The Claimant suffered from appendicitis and attended A&E complaining of abdominal pain. A scan was ordered but there was a negligent delay before the scan was undertaken. During the delay the Claimant’s appendix ruptured and sepsis had developed incrementally over a period of approximately six hours causing him injury to his heart and lungs.

The central issue was causation. At first instance, Hellman J held that although there had been negligence in the form of culpable delay, causation was not established on but for principles. The Court of Appeal of Bermuda (Evans and Ward JJA and Bell AJA) reversed the judge’s decision on causation stating that the question was not whether the negligent delay caused the injury, but rather whether it contributed materially to it.

The Hospital Board appealed to the Judicial Committee of the Privy Council (Lady Hale; Lord Clarke; Lord Hughes; Lord Toulson; Lord Hodge). The Privy Council applied the principles in Bonnington Castings Ltd v Wardlaw [1956] AC 613 and found that on the balance of probabilities the hospital board’s negligence materially contributed to the injury to the Claimant’s heart and lungs.

The appeal was accordingly dismissed.


This Privy Council decision on causation affirmed the doctrine of “material contribution” as established in Bonnington and clarified that successive events were capable of each making a material contribution to the outcome. The “material contribution” approach to causation was therefore not confined to cases in which the timing of origin of the contributory causes was simultaneous.