwan might have a sinister latent condition and that they should arrange more tests. Dr Cowie, the doctor then in charge at Spurs, claimed that Dr Mills did not do enough to alert her to Radwan’s possible diagnosis.

The case involved experts in cardiology and experts who could speak to the standards to be expected of doctors in sports medicine. It also involved, by way of preparation, a thorough reading of many hundreds of articles in specialist cardiological journals relevant to the issue of the cardiology of young athletes.

The case was tried by Mr Justice Hickinbottom in the High Court in London in February 2015. The trial lasted five days.
A couple of days into the trial, Dr Mills admitted, through his lawyers, that he owed Radwan a duty of care after all, that he had been in breach of that duty and that his breach caused or contributed to Radwan’s injury. That left the judge only having to decide whether Dr Cowie (and hence Spurs) were liable to Radwan and, if so, the apportionment of liability between Dr Mills and Dr Cowie.
The judge found that Dr Cowie had failed to discharge her duty of care to Radwan as a specialist sports doctor in failing to pick up the suspicion Dr Mills had tried, inadequately, to communicate to her. He found that Dr Mills was 30% to blame and Dr Cowie (and hence Spurs) 70% to blame.

The judgment can be found at http://www.bailii.org/ew/cases/EWHC/QB/2015/298.html.

Radwan’s damages have yet to be assessed. The judge described his predicament as “tragedy writ large”.

Radwan’s case emphasises yet again the critical importance of thorough and meticulous cardiological testing of young athletes, especially those who expect to undergo considerable physical exertion such as footballers. Many tragic deaths and catastrophic injuries can be easily and inexpensively avoided by having proper diagnostic protocols in place, and by then following them clearly and to the letter. Clear communications between, and meticulous record keeping by, medical personnel caring for young athletes are essential. One can only hope that Radwan’s case has alerted cardiologists who examine young athletes and sports doctors generally to re-examine their procedures to ensure that they are fit for purpose.