Williams v The Bermuda Hospitals Board (Bermuda) [2016] UKPC 4 (25 January 2016)

On 30 May 2011 the Respondent attended hospital with abdominal pain and later that day underwent appendicectomy. He had a complicated recovery and claimed it was caused by negligent delay in his treatment.

“In the present case the judge found that injury to the heart and lungs was caused by a single known agent, sepsis from the ruptured appendix. The sepsis developed incrementally over a period of approximately six hours, progressively causing myocardial ischaemia. (The greater the accumulation of sepsis, the greater the oxygen requirement.) The sepsis was not divided into separate components causing separate damage to the heart and lungs. Its development and effect on the heart and lungs was a single continuous process, during which the sufficiency of the supply of oxygen to the heart steadily reduced.” (paragraph 41)

“On the trial judge’s findings, that process continued for a minimum period of two hours 20 minutes longer than it should have done. In the judgment of the Board, it is right to infer on the balance of probabilities that the hospital board’s negligence materially contributed to the process, and therefore materially contributed to the injury to the heart and lungs.” (paragraph 42)

The Court applied the reasoning of Bonnington.

The Court commented on the Bailey case as follows: “The Board does not share the view of the Court of Appeal that the case involved a departure from the “but-for” test. The judge concluded that the totality of the claimant’s weakened condition caused the harm. If so, “but-for” causation was established. The fact that her vulnerability was heightened by her pancreatitis no more assisted the hospital’s case than if she had an egg shell skull.” (paragraph 47)