## Facts

- Mrs. Williams underwent surgery at Bermuda Hospital for fibroid removal.
- During the procedure, she suffered a cardiac arrest resulting in severe brain damage.
- Mrs. Williams alleged that the hospital and its staff negligently failed to adequately monitor her oxygen levels and respond promptly to her deteriorating condition.
- At trial, the court found the hospital breached its duty by failing to provide adequate monitoring and timely intervention.
- Causation was complicated by Mrs. Williams' pre-existing medical conditions and the ordinary risks of surgery.
- The trial court applied the material contribution approach, determining the hospital’s negligence was a significant factor in the injury.
- The hospital appealed, leading to review by the Judicial Committee of the Privy Council (UKPC).

## Issues

1. Whether the hospital’s negligence materially contributed to Mrs. Williams’ injury despite the presence of other risk factors and pre-existing conditions.
2. Whether the material contribution doctrine could be applied in this medical negligence context to establish causation.
3. What evidentiary standards govern the proof of causation in clinical negligence where multiple contributing factors exist.

## Decision

- The UKPC held that the material contribution doctrine applied to the case.
- It was determined that it was not necessary for Mrs. Williams to prove the hospital’s negligence was the sole cause of her injury.
- The court found that the hospital's breach of duty was a substantial, significant contributing factor to the harm suffered.
- The existence of other factors (such as pre-existing conditions and risks of surgery) did not remove the hospital’s liability.
- The appeal by the hospital was rejected, upholding the trial court’s determination of liability based on material contribution.

## Legal Principles

- The material contribution doctrine allows claimants to establish causation where a defendant’s negligence made a significant contribution to the harm, even if other factors are present.
- It is not required to show that negligence was the sole cause; sufficient contribution to the risk or injury can establish liability.
- Courts rely heavily on expert evidence to assess standard of care and causality in medical negligence claims.
- Defendants can be liable if their breach materially increases the risk of harm, notwithstanding the presence of concurrent causes.
- The principles align with those established in other common law jurisdictions.

## Conclusion

The UKPC confirmed that in complex medical negligence cases with multiple contributing factors, a defendant may be held liable if their negligence materially contributes to the harm. The material contribution doctrine remains a central principle for establishing causation where uncertainty exists about the sole cause of injury.


Williams v Bermuda Hospital [2016] UKPC 4