Knott v Newham Healthcare NHS Trust

A trial judge’s evaluation of conflicting expert evidence should be upheld where the findings are available on the evidence and the judgment adequately explains the essential issues. Reasons need not address every argument or item of evidence. A pre-existing degenerative condition does not prevent liability where an employer’s breach materially contributes to a later disc prolapse and neurological injury. Apportionment principles applicable to cumulative or divisible injury do not apply where the accepted mechanism is a single, indivisible injury caused by the defendant’s breach.

The claimant, a nurse employed by the defendant NHS trust, claimed damages for serious spinal and neurological injuries allegedly caused by inadequate systems, training and equipment for manually handling patients. Simon J found a breach of statutory and common-law duty, and accepted that lifting at work caused or materially contributed to the injury. The defendant appealed, challenging the factual basis of the claimant’s expert evidence, the adequacy of the judge’s reasons, causation, and the failure to apportion liability for earlier nursing employment. The central issues were whether the judge’s findings and reasons justified the causation conclusion and whether apportionment was required.

Appeal dismissed with costs. May LJ gave the first judgment and Thorpe LJ agreed.

1. The challenge to the adequacy of the judge’s reasons failed. A judgment must identify the issues vital to the result and explain how they were resolved, but need not deal separately with every argument or item of evidence. The approach stated in English v Emery Reimbold & Strick Ltd [2002] 1 WLR 2409, drawing on Flannery v Halifax Estate Agency Ltd [2000] 1 WLR 377 and Eagil Trust Co Ltd v Pigott-Brown [1985] 3 All ER 119, was satisfied. The judge had addressed the defendant’s causation case and sufficiently explained why the claimant’s experts were preferred.
2. The judge’s factual findings were available on the evidence. He found regular lifting, increased heavy lifting after September 1997, and episodes of back pain before the bath incident. Those findings were sufficient to support the claimant’s expert opinions, despite being less extensive than the history advanced at trial. Professor Swash’s explanation of the neurological symptoms was accepted, and the MRI evidence did not provide an alternative explanation. A retrial was therefore unnecessary.
3. The finding that the defendant’s breach caused, or at least materially contributed to, the injury was sustainable. Long-standing degeneration was distinct from the later disc prolapse. The accepted mechanism was that negligent lifting progressively weakened the disc annulus, resulting in prolapse and neural damage. The breach therefore remained causally relevant notwithstanding the pre-existing condition.
4. Holtby [2000] 3 All ER 421 concerned cumulative exposure and divisible or quantifiable disability, for which responsibility could be apportioned. It also recognised that a court should make the best assessment possible even where quantification was difficult. That approach did not govern this case. The accepted mechanism was a single, indivisible injury caused by the defendant’s breach, so apportionment for earlier employment did not arise.
5. Although the trial judge should have dealt expressly with the clear apportionment submission, remission was unnecessary. The conclusion that apportionment was unavailable followed necessarily from the findings already made.

• Court of Appeal (Civil Division): On 13 May 2003, the court dismissed the defendant’s appeal from Simon J’s decision and order, with costs.
• High Court, Administrative Court: Simon J decided the claim on 16 October 2002, finding breach of duty and causation in the claimant’s favour. Hale LJ granted permission to appeal on some grounds.