Toon v Central Adelaide Local Health Network [2025] SADC 98
At a glance
- The South Australian District Court dismissed a medical negligence claim for damages against the Central Adelaide Local Health Network (CALHN) following treatment for compartment syndrome compounded by a closed brachial plexus injury.
- The Court found no breach of duty of care or causation, preferring the Respondent’s expert evidence.
- Despite dismissing the claim, damages were assessed at $287,086.88 plus future economic loss and interest to be calculated at the date of judgment.
Background
On 19 April 2017, the Applicant presented to the Queen Elizabeth Hospital emergency department and was diagnosed with compartment syndrome in his left forearm, alongside a closed brachial plexus injury. The Applicant alleged that the Respondent failed to perform fasciotomy surgery in a timely manner, performed initial surgery negligently, delayed further surgeries, and generally failed to treat him with due care and skill, taking into account his pre-existing substance abuse and mental health conditions. He claimed that these alleged breaches resulted in injury including contracted fingers, minimal range of motion, and impaired fine motor skills. The Respondent denied negligence, maintaining that the injuries were caused by prolonged muscle compression prior to the Applicant’s arrival.
The Applicant underwent four surgeries between April and May 2017, including emergency fasciotomy, relief of swelling, debridement of necrotic tissue, and closure of the forearm via skin graft. He was subsequently treated for mental health conditions. In 2019, he underwent further surgery to remove scar tissue and perform neurolysis of the median nerve, which improved the arm’s appearance but not its function.
Primary decision: No breach of duty found
The Applicant’s experts opined that initial surgery was delayed and insufficiently extensive. The Court found the Applicant’s experts partisan , describing one expert as combative and argumentative during cross-examination.. By contrast, the Respondent’s experts, , were found to be impressive, balanced, and non-partisan. They assisted the Court in understanding complex medical issues, supported the surgical approach taken, and concluded that any delay made no difference to the outcome given the pre-presentation injury.
After a 12-day trial, the Court held that there was no breach of duty under sections 40 or 41 of the Civil Liability Act 1936 (SA). The treatment provided by hospital staff, did not fall below the standard of care, and the Applicant’s injuries were not caused by the Respondent. The claim was dismissed.
Damages assessment
Even though liability failed, damages were assessed as follows (excluding future economic loss):
- General damages: $83,200 (27 points on the scale)
- Past economic loss: $47,648.75 + $5,241.36 in superannuation
- Future equipment: $32,000
- Future care: $88,938.18 (25% contingency reduction for pre- and post-injury mental health/substance abuse issues)
- Future medical expenses: $27,651.20 (pain medication)
This totalled to $287,086.88 plus future economic loss to be calculated following further particulars from the parties. Interest is to be determined at the date of any judgment on damages.
Implications: Expert evidence and medical negligence claims
This case highlights the importance of clear, balanced, and non-partisan expert evidence in complex medical negligence claims. Courts are less likely to rely on experts who are partisan, combative, or resistant to adapting their views to established facts.
Plaintiffs must demonstrate not only a breach of duty but also causation, particularly where significant pre-presentation injury exists. Even where damages are quantified, they will not be awarded if liability is not established.
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