PI Brief Update

Causation proves fatal in tragic suicide case - Michael Brooks Reid, Temple Garden Chambers

18/12/25. Michael Brooks Reid discusses the recent Court of Appeal decision in the clinical negligence case Zgonec-Rozej and Ors v Dr Stephen Pereira[2025]EWCA Civ 171. The judgment addresses interesting issues of causation and evidence of relevance to all personal injury practitioners.

Facts

John Jones QC (“Mr Jones”) was a patient of the defendant psychiatrist, Dr Stephen Pereira, at the Nightingale Hospital beginning in January 2016, suffering from severe anxiety and insomnia. Dr Pereira’s working diagnosis was bipolar affective disorder.

On 21 March 2016, Mr Jones’ parents contacted Dr Pereira urgently, reporting that Mr Jones was in crisis and a danger to himself. He was admitted to the Nightingale Hospital the following day. However, on around the same day, Dr Pereira went on three weeks’ leave without informing Mr Jones. Care was transferred to another consultant psychiatrist, Dr Bakshi, following an undocumented telephone handover.

Between 23 March and 10 April 2016, there was virtually no evidence before the court regarding Mr Jones’ care. This evidential gap resulted from a confidential settlement between the claimants and Dr Bakshi and the hospital, which rendered that period effectively off-limits.

Dr Pereira resumed care on 10 April 2016. Although he considered psychotherapy an important part of treatment, none took place. Following a deterioration reported by Mr Jones’ family, a meeting took place on 15 April to discuss whether Mr Jones should remain as an inpatient or be discharged. Early on Monday 18 April 2016, Mr Jones died at West Hampstead station after being struck by a train.

Members of Mr Jones’s family (“the claimants”) brought a claim in clinical negligence against Dr Pereira.

High Court decision

At first instance, Bourne J found that Mr Jones was suffering from a depressive reaction to stressful events rather than bipolar affective disorder but that the bipolar working diagnosis was not negligent. However, he identified three breaches of duty: failure to inform Mr Jones of Dr Pereira’s planned absence; inadequate handover to Dr Bakshi; and failure to arrange psychotherapy promptly on resuming care.

Despite these findings, the claim failed on causation. Bourne J held that none of the established breaches had been shown, on the balance of probabilities, to have caused or materially contributed to Mr Jones’ death. Had liability been established, he would have applied a 25% reduction for contributory negligence, finding that Mr Jones retained autonomy when he took his own life.

Court of Appeal decision

Causation

The claimants argued that the judge’s causation analysis was internally inconsistent. Psychotherapy was a central element of treatment for both bipolar affective disorder and depressive illness. Accordingly, a competent handover would necessarily have included a plan for psychotherapy. The failure to do so should therefore have been treated as causative, notwithstanding uncertainty as to what occurred during Dr Bakshi’s period of care.

The claimants also relied on the judge’s counterfactual observations that...

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