## Facts

- A night watchman attended the Accident and Emergency department of Chelsea and Kensington Hospital with severe stomach pain and vomiting.
- The watchman was not examined by a doctor; instead, he was advised by the medical staff to consult his general practitioner.
- The watchman died a few hours later from arsenic poisoning.
- It was established that the hospital failed to properly examine the patient, which constituted a breach of their duty of care.
- Medical evidence indicated that, even with prompt examination and treatment, the outcome—death due to advanced arsenic poisoning—would not have changed.

## Issues

1. Whether the hospital owed a duty of care to the patient and breached this duty by failing to examine him.
2. Whether the breach of duty by the hospital caused the patient’s death, applying the 'but for' test of factual causation.
3. Whether the harm suffered was legally too remote or unforeseeable as a consequence of the breach.

## Decision

- The court found that the hospital owed a duty of care and breached this duty by not examining the patient.
- Despite this breach, the court held that the hospital's negligence did not cause the patient’s death because, according to medical evidence, the patient would have died regardless of medical intervention at that stage.
- The 'but for' test of causation was not satisfied, as the death was not preventable even had proper care been given.
- As causation was lacking, the hospital was found not liable for the patient's death.

## Legal Principles

- Establishing negligence requires proving duty of care, breach of that duty, and causation between the breach and the harm.
- The 'but for' test is central to factual causation: if the harm would have occurred regardless of the breach, causation is not established.
- Legal causation assesses whether the harm is too remote; however, if factual causation fails, legal causation need not be considered.
- Medical negligence claims require clear evidence that the defendant’s breach caused the harm suffered.

## Conclusion

The court confirmed that a breach of duty alone does not incur liability unless it is shown, on the balance of probabilities, that the harm would not have occurred but for the breach; in this case, the hospital was not liable as its negligent omission did not cause the patient's death.


Barnett v Chelsea and Kensington Hospital Management Committee [1969] 1 QB 428