R.8 and Andrews v DPP [1937] AC 576, confirmed that there needed to be in existence a breach of duty of care where the serious and obvious risk of death was reasonably foreseeable and that the breach or omission in question caused actual death and that the conduct of the defendant, when all the circumstances were considered, was so bad as to amount to a criminal act or omission.

[5][6] At 9:45 am, anaesthesia and paralysis were induced by the intravenous administration of drugs and an endotracheal tube was inserted to enable the patient to breathe with the aid of a mechanical ventilator.

[7] At 45 minutes into the operation there was a change of anaesthetist from the registrar, Dr. Said and his assistant, to Dr John Adomako, a locum peripatetic.

It was not until an alarm sounded on a blood pressure monitoring machine that the anaesthetist was alerted to a problem of some kind at which point Dr Adomako checked various pieces of equipment but failed to notice the disconnected oxygen tube which by now had not been supplying oxygen for at least four and a half minutes.

[5] Although Alan Loveland was successfully resuscitated, the prolonged period of oxygen deprivation caused cerebral hypoxia leading to severe brain damage.

[19] In a criminal court, it must be established that there is mens rea, where the extent of the defendant's liability depends on the amount of damage done and the degree of negligence.

[22] In the case of Adomako, the breach of duty was so serious that the appellant's conduct amounted to "a gross dereliction of care".