‘Novus actus interveniens’ or breaking the chain of causation, is a maxim often relied upon in criminal cases; however, while the principle itself is simple enough, the facts required to establish it prove far from clear.
In a case involving the potentially fatal shooting of an unwitting victim, the surgical aftercare provided, became subject to the scrutiny of the courts when death followed soon afterwards.
In late 1987, the deceased was party to an argument with the now appellant, which resulted in three shots being fired from a concealed handgun.
The first bullet was fired in the air above them, while the second and third entered the victim’s upper thigh and abdomen, shortly before the appellant fled from the scene.
Having been rushed to hospital, the surgeons cleaned up both wounds, while reconnecting the thigh bone and undertaking an extensive bowel resection in order to prevent further complications.
In the weeks following his admission, the deceased complained of breathing difficulties, at which point a tracheotomy was performed, after a simple ventilating machine had failed to properly address the problem.
Around a month later his condition deteriorated, and so investigative measures were taken to inspect the stomach wound, while the deceased began to suffer with vomitous discharge and chest infections, later resulting in fluid permeation of the lungs.
It was then, after numerous complaints and several visits by the consultant general surgeon, surgical registrar, orthopaedic registrar and finally the house surgeon, that his breathing pattern was recognised as ‘stridor’, a disturbing vibration typically associated with an obstruction of the larynx or windpipe.
Unfortunately, despite the intervention of a medical registrar and urgent cardiac massage, the deceased died as a result of mucus blockage of the windpipe resulting from excessive tracheotomy scarring; upon which, the resident pathologist concluded that:
“I give as the cause of death cardio-respiratory arrest due to gunshot wounds of the abdomen and leg.”
At the trial, the judge directed the jury to establish a conviction of recklessness on the part of the hospital, which if proven, would support the breaking of the chain of causation on grounds that the hospital had failed to properly identify the actual cause of death; and that in doing so, the appellant’s actions were now secondary to the death of the victim.
After a degree of jury deliberation, a verdict was passed in favour of the hospital, before the appellant challenged the judgment under section 23 of the Criminal Appeal Act 1968.
Presented to the Court of Appeal, consideration was given to the principle of recklessness and gross negligence, while particular reference was made to the words of Goff LJ in R v Pagett, who said:
“Even where it is necessary to direct the jury’s minds to the question of causation, it is usually enough to direct them simply that in law the accused’s act need not be the sole cause, or even the main cause, of the victim’s death, it being enough that his act contributed significantly to that result…nevertheless the intervention of a third person may be regarded as the sole cause of the victim’s death, thereby relieving the accused of criminal responsibility.”R v Pagett
However, in R v Smith it was also argued by Parker CJ that:
“It seems to the court that if at the time of death the original wound is still an operating cause and a substantial cause, then the death can properly be said to be the result of the wound, albeit that some other cause of death is also operating. Only if it can be said that the original wounding is merely the setting in which another cause operates can it be said that the death does not result from the wound. Putting it in another way, only if the second cause is so overwhelming as to make the original wound merely part of the history can it be said that the death does not flow from the wound.”R v Smith
Before Lane CJ later reiterated in R v Malcherek that:
“[T]he fact that the victim has died, despite or because of medical treatment for the initial injury given by careful and skilled medical practitioners, will not exonerate the original assailant from responsibility for the death.”R v Malcherek
With careful appreciation of the medical evidence, along with reasoned accommodation of the high threshold of surgical margins of error, the Court held that despite the alleged negligence of the hospital staff, there was simply insufficient evidence to uphold the application of ‘novus actus interveniens’.
And that even with the best medical team on hand to treat the deceased, the fundamental cause of death preceding the complication was, and remained, the shooting by the appellant; and so, on those grounds the appeal was dismissed and the original murder charge upheld, while the Court reminded the parties that:
“Whilst medical treatment unsuccessfully given to prevent the death of a victim with the care and skill of a competent medical practitioner will not amount to an intervening cause, it does not follow that treatment which falls below that standard of care and skill will amount to such a cause.”