Naomi McLoughlin discusses – ‘When should a Coroner leave the question of causation to a jury in an inquest?’Naomi McLoughlin
R (on the application of John Paul Chidlow) v HM Senior Coroner for Blackpool & Fylde, (1) Constable of Merseyside (2) North West Ambulance Service
Hickinbottom LJ; Pepperall J
The claimant applied for judicial review of a coroner’s decision not to leave the issue of causation to the jury at the inquest into the death of his brother (B).
When should a Coroner leave the question of causation to a jury in an inquest?
Where there was apparently credible additional causation evidence which, if accepted, together with general statistical evidence could properly lead the jury to find on the balance of probabilities that the event or omission more than minimally, negligibly or trivially contributed to the death, it would usually be proper and safe to leave causation to the jury.
B had been 18 years old and an alcoholic. His neighbour had called the police after hearing him scream. The police attended, and called the ambulance service at 23.54 stating that B was threatening suicide and lying on the floor. The police entered the flat and called the ambulance service again, at 00.10 stating that B was now in a fit. The responder did not re-prioritise the case. B was restrained by the police. After 00.30 he stopped breathing and the ambulance was called again. The responder re-prioritised the call to an 8 minute vehicle response. At 00.38 B went into cardiac arrest. The ambulance arrived at 00.46 but death was pronounced shortly thereafter. The ambulance admitted that at 00.10 the call should have been re-prioritised to an 8 minute vehicle response.
At the inquest, a consultant in critical care & emergency medicine gave evidence that B had become critically ill for 25 minutes before cardiac arrest, and that there was evidence from a study that the survival rate of critically ill patients attended to before cardiac arrest was 80%. He concluded that if treated before cardiac arrest, B’s chances of survival would have markedly increased, regardless of the underlying diagnosis. The coroner ruled that without the knowledge of the cause of death, it was not safe to allow the jury to making a finding as to whether there was a causal link between the ambulance’s delay and B’s death.
There are a number of relevant principles for consideration which are as follows:
- When determining what findings to leave to the jury, a coroner had to ask whether there was evidence on which a properly-directed jury could properly reach the particular finding, and also whether it would be safe for the jury to reach the finding on the evidence R. (the Galbraith Plus test). v Galbraith (George Charles)  1 W.L.R. 1039,  5 WLUK 173 and R. (on the application of Secretary of State for Justice) v HM Deputy Coroner for the Eastern District of West Yorkshire  EWHC 1634 (Admin) , Inquest L.R. 76,  6 WLUK 242;
- The question of a causal link between an event or omission and the death should be left to the jury if there was sufficient evidence on which it could safely find, on the balance of probabilities, that the event or omission had more than minimally, negligibly or trivially contributed to the death. R (on the application of Tainton) v HM Senior Coroner for Preston and West Lancashire EWHC 1396 (Admin),  4 W.L.R. 157, 6 WLUK 395;
- In considering whether it was safe to leave an issue to the jury, the coroner had to have regard to all relevant evidence, which could include general statistical evidence such as the survival rate in a particular group. General statistical evidence alone was unlikely to be sufficient; being a figure in a statistic did not of itself prove causation, Hotson v East Berkshire HA  2 W.L.R. 287,  11 WLUK 152;
The Court found that in most cases there would be other evidence as to whether the deceased probably would have fallen within the statistical group of survivors. Where there was apparently credible additional causation evidence which, if accepted, together with general statistical evidence could properly lead the jury to find on the balance of probabilities that the event or omission more than minimally, negligibly or trivially contributed to the death, it would usually be proper and safe to leave causation to the jury (see paras 33-37, 52 of judgment).
It went on to note that the 80% survival statistic was not sufficient to prove causation but the expert had not only relied on statistics. The absence of post-mortem findings meant that various underlying health problems could be excluded. The lack of disease or infection in an apparently fit young man was a significant finding that the expert could take into account in determining whether B had been more likely than not to fall into the 80% of severely unwell patients who would survive with prompt treatment. The expert had explained that establishing cause of death was not essential to being able to form an opinion on delayed treatment. He had concluded that on balance of probabilities he would have expected B to survive with prompt treatment- that view was not so obviously unreliable that it was not safe to leave causation to the jury.
The court decided that the coroner had fallen into error in concluding that the lack of a clear cause of death had prevented the jury from being able to consider the possible causal effect of the delay in treatment. Whilst establishing the medical cause of death would plainly have assisted, it had not been essential to being able to form an opinion as to the effect of delayed treatment. The record of inquest was quashed, and the case remitted for a fresh inquest.
- This case make comment that causation should be left to the jury when there is credible causation evidence and general statistical evidence which, if accepted could properly lead the jury to find on the balance of probabilities that the event/omissions contributed to the death;
- This case provides guidance on the need for any statistical data to be considered and explored by any relevant expert before it can be left before a jury to consider. It is noteworthy that on this occasion, the statistical data alone was thought not by the Court to be sufficient to prove causation;
- The relevant principles are an important reminder of what principles should be considered when leaving evidence before a jury within an inquest setting.