[2023] UKSC 48
On appeal from: [2021] EWCA Civ 1442
JUDGMENT
TUI UK Ltd (Respondent) v Griffiths (Appellant)
before
Lord Hodge, Deputy President
Lord Lloyd-Jones
Lord Briggs
Lord Burrows
Lord Stephens
29 November 2023
Heard on 21 and 22 June 2023
Appellant
Robert Weir KC
Stephen Cottrell
Thomas Westwell
(Instructed by Irwin Mitchell LLP (Birmingham))
Respondent
Howard Stevens KC
Sebastian Clegg
Dan Saxby
(Instructed by Kennedys Law LLP (London))
LORD HODGE (with whom Lord Lloyd-Jones, Lord Briggs, Lord Burrows and Lord Stephens agree):
Mr and Mrs Griffiths and their youngest son went on a package holiday to a resort in Turkey. While staying at a hotel, which offered an inclusive package of meals and facilities, Mr Griffiths suffered a serious stomach upset which has left him with long term problems. He sued the travel company. At trial Mr and Mrs Griffiths gave uncontested evidence as to fact. Mr Griffiths also led the evidence of an expert who opined that, on the balance of probabilities, the food or drink served at the hotel was the cause of Mr Griffiths’ stomach upset. The travel company defendant did not require the expert to attend for cross-examination and did not lead any evidence of its own. In his closing submissions, the travel company’s counsel argued, and persuaded the judge, that deficiencies in the expert’s report meant that the claimant had failed to prove his case on the balance of probabilities.
The appeal raises a question of the fairness of the trial. The question is whether the trial judge was entitled to find that the claimant had not proved his case when the claimant’s expert had given uncontroverted evidence as to the cause of the illness, which was not illogical, incoherent or inconsistent, based on any misunderstanding of the facts, or based on unrealistic assumptions, but was criticised as being incomplete in its explanations and for its failure expressly to discount on the balance of probabilities other possible causes of Mr Griffiths’ illness.
Factual background
Mr Griffiths entered into a package holiday contract with TUI UK Ltd (“TUI”), which is a well-known tour operator, for himself, his wife and their youngest son. The holiday package included return flights from the United Kingdom to Turkey and 15-nights’ all-inclusive accommodation at the Aqua Fantasy Aquapark Hotel in Turkey between 2 and 16 August 2014. Mr Griffiths fell ill on the evening of 4 August 2014 suffering from stomach cramps and diarrhoea. He spent two days in his bedroom before his symptoms began to lessen but they did not settle completely. On 7 August 2014, on the advice of a tour representative, Mr Griffiths, his wife and his son took a hotel shuttle bus to the local town to obtain medication from a pharmacy. While in the town, the Griffiths family went to a local restaurant. Mr Griffiths ordered a meal but could not eat much as he did not have much of an appetite.
After 8 August Mr Griffiths felt that he was beginning to recover. But on 10 August 2014 Mr Griffiths began to feel unwell again. He suffered from diarrhoea and needed to visit the bathroom approximately every hour. He spoke to a doctor, who advised him that he needed hospital treatment. He was admitted to Kusadasi hospital on 13 August where he remained for three days and two nights. He was diagnosed as suffering from acute gastroenteritis and was given intravenous fluids and antibiotics. A stool sample was taken, which on analysis showed multiple pathogens, both parasitic and viral. He continued to feel unwell but was able to travel home with his wife and son on 16 August 2014.
Before Mr Griffiths went on holiday he had eaten food, including a Burger King meal at Birmingham airport. Between 2 and 4 August Mr Griffiths ate only at the hotel. The only food which he ate in Turkey outside the hotel was when he and his family ate at the local restaurant mentioned in paragraph 3 above.
At the time of his trial in June 2019 Mr Griffiths was still suffering from stomach churning and bubbling, cramping pains in his stomach, increased stomach bloating and an increased frequency in bowel movements with urgency and episodes of diarrhoea. Those symptoms are likely to be permanent and affect his ability to undertake social outings. He has concerns about long car journeys. As explained more fully below, the trial judge, HHJ Truman, dismissed his claim. The trial judge expressed the view that the appropriate level of compensation would have been £29,000 for pain, suffering and loss of amenity (including the spoiling of the holiday), plus damages for care and medication costs.
