By Bronwyn Ackland, Partner and Will Hudson, Associate
The recent decision in Toon v Central Adelaide Local Health Network [2025] SADC 98 required the District Court of South Australia to consider allegations of negligence in the context of emergency surgical treatment provided at a public hospital. The matter raised critical questions about standard of care, breach, causation, and the evidentiary threshold required under the Civil Liability Act 1936 (SA) (CLA).
The Applicant brought proceedings against the Central Adelaide Local Health Network (Respondent), alleging negligent treatment of a serious forearm injury suffered in April 2017. The alleged breaches included:
However, the Court ultimately dismissed the claim, finding no breach of duty and, even if there had been one, no causal link between the medical treatment and the Applicant’s injuries.
On 19 April 2017, the Applicant awoke with significant swelling, pain, and a loss of control in his left forearm and hand. He presented at the Queen Elizabeth Hospital (QEH) where an initial examination revealed a swollen and tense forearm with skin mottling, though a pulse remained strong. The Applicant underwent emergency fasciotomy surgery that same day.
Due to ongoing swelling and skin tightness, a second operation was performed on 20 April 2017. The Applicant subsequently underwent two further surgeries: a debridement on 9 May 2017 and skin grafting on 12 May 2017. He remained in hospital until 29 May 2017, at which time he self-discharged.
He later alleged that negligent delays and technique during the first procedure caused permanent damage to his left forearm and hand, resulting in pain, loss of employment, and psychological injury.
The Applicant’s allegations primarily centred on delay in performing the initial surgery, and the alleged inadequacy of the fasciotomy technique used. In particular, he criticised the treating doctor’s decision to make only limited incisions.
However, Judge Deuter found that the medical team acted within the bounds of competent professional practice, as recognised in Australia. In rejecting the negligence claims, Her Honour concluded that the fasciotomy was performed using a method widely accepted by peers in the profession.
Accordingly, the Court found no breach of sections 40 or 41 of the CLA. As no departure from the standard of care was established, the claim was dismissed at the liability stage.
Notwithstanding the dismissal, the Court proceeded to assess quantum in the event its liability findings were incorrect. Her Honour applied the reasoning in Tabet v Gett, particularly Kiefel J’s application of the ‘but for’ test for causation.
The Respondents experts concluded that the Applicant’s injuries were caused by a catastrophic crush injury arising from a prolonged period of unconsciousness and immobility – likely drug-induced – on 18 April 2017. By the time the Applicant presented at QEH, irreversible damage had already occurred.
Her Honour concluded that even if the surgical procedures had been performed earlier or differently, the outcome would not have changed. Causation, therefore, was not established on the balance of probabilities.
While the injury met the statutory threshold for non-economic loss, the Court did not accept the Applicant’s proposed scale value of 33. Instead, Her Honour assessed a scale value of 27, equating to general damages of $83,200.00 (as at 2017).
In terms of economic loss:
Despite total assessed damages of $287,086.88, no award was made, as the claim was dismissed in full.
This case reinforces the strict evidentiary and legal thresholds required in medical negligence matters. The decision demonstrates the significant role that expert evidence plays in establishing causation and breach, especially in complex clinical scenarios involving pre-existing health conditions.
It also highlights that compensation will not be awarded for serious injuries unless a clear causal link can be drawn between the alleged breach and the harm suffered. The presence of serious, even catastrophic injury, is not enough – claimants must still overcome the significant hurdles posed by the Civil Liability Act and the requirement to prove breach and causation on the balance of probabilities.
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