Hotson v East Berkshire Area Health Authority [1987] AC 750
Facts
(H) aged thirteen, fell from a tree and suffered an acute traumatic fracture of the left femoral epiphysis. He did not get correctly treated for five days and suffered avascular necrosis, involving disability of the hip joint and the virtual certainty of osteoarthritis. The health authority admitted negligence. The trial judge assessed at 75% the chance the avascular necrosis would have developed anyway form the fall and awarded damages based on the loss of a 25% chance of full recovery. The Health Authority appealed.
Legal Issue
- Did H satisfy the burden of proof in establishing that the Health Authority actions had been the cause of his injuries.
Held
The House of Lords allowed the health authority's appeal against the award for the lost chance of recovery. The findings showed that, on the balance of probabilities, the damage from the original fall had already made the condition unavoidable. The claimant had therefore not established that the negligent delay caused the avascular necrosis. A 25 per cent possibility of a better outcome could not replace proof of that causal link with a proportionate personal-injury award. The reasoning concerned uncertainty about the claimant's actual condition following the accident. Assessing future losses after actionable injury has been established is a different exercise and may involve probabilities in their valuation.
⭐ Legal Principle
A claimant must establish on the balance of probabilities that negligent treatment caused the injury claimed. Hotson rejected a proportional award for a 25% recovery possibility where the findings established that the original accident probably made the condition unavoidable. Future loss valuation is a separate question.
Significance
Hotson distinguishes uncertain proof of an existing causal fact from the valuation of future consequences after liability is established. The court could not simply award a fraction of damages because negligent delay removed a statistical chance. Gregg later revisited medical loss-of-chance arguments, while Allied Maples concerns commercial opportunities. The decision does not establish that chances are irrelevant throughout damages law or that no injury caused by the delay could ever be compensated.
Common exam questions about this case
Why was the 25% award rejected?
The findings indicated that the original fall had probably already caused the irreversible process leading to the hip disability. The claimant therefore failed to prove that the negligent delay caused that outcome. Awarding 25% for a possible recovery route would replace the ordinary causal proof requirement with a different loss-of-chance approach.
Are future risks ignored once negligence liability is established?
No. Once an actionable injury caused by the defendant is proved, uncertain future consequences may be valued according to their likelihood. Hotson separates that exercise from establishing whether the defendant caused the injury in the first place. The same percentage language can therefore perform different legal functions.
Could pain caused by the treatment delay still be relevant?
Yes, if it is separately proved to have resulted from the negligent delay. The rejection of compensation for the hip disability does not make every consequence of delayed care legally irrelevant. A claimant must identify each head of damage and establish its causal connection rather than rely on a single overall probability.