The legal proceedings
Pre-trial
In August 2017 Mr Griffiths commenced his action in the County Court. He pursued his claim on two bases: first, he claimed damages as a consumer against TUI under the Package Travel, Package Holiday and Package Tour Regulations 1992 (SI 1992/3288); secondly, he pursued a claim under sections 4 and 13 of the Supply of Goods and Services Act 1982.
TUI lodged a defence, in which it denied that the illness had been caused by the consumption of food or drink in the hotel and put Mr Griffiths to proof as to the cause of his illness. Thereafter, the claim was allocated to the multitrack under Part 29 of the Civil Procedure Rules on 12 January 2018. Mr Griffiths obtained medical reports from a gastroenterologist, Dr Linzi Thomas, and a microbiologist, Professor Hugh Pennington. Under the case management by the court which that procedure provides, both parties were given permission to rely on expert evidence from a gastroenterologist and a microbiologist.
TUI failed to serve a report from a gastroenterologist within the time specified by the court. It chose not to serve a report by a Dr Gant, a consultant microbiologist, which addressed causation. TUI confirmed that it did not intend to rely on expert evidence from a microbiologist. Mr Griffiths’ lawyers served Professor Pennington’s report. TUI’s lawyers had by then applied for permission to rely on a report by a gastroenterologist and for relief from sanctions. The court refused that application with the result that TUI went to trial without the support of any expert evidence. TUI lodged witness statements by witnesses as to fact who TUI had intended would give evidence by video link but, in the event, they were not called or cross-examined. Their evidence was accordingly discounted. Further, TUI did not seek to have Professor Pennington attend the trial for cross-examination with the result that his evidence was accepted on paper. His expert evidence was therefore uncontroverted in the sense that it was not in conflict with any other evidence led at the trial and was not subjected to challenge by cross-examination.
The trial
HHJ Truman heard the evidence and the submissions of the parties in a one-day trial on 20 June 2019. She accepted the evidence of Mr and Mrs Griffiths, who were cross-examined and whom she described as patently honest and straightforward witnesses. Mr Griffiths in his witness statement criticised the hygiene standards of the hotel, and in particular the buffet restaurants in the open air, and Mrs Griffiths confirmed the contents of his statement. The trial judge made no findings of fact on those matters, but recorded the allegations made in the Statement of Claim. The trial judge recorded the evidence of Dr Thomas including that relating to causation, which drew on the Griffiths’ witness statements about the hygiene standards in the hotel. Dr Thomas was asked questions under CPR Pt 35.6, which she answered, but she did not attend trial . In the event, Mr Griffiths’ counsel relied on Dr Thomas’s report in relation to diagnosis and prognosis but did not rely on her conclusions in relation to causation. As a result, the only expert evidence on causation before the trial judge at the conclusion of the trial was the uncontroverted expert report of Professor Pennington and his answers to questions posed by the defendant’s solicitors under CPR Pt 35.6.
Counsel for TUI made specific criticisms of Professor Pennington’s evidence which were set out in a skeleton argument served on the afternoon before the trial. Those criticisms formed the basis of counsel’s submissions at trial and of the trial judge’s decision. It is therefore necessary to set out in full the substantive parts of Professor Pennington’s report and the CPR Pt 35.6 questions and answers which followed it.
After Professor Pennington recorded his professional qualifications and the materials with which he had been provided for his report, he described his instructions as being to comment on the chronology of events, provide a detailed commentary on the issue of gastric illness and any breaches of health and safety procedures in place at the hotel, and express an opinion as to whether on the balance of probabilities Mr Griffiths’ illnesses were caused by staying at the hotel and a breakdown of health and hygiene practices there. After a brief summary of Mr Griffiths’ symptoms, Professor Pennington recorded the results of the tests on stool samples taken in the Turkish hospital. He stated (para 2):
“According to the discharge report of 16 August 2014 by Dr Yusuf Tuna, Entamoeba histolytica cysts and Giardia intestinalis were said to be seen on microscopy, and rotavirus, adenovirus, E. histolytica and Giardia antugen (sic) tests were positive. However, [according to] the Witness statement of Ibrahim Kocaoglu, the hotel doctor, the stool testsshowed Entamoeba histolytica and Giardia intestinalis cysts, but the Rota, Adeno and Noro virus tests were negative. His statement says that Peter Griffiths was seen on 13 August 2014 with a history of 6 days sickness, abdominal cramps, and diarrhoea, which complaints started after dinner in Kusadasi town center (sic) on 6 August 2014. Self medication partially relieved the symptoms, but diarrhoea started again on 11 August 2014.”
