Be aware of vicarious claims

'But for' test - Cork v Kirby, Barnet v Chelsea(?), more than 50 percent chance
that defendant's breach caused the loss

Independent causes - loss caused by one factor only, either will result in loss.
Apply the but-for test
Hotson v East Berkshire HA - loss of chance should not be used, causation based
only the likelihood that tort caused the damage
But loss of chance might be allowed for pure economic loss (Allied Maples Group v
Simmons & Simmons

Cumulative causes - Bonnington Castings v Wardlaw, exposure to dust caused

respiratory disease but only part of the exposure was due to breach of duty, other
part was a natural consequence of work itself. But for impossible. Material
contribution test introduced, defendant liable as long as the breach 'more than
negligibly' contributed to the loss.

Bailey v Ministry of Defence extends the material contribution test beyond

industrial diseases to medical negligence as well.

Always start with but for test, if doesn't work, do the material contribution test.
McGhee v National Coal Board, dermatitis from exposure to brick dust but cannot
determine whether caused by tortious or non-tortious dust, but still liable since
breach had materially increased the risk of injury.

Exception: Fairchild v Glenhaven Funeral Services - single exposure but not sure
which employer caused exposure that resulted in the disease, found liable anyway
because each increased risk. Barker v Corus - liability apportioned to contribution
to total risk but reversed by Compensation Act 2006 s3, joint and several
liability. (material increase in risk might be applied only when there is one
causal agent, where the disease is indivisible)

Apportionment: used after factual causation is established. Multiple causes

Fitzgerald v Lane & Patel, when multiple parties are at fault, blame is apportioned

Natural events will not break chain of causation if foreseeable (Humber Oil v
Sivand; neither will linked diseases Meah v McCreamer)

Acts of third party breaks chain if unforeseeable and unconnected (Knightley v

Johns), but not if they acted instinctively (Scott v Shepherd)

Only grossly negligent medical treatment will break chain of causation (Robinson v
The Post Office; liable also for the worsening by doctor)

Chain breaks only If claimant act is unforeseeable. Emeh v Kensington and Chelsea
HA, refusal of abortion does not break chain of causation

(Dr Sido John v Central Manchester - might be willing to apply material

contribution to clinical negligence case)

If cumulative cause, no further acts of third parties

if independent cause, there is acts of third parties

Parties: Fred claiming against first ambulance

Tort: negligence (breach of duty of care causing loss)

Loss: exacerbation of physical injury (peritonitis) owing to crash and resulting

delay
Duty of care: driver to passengers (Nettleship v Weston)
Breach of Duty: standard is a reasonably competent driver (Nettleship v Weston),
whether the ambulance has fallen below that standard depends on whether the
ambulance driver reasonably foresaw the skid and took precaution (e.g. rushing on
thin ice, even if in emergency per Ward v London County Council). However, the
ambulance driver might be justified in taking the risk by the social utility of his
conduct i.e. saving life and so unlikely to fall below the standard.
Causation: single agent, peritonitis, cumulative clauses, appendicitis + delayed
diagnosis and treatment
Factual causation: but for the poor driving, the ambulance would not have skidded?
If no, then no causation.
If yes, ask if there is legal causation, i.e. no foreseen natural event. If the ice
is not foreseen then no causation, but if foreseen, then causation.
Even if driving led to crash, but for test failed, since cannot tell how much loss
of time which made his appendicitis worse is due to the crash, or due to the late
arrival of the second ambulance, or due to the misdiagnosis
Apply the material contribution test per Bonnington Casting, the ambulance crashing
would not have made more than a negligible contribution to the delay in time had
the second ambulance arrived on time, but since the crash is the reason why the
second ambulance was called in the first place, it has made more than a negligible
contribution to the delay in time and thus satisfies the material contribution
test.

Parties: Fred claiming against second ambulance

Tort: negligence
Loss: exacerbation of physical injury (peritonitis) owing to delay
Duty of care: Kent v Griffith, once responded ambulance has duty to respond within
reasonable time
Breach of duty: seeing that calling a second ambulance caused an hour's delay there
is thus a breach of duty to arrive within reasonable time if there are no more
pressing emergencies or other justifications.
Causation: factual causation, can't tell whether had the ambulance arrived more
promptly, the injury would not have been exacerbated by a delayed re-diagnosis.
Could be that, had it arrived promptly, Fred would have been misdiagnosed but then
diagnosed correctly again in time by the second doctor, or that the first doctor
would have had more time to examine him.
But according to the material contribution test, the ambulance's delay is more than
negligible since the second doctor diagnosed again only after two hours, but the
ambulance arrived close to an hour late.
No novus actus so legal causation also established.

Parties: Fred claiming against first doctor

Tort: clinical negligence
Loss: exacerbation of physical injury due to misdiagnosis (peritonitis)
Duty of care: doctor to patients (Cassidy v Ministry of Health)
Breach of duty: standard is that of professional - A & E doctor Bolam test, has he
fallen below the standard? How common is the misdiagnosis?
Causation: Factual
But for the misdiagnosis, would his appendicitis had been treated in time to
prevent peritonitis? Time loss due to ambulance arrival and time loss due to
misdiagnosis
Yes according to material contribution test of Bonnington
Per Fitzgerald v Lane & Patel damage may be apportioned between the first doctor
and the second ambulance