When Malnutrition Becomes Negligence: A Case Every Solicitor Should Read

It wasn’t a surgical error.

It wasn’t a misprescribed drug.

It was malnutrition — slow, silent, and entirely preventable.

In one of my recent expert witness instructions, I reviewed the records of a patient who endured months of gastrointestinal illness, rapid weight loss, and multiple admissions before nutrition was even mentioned.

By the time a dietitian became involved, the patient had lost more than 10% of body weight, crossing the threshold that NICE classifies as severe malnutrition risk. Recovery was slow, the hospital stay extended, and a preventable complication had turned into a prolonged, high-cost episode of care.

Malnutrition Missed, Missed Duty of Care

NICE CG32 and the 2024 update NG252 both make it clear:

• Any patient who has eaten little or nothing for five days, or

• Lost more than 10% of body weight within 3–6 months

should be screened for malnutrition and offered nutrition support.

In this case, there were no weights recorded for months. No Malnutrition Universal

Screening Tool (MUST) assessment. No thiamine or electrolyte monitoring before feeding resumed.

These omissions might appear minor — but legally, they represent a systemic failure in basic duty of care.

Refeeding Syndrome: A Preventable Complication

When feeding finally began, the patient showed signs of refeeding syndrome — a well-documented, entirely preventable metabolic emergency caused by rapid reintroduction of carbohydrates after starvation.

Guidelines from NICE and ESPEN are explicit:

• Thiamine should be prescribed before feeding.

• Electrolytes (phosphate, potassium, magnesium) should be checked and replaced daily.

• Caloric intake should be built gradually over 4–7 days.

None of these steps were followed.

The result?

Delayed recovery, prolonged weakness, and biochemical instability that could have been avoided with a single early dietetic referral.

The Turning Point

Once the nutrition plan was implemented — fortified meals, oral supplements three times a day, and structured monitoring — the patient’s progress was remarkable.

Within two weeks, appetite returned, inflammation markers fell, and the hospital stay finally came to an end.

This was the same body, the same disease — but a different input.Early nutrition changed the outcome.

As an expert witness, that’s the turning point I look for in every case: the moment the omission became causal.

Why It Matters in Clinical Negligence Cases

Solicitors often focus on the obvious elements — diagnostic delay, procedural error, surgical complication — but nutrition is frequently the unseen accelerant of harm.

In negligence terms, missed nutrition screening can breach duty, undermine recovery, and extend loss.

It's rarely the “headline” failure, but often the missing link between breach and outcome.

When reviewing hospital records, I repeatedly see the same red flags:

• No recorded weight for weeks or months

• Lack of nutrition screening or dietetic referral

• No thiamine prior to feeding

• No electrolyte monitoring during reintroduction

Each of these is a preventable lapse, and collectively they define the boundaries of reasonable care under NICE and ESPEN standards.

The Wider Context

National audits still show that up to 40% of adults admitted to hospital are at risk of malnutrition, yet fewer than half are screened properly.

The estimated cost to the NHS in England exceeds £19 billion per year (Elia, BAPEN 2017).

This isn’t a resource issue — it’s a recognition issue.Nutrition isn’t “extra care”; it’s fundamental care.

Final Reflection

This case resolved positively once nutrition was prioritised.But it highlights an uncomfortable truth for clinical governance and litigation alike: malnutrition remains one of the most overlooked causes of preventable harm in modern healthcare.

For solicitors handling complex injury or clinical negligence claims, one extra question can reveal that missing link:

“Was nutrition assessed, documented, and managed according to NICE guidance?”

If the answer is no, there’s often more to uncover.