Professor Pennington then briefly stated his opinion as to the cause of Mr Griffiths’ symptoms. He stated:
I do not think that Peter Griffiths had amoebic dysentery caused by Entamoeba histtolytica (sic). Entamoeba cysts (which were found in his stools) are not diagnostic on their own because they cannot be distinguished routinely from the far commoner cysts of the harmless Entamoeba dispar. The onset of amoebic dysentery is usually gradual or intermittent; acute colitis is uncommon. Vomiting is not a feature and the diarrhoea is almost always bloody. Cases of amoebic dysentery most commonly have an incubation period of 2 to 4 weeks. None of these features lend support to a diagnosis of amoebic dysentery contracted in Turkey in Peter Griffith’s (sic) case. I consider it to be statistically improbable that he had been infected simultaneously with Giardia, adenovirus and rotavirus. I note that a microscopic diagnosis of Giardia is not straightforward. However, it is much more likely as a cause of gastroenteritis in this case than any of the other pathogens.
The possibility cannot be ruled out that Peter Griffiths had two infections, one starting on 4 August, and a second starting on 11 August.
It is not possible to make an accurate aetiological diagnosis in cases of gastroenteritis from symptoms alone. On the balance of probabilities the absence of vomiting as a symptom make (sic) a virus cause much less likely than a bacterial one. The commonest recorded bacterial causes of acute gastroenteritis in places like Turkey are Campylobacter, Shigella and Salmonella. Giardia is considered to be reasonably common. Campylobacter is more commonly recorded in travellers returning to the UK from holidays abroad than Salmonella or Shigella. Enterotoxigenic E.coli (ETEC) and its relatives are considered to be common causes of diarrhoea in countries such as Turkey. For technical reasons they are not routinely tested for in the UK.
The incubation period for Giardia ranges from 1 to 14 days. It averages 7 days. Peter Griffith (sic) had been at the hotel for 2 days before he fell ill, and 9 days before his diarrhoea returned. Campylobacter has an average incubation period of 3 days. For ETEC it ranges from 12 to 72 hours. On the balance of probabilities Peter Griffiths acquired his gastric illnesses following the consumption of contaminated food or fluid from the hotel.”
On receiving Professor Pennington’s report, TUI’s lawyers asked the following CPR Pt 35.6 questions:
You refer to ‘contemporaneous evidence’ in Paragraph 1 of your report. Please can you set out exactly what ‘contemporaneous evidence’ you relied upon when writing your report?
Please confirm whether you examined the Claimant or interviewed him prior to writing your report.
Do you agree with the proposition that stool samples taken and analysed at the time of an illness complain (sic) are the most reliable form of ascertaining or determining the types of pathogen that may be causing that illness?
You offer opinion that the Claimant suffered gastric illness caused by consumption of contaminated food or fluid from the hotel. In relation to your opinion on causation, to what extent do you consider that there would be:
A range of opinion on causation amongst appropriate experts?
If there is a range, what is it?
What is your position within that range?
What facts and matters have your (sic) relied upon in adopting your position within that range?
To what extent were you able to identify the exact source of contaminated food or fluid that caused the illness? If so, please state what exactly was contaminated and provide supporting evidence of the contamination.
If the Court finds as a fact that the Claimants ate outside of the hotel in the days/weeks leading to inset (sic) of illness, to what extent would that impact on the opinions you express in relation to causation?
If the court finds as fact that others on this holiday who had consumed the food provided by the hotel, were not similarly afflicted, to what extent would that impact on the opinions you express in relation to causation?
If the court finds as fact that the hotel was applying high standards in relation to hygiene and monitoring of food, to what extent would that impact on the opinions you express in relation to causation?
Is Rotavirus a viral infection?”
In the tenth question TUI’s lawyers referred to four official publications in the United Kingdom on Giardia and Rotavirus and asked whether he considered the content of the publications to be reliable sources of information.
Professor Pennington responded as follows:
Flight and hotel bookings.
I did not interview the claimant.
