"I think it was after the appointment on the 19 th September 2001 which is noted in my medical records that I was started on the two week test dose of Rifinah having been told my blood tests showed my liver function was normal. I then went back to the hospital on the 5 th October 2001 when I was prescribed the first month's worth of the three month course of the drug having again been told that the check blood tests were normal."
"he took twice the maximum dose over a period of seven weeks."
"4. Instructions to the Appointed Legal Representative The Insured gives irrevocable instructions to the Appointed Legal Representative to: a) provide Temple with such information, documentation or particulars, whether privileged or not, relating to the Legal Action as it may require; b) notify Temple of any fact or matter adversely affecting the prospects of a successful outcome for the Insured . . . "
" Termination . . . If there is any material deterioration in the prospects of a successful outcome at trial for the Insured . . . Temple may terminate this Certificate immediately."
"Withdrawal of the ATE cover would be the inevitable consequence in this situation. Any advice from Counsel would be an essential part of this process. Unless there were any substantial reasons not to do so, Temple would obviously place great reliance on Counsel's advice in a case, which would be treated as authoritative and effectively a conclusive assessment of merits and prospects."
"Dr Yugam initially issued a prescription for Rifinah for a test period of 300/150 two per day for two weeks: however, when Mr Duffield returned at the end of the two weeks, a further prescription was written but not by Dr Yugam but now by Mr Duffield's GP who, not being familiar with Rifinah, based his prescription on the letter on file which specifically stated the dose at 600 mg twice per day. I suspect this is a transcription error on the part of Dr Yugam's Secretary, but Dr Yugam failed to spot the error and must take responsibility for it. The result was that from05 October 2001 onward Mr Duffield was given Rifinah 300 mg four times a day in error."
"You say that Dr Yugam asked you whether you wished to receive the drugs from the TB clinic or via your GP. You chose your GP. You say you clearly remember collecting your prescription for the Rifinah from the GP on two occasions and taking it to the local pharmacy where it is dispensed. [Mr. Wynne] queries why when he repeatedly asked you about where the prescriptions were received from and that the drugs dispensed days ago and then you said you could not remember at all but now you have such a clear memory."
"This is a very complex case in which there is expert evidence that may link the administration of a drug to the development of one, or possibly two, conditions that may themselves be causally linked. There are competing non-negligent causes. The position as to breach of duty is also difficult, notwithstanding excessive dosage of the index drug(s), it is unclear whether the postulated drug-related condition is dose-dependent: if it is not, then the identified breach is not material."
"Professor Moore's opinion provides a superficially logical basis for a causal connection, however this must be weighed against the opposing points made by Professor Whalley. I take into account the point regarding the difference between isoniazid and iproniazid, and the absence of any cases of Rifinah-induced PBC in the scientific literature. The latter is brought into focus by the long and extensive use of the drugs in question. The fact that the two Professors can take different views underlines the probability that should the matter come to Trial, it is inevitable that the Defendant will find expert evidence that is contrary to Professor Moore's analysis. In that circumstance, the Judge will put in the position of deciding a scientific question and it is improbable that (s)he will accept such an invitation, but will find in the Defendant's favour, given that the onus is on the Claimant to prove his case."
" Re Pots Dr Hayat's view in his written report raised the possibility that there might be a causal connection, but the language used in his written report fell below the power required to prove the case at Trial, the reason being that it did not amount to a probability as opposed to the weaker possibility. In conference Dr Hayat expressed his opinion in stronger terms raising the prospects of success with regards to proving that the POTS was caused by the isoniazid. Subsequently, Dr Hayat has not confirmed his opinion: indeed, he has effectively resiled form it. It therefore follows that the prospects of proving negligence as to the POTS is negligible. Re PBC I agree that Professor Moore did support a causal role for the isoniazid in the development of the PBC. Upon reading all of the papers again, I have reached the view that the prospect of proving the connection between the isoniazid and the PBC is less than 50%, where at conference I had been more optimistic. My reasons for taking this different view are as follows The best point that Professor Moore made was the reported effects of iproniazid. The other points are much weaker: only some cases of PBC are in males; there has to be more than proximity in time between taking a drug, even in overdose, and experiencing a disease process to prove a causal connection between the two. I have given considerable thought as to the hurdles that would stand in the way of Professor Moore's opinion, and set out my conclusions below: 1 Iproniazid is different, albeit slightly, from isoniazid. 2 Despite being in use for many years and having been given to a huge number of patients being monitored on account of having a contagious disease (TB), there is an absence of recorded associations between isoniazid and PBC . . . I am aware of the tendency for doctors to publish very rare or novel side effects, either in scientific articles, or to regulatory bodies, or to both, so the absence of such reports is very pertinent. 3 The effect is that Professor Moore would be asking the Court to accept a very rare or even unique reaction to a drug, based upon an effect seen with a slightly different drug in connection with production of anti-bodies. That would also raise the problem as to the role of antigens and antibodies concerning the cause and development of PBC. 4 Asked the simple question as to whether Professor Moore's theory is the probable cause of the PBC as opposed to only a possible cause, I take the view that a Judge would be more likely to prefer an opinion that Professor Moore's theory could be possible , but was not probable. The effect would be that the case would fail. 5 It is very difficult for Judges when they have to decide between two respectable views provided by respected experts, especially if one view has weak scientific support. It is important to remember that it is for the Claimant to prove his case and that if faced with difficult scientific evidence that the Judge cannot resolve, it is sufficient for the Judge to decide that the Claimant has simply failed to prove his case. 6 For these facts and reasons, I have concluded upon reflection that Mr Duffield's case has prospects of less than 50%."
