Cambridge BA: Breach, Causation & Remoteness Exam Paper

Dr. Sarah Mitchell, a consultant cardiologist at Cambridge University Hospital, was treating James, a 45-year-old patient with a history of heart problems. During a routine consultation, James complained of severe chest pain and shortness of breath. Dr. Mitchell examined James but failed to order an ECG or blood tests, despite hospital protocols requiring such tests for patients presenting with these symptoms. She diagnosed James with indigestion and prescribed antacids. Three hours later, James suffered a massive heart attack in the hospital car park and died before paramedics could save him. Medical evidence shows that: (i) 80% of competent cardiologists would have ordered the tests; (ii) if the tests had been performed, they would have revealed signs of an impending heart attack; (iii) immediate treatment could have prevented the heart attack in 70% of similar cases; (iv) even with immediate treatment, James had a 40% chance of dying within 24 hours due to his pre-existing condition. James's widow, Emma, seeks to sue Dr. Mitchell for negligence. However, it emerges that James had been secretly taking cocaine for several months, which significantly increased his risk of cardiac arrest, and he had stopped taking his prescribed heart medication two weeks before his death without informing Dr. Mitchell. Advise Emma on the prospects of her claim, paying particular attention to issues of breach of duty and causation.

Ace Construction Ltd was contracted to build a new residential development in Cambridge. The company's site manager, Tom, noticed that the concrete supplier had delivered concrete that appeared to have an unusual consistency, but he decided to use it anyway to avoid delays. The concrete was used to construct the foundation of Building A. Six months later, cracks appeared in Building A's foundation due to the defective concrete. Emma, who had purchased Flat 3 in Building A, noticed the cracks but was assured by Ace Construction that they were merely 'cosmetic settling' and not dangerous. Relying on this assurance, Emma decided not to hire an independent surveyor. Two months later, during a particularly heavy rainstorm, Building A's foundation gave way. Emma suffered serious injuries when part of her ceiling collapsed, and her expensive artwork collection was destroyed by water damage. It later emerged that: (i) any reasonable site manager would have rejected the concrete; (ii) independent testing would have revealed the foundation problems; (iii) if repairs had been undertaken when the cracks first appeared, the collapse would not have occurred; (iv) the building had been constructed on particularly unstable ground, which would have made it vulnerable to collapse even with proper concrete, though not for several more years; (v) the rainstorm was the heaviest in the area for 50 years. Additionally, it transpires that Emma had removed several internal supporting walls in her flat without seeking permission or surveyor advice, which may have contributed to the ceiling collapse. Advise Emma regarding potential claims in negligence against Ace Construction Ltd, focusing particularly on breach of duty and causation issues.

The courts have struggled to develop coherent principles for determining when a defendant's conduct constitutes a breach of duty in negligence cases. Critically analyse the evolution and current state of the law governing breach of duty, considering whether the objective standard established in Vaughan v Menlove has been applied consistently across different categories of defendants. In your answer, consider the particular challenges posed by professional liability cases and whether the Bolam/Bolitho line of authority represents a departure from or development of orthodox negligence principles.

The 'but for' test of causation, while conceptually straightforward, has proven inadequate to deal with many of the complex causal scenarios that arise in modern tort litigation. Critically evaluate the various approaches courts have adopted to address the limitations of traditional causation principles, including the treatment of multiple causes, statistical evidence, and loss of chance cases. Consider whether these developments have created a more just system or have undermined the conceptual foundations of tort liability.