Tort Law

Barnett v. Chelsea and Kensington Hospital Management Committee

[1969] 1 QB 428

Facts

• Three night-watchmen became ill after drinking tea.
• They attended the casualty department of the defendant hospital during the early morning.
• They complained of vomiting and other severe symptoms.
• A nurse telephoned the casualty medical officer and described their condition.
• The doctor did not personally examine the men.
• He instructed the nurse to tell them to return home and consult their own general practitioners.
• One of the men, Mr Barnett, later died.
• Medical investigation revealed that he had been poisoned with arsenic.
• Barnett’s widow sued the hospital.
• She alleged that the doctor negligently failed to examine, diagnose and treat him.
• It was established that the doctor owed Barnett a duty and had breached it by refusing to attend.
• Medical evidence nevertheless indicated that the arsenic poisoning was already too advanced when Barnett reached the hospital.
• Even immediate diagnosis and treatment would probably not have saved his life.

• Whether the casualty doctor breached the duty of care.
• Whether the doctor’s failure to examine Barnett caused his death.
• How the “but for” test applies where the same harm would have occurred despite proper care.
• Whether breach alone was sufficient to establish negligence liability.

• Negligence requires proof of:
o duty;
o breach;
o factual causation;
o legal causation; and
o damage.
• Factual causation ordinarily uses the but for test:
Would the claimant probably have suffered the same harm but for the defendant’s breach?
• The claimant bears the burden of proving causation on the balance of probabilities.
• The claimant must show that proper treatment would more likely than not have prevented the harm.
• A mere possibility of a better outcome is ordinarily insufficient.
• Breach does not create liability where the injury would have occurred in any event.

• The casualty doctor should have personally examined Barnett after being informed of his serious symptoms.
• Sending him away without examination fell below reasonable medical care.
• The hospital therefore breached its duty.
• The court then considered causation separately.
• Expert evidence showed that arsenic had already entered Barnett’s system to such an extent that no treatment available at the time would probably have saved him.
• Even if the doctor had:
o attended immediately;
o correctly diagnosed arsenic poisoning;
o admitted Barnett;
o provided an antidote; and
o arranged intensive treatment,
Barnett would still have died.
• The widow could not establish that the negligent omission made the required factual difference.
• It was insufficient to argue that examination might have provided some chance of survival.
• Liability for the death required proof that proper treatment would probably have avoided it.
• The judgment demonstrates that breach and causation are independent elements.
• A court may strongly criticise the defendant’s conduct while denying damages for a harm that the breach did not cause.

• The court held that the hospital had breached its duty by failing to examine Barnett.
• However, the breach did not cause his death.
• On the balance of probabilities, Barnett would have died from arsenic poisoning even with proper treatment.
• The claim was therefore dismissed.