"Normally having received unsupportive Counsel advice we would simply notify the Insurer of that and that we are therefore not proceeding with a claim . . . Yesterday you advised you did not wish to proceed with your claim and so this would be what I did here. In view of Counsel's advice and my own view of a claim on your behalf having less than 50% prospects of succeeding, my firm would not be willing to continue to act on your behalf pursuing this matter. As indicated the situation is complex hence my offer to speak with you to discuss."
"(m) The Claimant's PBC and POTS were caused or materially contributed to by the negligence of the Trust and/or the Claimant's GP, specifically by the prescription of Rifinah and/or the overdose of Rifinah. (n) Had the Defendant acted reasonably in the management of the original claim, including commencing proceedings validly (at the right value) against the Trust, issuing protectively against the GP, serving proceedings and continuing the claim, querying the advice of Dr Punt to abandon the claim, obtaining a second opinion from other counsel then it is probable that a claim would have succeeded, whether by trial or settlement, against the Trust and/or GP. (o) The Claimant contends that overall his prospects of securing a successful outcome (agreement for damages or success at trial) were of the order of 60% + and the Defendant's negligence deprived him of this chance. (p) It is likely that had the claim against the Trust and/or the GP been pursued with reasonable care and skill it would have resolved between about December 2018 (some 18 months after Dr Punt's final written advice advising that the claim be abandoned) and June 2019. (q) The probable value of the 'lost' claim is set out in the . . . schedule and the Claimant seeks a proportion of this figure to reflect the lost chance of success."
"it was unknown to our client that his GP (Dr Ghandi) might be responsible for having prescribed the overdose until issues in respect of your client's medical records were raised by Dr Branley following receipt of his report in October 2015. Prior to this, our client had understood that the hospital was responsible for prescribing the drug, as stated in Dr Yugambaranathan's letter dated19 September 2001 and as considered in the complaints process with the Trust. It was not until your client began to revisit events that it transpired that Dr Ghandi might bear some responsibility for the incorrect prescription."
"in the ordinary run of cases, satisfying the "but for" test is a necessary if not a sufficient condition of establishing causation. Here, in my opinion, it is not satisfied. Miss Chester has not established that but for the failure to warn she would not have undergone surgery. She has shown that but for the failure to warn she would not have consented to surgery on Monday,21 November 1994 . But the timing of the operation is irrelevant to the injury she suffered, for which she claims to be compensated. That injury would have been liable to occur whenever the surgery was performed and whoever performed it."
"I would accept that a solution to this problem which is in Miss Chester's favour cannot be based on conventional causation principles. The "but for" test is easily satisfied, as the trial judge held that she would not have had the operation on21 November 1994 if the warning had been given. But the risk of which she should have been warned was not created by the failure to warn. It was already there, as an inevitable risk of the operative procedure itself however skilfully and carefully it was carried out. The risk was not increased, nor were the chances of avoiding it lessened, by what Mr Afshar failed to say about it."
"If a patient in the position of Miss Chester or Mrs Hart had been injured by some wholly unforeseeable accident of anaesthesia (the scenario suggested by Gummow J in Chappel v Hart , at p 257, para 66) or because the operating theatre was struck by lightning (Hayne J's more fanciful scenario at p 286, para 129) the injury could have been described as coincidental in the sense indicated by Mason CJ in March v E & MH Stramare Pty Ltd(1991) 171 CLR 506 , 516: "a factor which secures the presence of the plaintiff at the place where and at the time when he or she is injured is not causally connected with the injury, unless the risk of the accident occurring at that time was greater."
"Had the Defendant acted reasonably in the management of the original claim, including . . . issuing protectively against the GP, serving proceedings and continuing the claim . . . then it is probable that a claim would have succeeded, whether by trial or settlement, against the . . . GP."