The Case of C
C is a 24-year-old male smoker visiting the area who leaves a public house at midnight on Christmas Eve
having consumed 6 pints of high-strength lager. He slips on the unlit icy steps of the pub and sustains a
grade 1 open pilon fracture to the left tibial plafond. The steps were not gritted. He is wearing flip-flops .
Consider the duty of care and breach of duty as it relates to the pub proprietors.
A Is there negligence?
B Is there contributory negligence?
C is admitted to Paternoster Holy Hospital under Mr Y, who goes on leave the next morning. C undergoes
wound excision and toilet within the next 24 hours. His legs are then dressed and elevated while his soft
tissues settle. On day 7 Mr Y returns from holiday and he is scheduled for internal fixation surgery and
flap cover with plastics on day 9. Risks documented as discussed are infection stiffness neurovascular injury
implant failure. Surgery is performed with reasonable skill. It is noted that the wound cavity was slightly
sloughy at the time of surgery. Nursing notes on day 7 document the presence of fracture blisters.
Consider that the duty of care and breach of duty under:
A the Bolam test
B the Bolitho test
The construct becomes infected and after several procedures over two years he undergoes left below knee
amputation. He is unable to continue work as a scaffolder / steel erector.
Using the ‘but for test’
A Consider the duty of care related to the initial consent
B Given negligence would be accepted; consider causation using the ‘but for test’
Are there any other considerations?