I agree that stool sample testing done by an accredited laboratory is the most reliable way to ascertain the microbial cause of gastroenteritis.
a-d Regarding causation etc, the appropriate experts would consider the gastroenteritis symptoms, their possible infective cause, the commonness of possible microbial causes in Turkey and their modes of transmission, their incubation periods, and the length of time the claimant had been at the hotel. I did the same. (Emphasis added)
In single cases of infective gastroenteritis it is usually not possible (as in this case) to determine the exact source of contaminated food that led to the infection. To determine the exact source under these circumstances it would be necessary for suspect foods to be tested for the possible pathogens; this is usually impossible because the suspected foods will have been consumed. It is highly unlikely that any will have been retained in a condition suitable for microbiological testing.
If the claimant had eaten outside the hotel the nature of the food and the date(s) of its consumption and the frequency of its consumption would be taken into account in assessing the probability that such food was more or less likely than hotel food to have been the source of the pathogen that caused the gastroenteritis. (Emphasis added)
The great majority of cases of food borne infective gastroenteritis are sporadic and do not occur in outbreaks. So if no other cases similarly affected had been reported, this would not affect my conclusions regarding causation.
I would expect the court to take into account the hotel HACCP plan and its implementation with all its associated documentation in determining its food hygiene standards; if high quality I would take it into account regarding causation. I would put much less weight on food monitoring itself as a food safety measure because of its inherent statistical limitations.
Rotavirus is a virus.
I consider these publications to be reliable sources of information.”
I have emphasised the answers to questions 4 and 6 as they are important to the understanding of Professor Pennington’s reasoning which I discuss in my analysis below.
The trial judge recorded in some detail the challenges which TUI’s counsel made to Professor Pennington’s report. Those criticisms were in summary: (i) there had been a failure to discount the occurrence of two separate infections and the meal in the local town as the cause of a second infection; (ii) Professor Pennington had set out the incubation periods but had given no explanation as to why he concluded that the illness was caused by food or fluid in the hotel; (iii) he had failed to mention the meal in Birmingham airport or the meal in the local town and to exclude them as causes; (iv) he had failed to comment on possible breaches of health and hygiene procedures in the hotel; and (v) he had failed to discount the methods of transmission of the illness which were not related to food which TUI’s counsel had listed.
The trial judge also criticised the report for failing to explain why the adenovirus and rotavirus found in the claimant had no effect or were otherwise discounted. She acknowledged Professor Pennington’s stated opinion that a viral cause was less likely than a bacterial one because of the lack of vomiting, but was unclear how that fitted the facts (i) that only parasites and viruses were isolated in the samples and not bacteria, and (ii) that the pathogens found were known to cause stomach upsets. She also observed that Professor Pennington had not expressly excluded the possible causes, other than food, which were listed in the Statement of Claim, such as the air conditioning system and leakage from a baby’s nappy in the swimming pool.
The trial judge was also critical of Professor Pennington’s responses to the CPR Pt 35.6 questions. In relation to the professor’s answer to question 4, she observed that he had not given any formal range of opinion or stated where within the range his opinion might fall. The judge also recorded Professor Pennington’s answer to questions 6, 7 and 10. The judge referred to and quoted the judgment of this court in Kennedy v Cordia (Services) LLP[2016] UKSC 6; [2016] 1 WLR 597 on the role of the expert witness and the judgment of the Court of Appeal in Wood v TUI Travel plc [2017] EWCA Civ 11; [2018] QB 927, which I discuss below. She criticised the report for not explaining why the pre-flight meal and the meal in the local town had been discounted as causes and why other possible causes and methods of transmission had been considered and excluded.
The trial judge held that Mr Griffiths had not proved his case and dismissed the claim. She summarised her reasons for so doing in para 29 of her judgment:
“Dr Thomas and Professor Pennington are undoubtedly experienced practitioners. They may both well consider, with their years of experience, that the Claimant had infective gastroenteritis caused by eating hotel food, but it seems to me that reports prepared after Wood v TUI need to deal with those matters the Court of Appeal specified. These reports do not do that. In some instances, they do not comply with CPR 35 (the failure to supply a range of opinion). They certainly do not provide me with sufficient information to be able to say that there is a clear train of logic between, for example, the incubation periods and the onset of illness, so that the pre-flight meal can be excluded or that the hotel food is a more likely cause; similarly for the ‘second’ illness – it is not said why it is more likely to be a relapse rather than a second infection, especially where the expert has said that it would be unlikely to have all the identified pathogens from one episode of eating contaminated food. It is thus not clear why the eating out in the local town can be discounted.”