Chidlow, R (On the Application Of) v HM Senior Coroner for Blackpool and Fylde

When deciding whether to leave causation to an inquest jury, a coroner must apply both limbs of the Galbraith Plus test. The issue should be left where evidence could enable a properly directed jury safely to find, on the balance of probabilities, that the relevant event or omission contributed more than minimally, negligibly or trivially to the death.

Statistical survival evidence may be relevant, but a bare population statistic will rarely suffice. It must be assessed with evidence concerning the individual deceased and the circumstances of the death. An unascertained medical cause of death does not, without more, prevent a jury from considering causation.

Carl Bibby died after a substantial delay in the attendance of an ambulance. Medical evidence established that his cause of death was unascertained. An emergency medicine consultant nevertheless considered that, had paramedics attended before cardiac arrest, Mr Bibby would probably have survived.

At the inquest, the coroner accepted that there was evidence on which a jury could find a causal link between the delay and death, but ruled that it would be unsafe to leave causation to the jury because the medical cause of death was unknown. Mr Bibby’s brother sought judicial review, an order quashing the record of inquest and a fresh inquest.

1. The claim succeeded. The coroner’s ruling was quashed and the matter was remitted for a fresh inquest before a different coroner.
2. Where Article 2 of the European Convention on Human Rights is engaged, the inquest must investigate the circumstances in which the deceased came by his or her death under section 5(2) of the Coroners and Justice Act 2009.
3. The coroner had to apply both limbs of the Galbraith Plus test: first, whether evidence existed on which a properly directed jury could properly reach the proposed conclusion; and secondly, whether it would be safe for the jury to reach it. The relevant causation question was whether, on the balance of probabilities, the ambulance delay had contributed more than minimally, negligibly or trivially to the death.
4. General statistical evidence may be considered alongside evidence about the particular deceased and the circumstances of death. A raw statistic that 80 per cent of severely ill patients survive with prompt treatment was insufficient by itself, but the expert’s opinion was not based on statistics alone. It also relied on his professional experience, the medical evidence, the deceased’s condition and the possible causes of death.
5. The absence of an ascertainable medical cause of death did not make the expert evidence necessarily speculative or unsafe. Establishing the medical cause would have assisted, but was not essential to forming an opinion on the likely effect of delayed treatment. The jury was not bound to accept the expert’s opinion, but it was not so unreliable that causation could not safely be left to it.
6. The possibility that restraint and lactic acidosis contributed to death did not alter that conclusion. The point had not materially undermined the expert evidence and was not the basis of the coroner’s ruling.

The judgment was a first-instance judicial review decision. The court quashed the record of inquest and remitted the matter for a fresh inquest.