Matthews v East Suffolk Health Authority

On an appeal concerned with factual findings, the Court of Appeal must reconsider the evidence while recognising the trial judge’s substantial advantage in assessing complex expert testimony. That advantage remains important even where the evidence is documentary and the experts’ evidence is contained in transcripts.

A claimant alleging that earlier medical treatment would have prevented or reduced injury must prove that causal case on the balance of probabilities. Where the evidence cannot establish that the injury occurred after the treatment should have been given, causation is not proved. A trial judge may draw a legitimate inference from expert evidence, but the burden of proof determines the outcome if the court remains unable to reach a definite conclusion.

Beth Matthews brought a medical negligence claim arising from serious brain damage sustained after her premature birth. The claim against the hospital concerned the failure to consider infection and administer antibiotics after an episode of collapse at noon on 5 August 1982.

Mr Justice Scott Baker found that the hospital was negligent but concluded that the brain damage had probably occurred by noon, so earlier antibiotics would not have made a material difference. He dismissed the claim. The appeal challenged those factual findings and the conclusion that causation had not been proved.

1. Appeal dismissed. The Court of Appeal upheld the trial judge’s conclusion that the appellant had not proved that earlier antibiotics would probably have avoided or materially reduced the brain damage.
2. On an appeal concerning fact, the appellate court must rehear and reconsider the evidence, but must give realistic recognition to the trial judge’s advantages. Those advantages include hearing and testing complex expert evidence, even where credibility in the ordinary sense is not the principal issue. The principle stated in Wilsher v Essex Area Health Authority [1988] 1 AC 1074 and reaffirmed in Pickford v ICI [1998] 1 WLR 1189 applied.
3. The trial judge was entitled to accept Professor Wigglesworth’s pathological analysis. The noon collapse was a legitimate inference from the evidence as the point at which the periventricular leucomalacia caused the brain damage manifested by neurological signs eight hours later. The judge was also entitled to reject the competing theories as speculative.
4. The expert evidence contained substantial uncertainty about when the brain damage occurred. Nevertheless, the judge was entitled to find on the balance of probabilities that it occurred at noon. Even if that finding were wrong, the appellant still had to prove that antibiotics administered at noon or shortly afterwards would probably have avoided or quantifiably reduced the injury. That causal case was not established.
5. The order dismissing the appeal was made, with the stated costs and legal aid directions.

• Court of Appeal (Civil Division): Appeal dismissed. The court upheld the factual findings and dismissal of the medical negligence claim.
• Queen’s Bench Division: Mr Justice Scott Baker dismissed the action on 31 July 1998. He found breach of duty but held that causation was not proved.