The Supreme Court has unanimously held in Darnley v Croydon Health Services NHS Trust [2018] UKSC 50 that, via a receptionist at a hospital accident and emergency (A&E) department, the respondent NHS trust owed the claimant a duty to give the correct information about waiting times and had breached that duty.
The Facts
Mr Darnley experienced a blow to the head during an assault and attended the A&E unit at Croydon University Hospital. Upon arrival, a receptionist (who was not clinically trained) informed Mr Darnley that it would be 4 to 5 hours before he would be seen. Mr Darnley proceeded to wait for 19 minutes before discharging himself without notifying medical staff or the reception team.
The information provided by the reception staff was incorrect. Although ‘the operational standard for A&E waiting times is that 95% of patients should be admitted, transferred or discharged within 4 hours of their arrival at any A&E department’, the actual system in place at the Hospital’s A&E department confirmed that a triage nurse would examine patients within 30 minutes of arrival. A decision would then be made regarding how urgently care should be provided. A short time following Mr Darnley’s departure, the triage nurse arrived at the A&E waiting area.
Mr Darnley was at home approximately 1 hour later when his condition deteriorated and he was returned to hospital by emergency ambulance. A CT scan revealed the presence of an extradural haematoma and Mr Darnley was transferred to St George’s Hospital, Tooting, where surgery was undertaken. However, by this point it was too late to prevent serious and permanent brain damage resulting in long term disabilities.
The Decision
The Supreme Court held that the case fell squarely within the established duty of care owed by those running A&E departments not to cause physical injury to patients and that duty had arisen when the claimant was “booked in” at the reception. It was held that the Court of Appeal had erred in treating the matter as a novel situation and had erroneously focused on asking whether it would be fair, just and reasonable to impose a duty of care in such circumstances.
The Supreme Court held that the scope of the respondent’s duty extended to not providing misleading information that might foreseeably cause physical injury. In this respect there was no distinction between information provided by staff who were and were not medically qualified. It was unclear who precisely the receptionist was, although it was definitely one of two people, neither of whom could remember the incident and both of whom could only give evidence of what their practice would have been (one said she would have advised that there would be a 30 minute wait, the other that the Claimant would be seen as soon as possible).
In reaching its decision, the Supreme Court adopted the three stage test in Caparo Industries v Dickman [1990] 1 All ER 568 and this approach to establishing whether a duty of care exists.
Under the Caparo test the claimant must establish:
- That harm was reasonably foreseeable
- That there was a relationship of proximity
- That it is fair, just and reasonable to impose a duty of care
The Supreme Court opined that the claimant had not broken the chain of causation by leaving the hospital as it was reasonably foreseeable that someone who was told it would take between four and five hours to be seen would go home.
Future impact?
Over 450,000 people attend A&E departments in England every week. This exposes untrained staff to potential negligence claims of this type and could have serious ramifications for the NHS and, consequently, may limit resources yet further and the treatment it seeks to provide its patients. Will the Supreme Court provide further clarification in future judgements? We shall have to wait and see…
